The impact of Hurricane Maria on individuals living with non-communicable disease in Puerto Rico: the experience of 10 communities.

BACKGROUND: Coinciding with the rising non-communicable disease (NCD) prevalence worldwide is the increasing frequency and severity of natural hazards. Protecting populations with NCDs against natural hazards is ever more pressing given their increased risk of morbidity and mortality in disaster contexts. This investigation examined Hurricane Maria's impacts across ten lower SES municipalities in Puerto Rico with varying community characteristics and hurricane impacts to understand experiences of supporting individuals with NCD management in the six-month period following the hurricane. METHODS: We conducted 40 qualitative interviews with mayors, first responders, faith leaders, community leaders, and municipal employees from 10 municipalities in Puerto Rico. Using QSR NVivo software, we deductively and inductively coded interview transcripts and undertook thematic analysis to characterize community-level hurricane impact and consequences for NCD management, and to identify convergent and divergent themes. RESULTS: Damages to infrastructure, including healthcare facilities and roadways, complicated the provision of timely health care for NCDs, patient transport, and pharmaceutical/medical supply chain continuity. Lengthy power outages at both healthcare facilities and private residences were barriers to healthcare service delivery, use of medical equipment, and storage of prescription medications with refrigeration, and led to a widespread mental health crisis. Cascading failures such as fuel shortages further compounded these challenges. The consequences of these impacts included the reported exacerbation of health conditions and loss of life among NCD patients. CONCLUSIONS: Study findings identify contributors to morbidity and mortality among individuals with NCDs following Hurricane Maria. With the growing frequency of catastrophic disasters from natural hazards, the experiences of communities that endured these impacts offer important lessons regarding policies and practices to better support community disaster resilience and address the evolving preparedness needs of NCD patients.

An alternate approach to simulate the dynamics of perturbed liquid drops.

Liquid drops when subjected to external periodic perturbations can execute polygonal oscillations. In this work, a simple model is presented that demonstrates these oscillations and their characteristic properties. The model consists of a spring-mass network such that masses are analogous to liquid molecules and the springs correspond to intermolecular links. Neo-Hookean springs are considered to represent these intermolecular links. The restoring force of a neo-Hookean spring depends nonlinearly on its length such that the force of a compressed spring is much higher than the force of the spring elongated by the same amount. This is analogous to the incompressibility of liquids, making these springs suitable to simulate the polygonal oscillations. It is shown that this spring-mass network can imitate most of the characteristic features of experimentally reported polygonal oscillations. Additionally, it is shown that the network can execute certain dynamics, which so far have not been observed in a perturbed liquid drop. The characteristics of dynamics that are observed in the perturbed network are polygonal oscillations, rotation of network, numerical relations (rational and irrational) between the frequencies of polygonal oscillations and the forcing signal, and that the shape of the polygons depends on the parameters of perturbation.

Oxigenoterapia con cánula nasal de alto flujo: experiencia en un servicio de urgencias de la ciudad de Bogotá / Oxygen therapy with a high-flow nasal cannula: experience in emergency service in the city of Bogotá

El objetivo de este estudio es analizar desenlaces clínicos de oxigenoterapia con cánula nasal de alto flujo (CNAF) en niños con dificultad respiratoria aguda en un servicio de urgencias. Estudio longitudinal, retrospectivo de datos panel en niños con diagnóstico de dificultad respiratoria moderada- severa. El resultado primario de interés fue ingreso a unidad de cuidados intensivos pediátricos (UCIP) o requerir intubación 24 horas posteriores al inicio de la terapia. Se calcularon medidas de frecuencia y tendencia central. Los grupos se compararon con las pruebas Chi2, Fisher, Wilcoxon y Kruskal-Wallis. El análisis de datos panel balanceados identificó puntos de inflexión en las curvas de normalización de respuesta respiratoria. Un total de 339 niños de 0 a 16 años cumplieron los criterios de inclusión. Mayoría hombres (62,24%), mediana de edad 2 años (RIQ= 0,75-3) y neumonía como principal causa de dificultad respiratoria (33,92%). El ingreso a UCIP (14,5%) y la intubación (0,9%) fue baja en la cohorte. En las primeras tres horas con CNAF se evidenció mejoría en los parámetros respiratorios, sin diferencias significativas entre pacientes con y sin respuesta clínica (frecuencia cardiaca p=0,317; frecuencia respiratoria p=0,423; SatO2 p=0,297; FiO2 p=0,116). No se presentaron eventos adversos ni casos de mortalidad. Los resultados sugieren que la oxigenoterapia con CNAF puede ser una alternativa de soporte respiratorio inicial en niños ≤16 años con dificultad respiratoria moderada a severa. La incidencia de intubación e ingreso a UCIP fue baja. La CNAF fue bien tolerada en los diferentes grupos de edad.

Objective: To analyze clinical outcomes of oxygen therapy with a high-flow nasal cannula (HFNC) in children with acute respiratory distress in an emergency department. We design a longitudinal retrospective study of panel data in children with a diagnosis of moderate-severe respiratory distress. The primary outcome of interest was admission to the pediatric intensive care unit (PICU) or requiring intubation 24 hours after initiation of therapy.We calculated the statistics of frequency and central tendency. Finally, the Chi2, Fisher, Wilcoxon and Kruskal-Wallis tests were used to compare groups. Balanced panel data analysis identified inflexion points in the respiratory response normalization curves. Children (n = 339) from zero to 16 years old met the inclusion criteria. Most men (62.24%), median age= 2 years (IQR = 0.75-3) and pneumonia as the main cause of respiratory distress (33.92%). Admission to the PICU (14.5%) and intubation (0.9%) was low in the cohort. In the first three hours with HFNC, improvement in respiratory parameters was evidenced, with no significant differences between patients with and without clinical response (heart rate p = 0.317; respiratory rate p = 0.423; SatO2 p = 0.297; FiO2 p = 0.116). There were no adverse events or mortality cases. The results suggest that oxygen therapy with HFNC can be an alternative for initial respiratory support in children ≤16 years of age with moderate to severe respiratory distress. The incidence of intubation and admission to the PICU was low. The HFNC was well tolerated in the different age groups.

[Decision making among older adults in hemodialysis. A qualitative assessment]. / Toma de decisiones en hemodiálisis crónica: estudio cualitativo en adultos mayores.

BACKGROUND: In Chile there are 22,310 people in Chronic Hemodialysis (CHD), 53% of them older adults (OA). Shared decision-making and advance directives (AD) are especially important in OA with end-stage chronic renal failure, since they have greater levels of disability, morbidity and mortality, raising doubts about the benefit of therapy. AIMS: To understand the experience in decision making and explore ways to express AD, in OA in CHD. MATERIAL AND METHODS: A qualitative phenomenological study, performing 12 in-depth interviews to OA who had been at CHD for at least one year. RESULTS: The analysis revealed four broad comprehensive categories, two related to participation in the decision to enter CHD, namely the experience of subjects as spectators and their lack of interest for decision support and two referred to the expression of AD, namely the difficulty in facing their own finitude and resistance to express AD. CONCLUSIONS: There is little participation of older adults in the decision about their admission to dialysis therapy, and once they enter the CHD program they are not prepared to discuss AD in general, nor an eventual suspension of dialysis in particular.

BNCT research activities at the Granada group and the project NeMeSis: Neutrons for medicine and sciences, towards an accelerator-based facility for new BNCT therapies, medical isotope production and other scientific neutron applications.

The Granada group in BNCT research is currently performing studies on: nuclear and radiobiological data for BNCT, new boron compounds and a new design for a neutron source for BNCT and other applications, including the production of medical radioisotopes. All these activities are described in this report.

Modulation of Aleurone Peroxidases in Kernels of Insect-Resistant Maize (Zea mays L.; Pob84-C3R) After Mechanical and Insect Damage.

Peroxidases (PODs) have many biological functions during the plant life cycle. In maize kernels, endosperm PODs have been identified as biochemical contributors to resistance against Sitophilus zeamais, but their identities have not been determined. In this study, we identified these PODs and determined whether their contributions are basal or inducible. Semi-purification and LC-MS/MS analyses showed that the protein ZmPrx35 is the predominant soluble endosperm POD from kernels of Pob84-C3R. Subsequent time-course analyses after mechanical damage showed that POD activity was regulated in a fluctuating kinetics pattern and that zmprx35 mRNA expression levels reflected this pattern. After 48 h of infestation with S. zeamais or Prostephanus truncatus, soluble endosperm POD activities were 1.38- or 0.85-fold, respectively. Under the same conditions, zmprx35 expression was induced 1.61-fold (S. zeamais infestation) and 1.17-fold (P. truncatus infestation). These findings suggest that ZmPrx35 contributes to the protective responses of aleurone cells against wounding and pest attacks, which could be enhanced/repressed by insect factors. Our data also provide evidence that the mechanisms of resistance of maize Pob84-C3R kernels toward the insect pests S. zeamais and P. truncatus are independent.

Toma de decisiones en hemodiálisis crónica: estudio cualitativo en adultos mayores / Decision making among older adults in hemodialysis. A qualitative assessment

Background: In Chile there are 22,310 people in Chronic Hemodialysis (CHD), 53% of them older adults (OA). Shared decision-making and advance directives (AD) are especially important in OA with end-stage chronic renal failure, since they have greater levels of disability, morbidity and mortality, raising doubts about the benefit of therapy. Aims: To understand the experience in decision making and explore ways to express AD, in OA in CHD. Material and Methods: A qualitative phenomenological study, performing 12 in-depth interviews to OA who had been at CHD for at least one year. Results: The analysis revealed four broad comprehensive categories, two related to participation in the decision to enter CHD, namely the experience of subjects as spectators and their lack of interest for decision support and two referred to the expression of AD, namely the difficulty in facing their own finitude and resistance to express AD. Conclusions: There is little participation of older adults in the decision about their admission to dialysis therapy, and once they enter the CHD program they are not prepared to discuss AD in general, nor an eventual suspension of dialysis in particular.

Conocimientos, actitudes y motivaciones respecto a la afiliación al colegio de enfermeras en docentes universitarios / Knowledge, attitudes, and motivations among university teachers regarding the affiliation to a Chilean College of Nurses / Conhecimentos, atitudes e motivações ao respeito da filiação ao colégio de enfermeiras em docentes universitários

Resumen Introducción: La participación en el colegio de enfermeras es una instancia relevante para el desarrollo de la profesión a nivel país, debido a la defensa que realiza por la enfermería desde los diferentes ámbitos de actuación; es indispensable inculcar esta visión desde la formación universitaria a través de los profesionales de enfermería que se dedican a la docencia. Materiales y métodos: Se realizó un estudio cuantitativo, transeccional y correlacional, en 49 académicos de las diferentes casas de estudio de la ciudad de Puerto Montt-Chile, en quienes se evaluó su afiliación al colegio de enfermeras, además de sus conocimientos, actitudes y motivaciones respecto a participar en dicha instancia gremial; para tal fin se aplicó un instrumento de elaboración propia (α Cronbach 0.71). Resultados: Se encontró que el 40.9% de los docentes está afiliado al colegio de enfermeras y que existe conocimiento suficiente respecto a esta organización, con una actitud desfavorable hacia el mismo, evidenciándose asociación entre la actitud y aspectos como la dinámica de trabajo (p=0.043 Correlación de Spearman: 0.158) y la afiliación al colegio (p=0.02 Coeficiente de Spearman: 0.142). Discusión: La participación colegiada permite el fortalecimiento de la profesión, además de favorecer la visibilidad, liderazgo e identidad profesional; aunque se reconocen estos aspectos no son suficientes para generar la afiliación o una actitud favorable a ésta. Conclusiones: En la promoción de la afiliación debe considerarse la tendencia a no afiliación de los docentes más jóvenes y los aspectos de motivación, ambos relevantes para destacar la participación colegial como un aspecto deontológico que forma parte del modelaje hacia los enfermeros en formación.

Abstract Introduction: The participation with the College of Nurses is a relevant action to support the development of nursing in Chile because this organization stands as an important defender to the practice. Therefore, it is advisable that nursing teachers promote this vision among the nursing community. Materials and Methods: This is a quantitative, transectional and correlational study with 49 academicians from diverse teaching centers in the city of Puerto Montt, Chile, who were assessed in terms of their affiliation to the College of Nurses, their knowledge, attitudes, and motivations regarding their participation with this organization. A locally-designed instrument (α Cronbach 0.71) was used. Results: 40.9% of the teachers were affiliated to the College of Nurses. Associations between attitudes and working dynamics (Spearman Correlation = 0.158, p =0.043), and affiliation to the College (Spearman Correlation = 0.142, p = 0.02) were found. Discussion: The participation with the College of Nurses can allow the strengthening of the profession by favoring its visibility, leadership, and professional identity, though these important gains are not always sufficient to encourage an affiliation or a positive attitude towards this organization. Conclusions: In order to better promote the affiliation to the College of Nurses, young teachers' indifference attitudes, as well as other overall motivation factors should be considered first.

Resumo Introdução: A participação no colégio de enfermeiras é uma instancia relevante para o desenvolvimento da profissão ao nível do país, devido à defesa que realiza pela enfermagem desde os diferentes âmbitos de atuação; é indispensável inculcar esta visão desde a formação universitária a través dos profissionais de enfermagem que se dedicam à docência. Materiais e métodos: Realizou-se um estudo quantitativo, transecional e correlacional, em 49 docentes das diferentes casas de estudo da cidade de Puerto Montt-Chile, em quem se avaliou sua filiação ao colégio de enfermeiras, além de seus conhecimentos, atitudes e motivações referentes a participar na instância gremial; para tal fim aplicou-se um instrumento de elaboração própria (α Cronbach 0.71). Resultados: Encontrou-se que o 40.9% dos docentes forma parte do colégio de enfermeiras e que existe conhecimento suficiente ao respeito desta organização, com uma atitude desfavorável a ele mesmo, evidenciando-se uma associação entre a atitude e aspectos como a dinâmica de trabalho (p=0.043 Correlação de Spearman: 0.158) e a filiação ao colégio (p=0.02 Coeficiente de Spearman: 0.142). Discussão: A participação colegiada permite o fortalecimento da profissão, além de favorecer a visibilidade, liderança e identidade profissional; ainda que se reconheçam estes aspectos, não são suficientes para gerar a filiação ou uma atitude favorável a esta. Conclusões: Na promoção da filiação deve considerar-se a tendência à não filiação dos docentes mais jovens e os aspectos de motivação, ambos relevantes para salientar a participação colegial como um aspecto deontológico que forma parte da modelagem aos enfermeiros em formação.

[Prevalence and management of condylomas in consulting population in Chile: "DIACON study"]. / Prevalencia y manejo de condilomas en población consultante en Chile: estudio "DIACON".

INTRODUCTION: Condylomas or genital warts (GW) are the most frequently diagnosed sexually transmitted infection (STI) in STI centers in Chile, but there are no population statistics available. OBJECTIVES: To describe the prevalence of GW in patients from 18-60 years of age who attend outpatient dermatology, gynecology and urology practice; the demographic characteristics of the patients and the diagnostic and treatment tools. METHODS: A sample of Chilean specialists stratified by region, population and gender of patients was provided with a logbook and answered a questionnaire. RESULTS: The GW prevalence was 2.44% for the whole group; 3.76% for the 18-34 age group and 1.29% for the 35-60 years group (p = 0.0000). The average age of patients with GW was 29.4 years in women and 32.7 years in men (p = 0.019). The distribution by age was different according to gender and health system. Visual inspection was the most frequent diagnostic method used and imiquimod cream the most common treatment, however, there were differences in the use of diagnostic and therapeutic tools according to the patient's gender, specialty of the doctor and health system. CONCLUSIONS: The high prevalence of GW confirmed the need and importance of public health interventions to address this problem.

Distribution of Taenia solium Diagnostic Glycoproteins in the Different Developmental Stages of the Parasite.

Taenia solium is a helminth parasite that causes 2 diseases in humans: cysticercosis and taeniasis. The establishment of T. solium metacestodes in the central nervous system causes neurocysticercosis, while development of the adult tapeworm in the small intestine causes taeniasis. Serological diagnosis of neurocysticercosis is performed by Western blot with an enriched fraction of glycoproteins that has been extensively used for clinical diagnosis and epidemiological surveys. The lectin-bound fraction that is used for this assay contains 7 antigenic glycoproteins. These antigenic proteins are considered to be highly specific for cysticercosis when tested with heterologous parasitic diseases. However, recent studies show that people with taeniasis have cross-reactive antibodies against the neurocysticercosis diagnostic glycoproteins and vice versa. Nevertheless, it is not known if these diagnostic proteins are expressed in the adult stage of the parasite. In this paper, we describe the location of 3 of these glycoproteins in T. solium adults and cysticerci using polyclonal antibodies raised against a synthetic peptide based on the amino acid sequence of TS14, a recombinant protein T24H, and the native GP50. The glycoproteins' distribution was different in invaginated and evaginated cysticerci as well as in adult tapeworms. Specifically, the 3 glycoproteins studied were differentially expressed during embryogenesis. Our findings indicate that expression of the diagnostic glycoproteins is developmentally regulated; this is noteworthy since these glycoproteins are considered specific for the diagnosis of neurocysticercosis but nevertheless are present in different structures throughout the development of T. solium. Here we describe the glycoprotein expression and localization, which can be important in understanding their biological functions. In addition, our results help clarify the cross-reaction observed between people with neurocysticercosis and taeniasis to TS14, T24H, and GP50, which are used as diagnostic antigens for neurocysticercosis.

Caracterización de la población con anemia en el embarazo y su asociación con la morbimortalidad perinatal / Characterization of pregnant population with anemia and asociation with perinatal morbimortality

Resumen Introducción: la anemia es el trastorno nutricional más frecuente en el mundo y en el embarazo constituye un riesgo para la madre, el feto o recién nacido, desencadenando complicaciones como IVU, aborto, RCIU, parto prematuro, preeclampsia, bajo peso al nacer, RPM, etc. Objetivo: Determinar los efectos de la anemia en el embarazo y el desenlace perinatal de las pacientes atendidas en el Hospital Universitario Hernando Moncaleano de Neiva en el periodo de junio de 2012 a junio de 2016. Metodología: Se realizó un estudio observacional, descriptivo, retrospectivo, en gestantes atendidas en consulta de alto riesgo obstétrico durante el periodo e institución mencionados, con cruce de variables para determinar la relación entre la gravedad de la anemia y sus complicaciones mediante el cálculo del Chi-cuadrado Resultados: De 1.493 pacientes, 101 mujeres embarazadas entre los 16 a 34 años fueron incluidas en el estudio. La prevalencia de anemia fue de 32.01% y las complicaciones identificadas fueron: Infección de vías urinarias (8,91%), restricción de crecimiento intrauterino (7,9%), bajo peso al nacer (6,9%), preeclampsia (4,95%), parto prematuro (3,96%), ruptura prematura de membranas (3,03%) y un solo caso de aborto. El 10,89% de los recién nacidos requirieron hospitalización, de los cuales 2 presentaron hipoglicemia y 5 ictericia neonatal. Conclusiones: La anemia es una patología subdiagnosticada que afecta a mujeres entre los 16 y 30 años cuyas complicaciones como bajo peso al nacer, restricción de crecimiento intrauterino e ictericia neonatal resultan dependientes de la gravedad de la anemia.

Abstract Introduction: Anemia is the most frequent nutritional disorder in the world and in pregnancy it is a risk for the mother, the fetus or newborn, triggering complications such as IVU, abortion, IUGR, preterm birth, preeclampsia, low birth weight, RPM, etc. Objective: To determine the effects of anemia on pregnancy and the perinatal outcome of the patients treated at the Hernando Moncaleano Hospital in Neiva from June 2012 to June 2016. Methodology: An observational, descriptive, retrospective study, In pregnant women attended at a high obstetrical risk visit during the period and institution mentioned, with cross-variables to determine the relationship between the severity of the anemia and its complications by the Chi-square calculation Results: Of 1,493 patients, 101 pregnant women Between the ages of 16 and 34 were included in the study. The prevalence of anemia was 32.01% and the complications identified were: Urinary tract infection (8.91%), intrauterine growth restriction (7.9%), low birth weight (6.9%), preeclampsia, 95%), preterm delivery (3.96%), premature rupture of membranes (3.03%) and a single case of abortion. 10.89% of the newborns required hospitalization, of which 2 had hypoglycemia and 5 neonatal jaundice. Conclusions: Anemia is an underdiagnosed pathology that affects women between 16 and 30 whose complications such as low birth weight, intrauterine growth restriction and neonatal jaundice are dependent on the severity of the anemia.

Predictores del comportamiento de automanejo en personas con enfermedades crónicas de Tamaulipas / Self-management behavior predictors among persons with chronic diseases in Tamaulipas / Preditores do comportamento de automanejo em pessoas com doenças crônicas de Tamaulipas

Resumen Introducción: Dado el carácter prioritario de atención a las enfermedades no transmisibles, la Organización Mundial de la Salud propuso el Modelo de Cuidados Crónicos. En este modelo incluye el automanejo como un elemento principal en el combate de dichas enfermedades. Objetivo: Identificar las variables predictoras del comportamiento de automanejo en usuarios con Diabetes Mellitus, Hipertensión Arterial y Obesidad. Métodos: La muestra no probabilística e intencional fue de 386 usuarios de la Secretaría de Salud de Tamaulipas (Ciudad Victoria y Tampico). El diseño de estudio fue no experimental, transversal. Resultados: casi la mitad (42.2%) de los participantes con ECNT refieren síntomas de trastorno depresivo en el continuo de leve a grave, la categoría que obtuvo mayor porcentaje de IMC fue sobrepeso con 33.2% y más de un tercio de la población (36.8%) percibe algún grado de disfunción familiar. Así también se aplicó un análisis de Regresión Lineal Múltiple con el método de pasos, el modelo indica que fueron siete predictores del comportamiento de Automanejo (varianza explicada R2=.325); la variable autoeficacia fue el más importante (β=38) y el apoyo social percibido el predictor con carga más baja (β=.10). Conclusiones: estos predictores representan elementos importantes para ampliar el conocimiento y entender el comportamiento del automanejo, área que es promovida en el modelo de atención a crónicos de la Organización Mundial de la Salud y en la actualidad es liderada por el área de enfermería.

Abstract Introduction: Considering the priority regarding the attention of non transmissible diseases, the World Health Organization proposed the Chronic Care Model which, by encompassing self-management as one main element, is intended to address these diseases. Objective: To identify predictor variables related to behavior on self-management among patients with Diabetes Mellitus, Hypertension, and Obesity. Methods: The intentional and non probabilistic simple included 386 patients from the Health Secretariat in Tamaulipas, Mexico (Ciudad Victoria and Tampico). The study design was non experimental and transversal. Results: About half (42.2%) of the participants with Chronic Non Transmissible diseases referred having depressive disorder ranging from mild to severe. Regarding the BMI, 33.2% showed overweight. Moreover, 36.8% perceived some degree of family dysfunction. A Multiple Linear Regression was calculated. The model indicated that there were seven predictors of the behavior on self-management (explained variance R2 =.325); being self-efficacy the most important (β=38), and perceived social support the lowest in load (β=.10). Conclusions: These predictors represent important elements to consider when building on the knowledge and understanding the behavior related to self-management, an area which is highlighted in the Chronic Care Model of the World Health Organization, particularly within nursing.

Resumo Introdução: Dado o caráter prioritário de atenção às doenças não transferíveis, a Organização Mundial da Saúde propôs o Modelo de Cuidados Crônicos. Neste modelo inclui-se o automanejo como um elemento principal no combate de tais doenças. Objetivo: identificar as variáveis preditoras do comportamento de automanejo em usuários com Diabetes Mellitus, Hipertensão Arterial e Obesidade. Métodos: A amostra não probabilística e intencional foi de 386 usuários da Secretaría de Salud de Tamaulipas (Ciudad Victoria e Tampico). O desenho de estudo foi não experimental, transversal. Resultados: quase a metade (42.2%) dos participantes com ECNT referem sintomas de transtorno depressivo no continuo de leve a grave, a categoria que obteve maior porcentagem de IMC foi sobrepeso com 33.2% e mais de um terço da população (36.8%) percebe algum grau de disfunção familiar. Assim também se aplicou uma análise de Regressão Linear Múltipla com o método de passos, o modelo indica que foram sete preditores do comportamento de Automanejo (variância explicada R 2 =.325); a variável autoeficácia foi a mais importante (β=38) no apoio social percebido e o preditor com carga mais baixa (β=.10). Conclusões: estes preditores representam elementos importantes para ampliar o conhecimento e entender o comportamento de automanejo, área que é promovida no modelo de atenção a crônicos da Organização Mundial da Saúde e na atualidade é liderada pela área de enfermagem.

Prevalencia y manejo de condilomas en población consultante en Chile: estudio "DIACON" / Prevalence and management of condylomas in consulting population in Chile: "DIACON study"

Resumen Introducción: Los condilomas o verrugas genitales (VG) son la infección de transmisión sexual (ITS) más diagnosticada en los centros de ITS en Chile, pero no existen estadísticas poblacionales. Objetivos: Describir la prevalencia de VG en pacientes de 18-60 años que acuden a consulta ambulatoria de dermatología, ginecología y urología; características demográficas de los pacientes y prácticas de diagnóstico y tratamiento. Material y Métodos: A una muestra de especialistas chilenos estratificados por región, población y sexo de pacientes se les proporcionó un diario de registro y aplicó un cuestionario. Resultados: Prevalencia VG grupo total: 2,4%; en grupo etario 18-34 años: 3,7%; en grupo etario 35-60 años: 1,29% (p = 0,0000). La edad media de los pacientes con VG fue 29,4 años en mujeres y 32,7 años en hombres (p = 0,019); la distribución por edad fue diferente según sexo y sistema de salud. La inspección visual fue el método diagnóstico más frecuente y la crema de imiquimod el tratamiento más común. Hubo diferencias en el uso de herramientas diagnósticas y terapéuticas según sexo del paciente, especialidad del médico y sistema de salud. Conclusiones: Existe una alta prevalencia de VG, que debería ser tomada en cuenta para planificar las intervenciones de salud pública para abordar este problema.

Introduction: Condylomas or genital warts (GW) are the most frequently diagnosed sexually transmitted infection (STI) in STI centers in Chile, but there are no population statistics available. Objectives: To describe the prevalence of GW in patients from 18-60 years of age who attend outpatient dermatology, gynecology and urology practice; the demographic characteristics of the patients and the diagnostic and treatment tools. Methods: A sample of Chilean specialists stratified by region, population and gender of patients was provided with a logbook and answered a questionnaire. Results: The GW prevalence was 2.44% for the whole group; 3.76% for the 18-34 age group and 1.29% for the 35-60 years group (p = 0.0000). The average age of patients with GW was 29.4 years in women and 32.7 years in men (p = 0.019). The distribution by age was different according to gender and health system. Visual inspection was the most frequent diagnostic method used and imiquimod cream the most common treatment, however, there were differences in the use of diagnostic and therapeutic tools according to the patient's gender, specialty of the doctor and health system. Conclusions: The high prevalence of GW confirmed the need and importance of public health interventions to address this problem.

Effect of Quercetin Rich Onion Extracts on Bacterial Quorum Sensing.

Quorum sensing (QS) regulates bacterial gene expression and studies suggest quercetin, a flavonol found in onion, as a QS inhibitor. There are no studies showing the anti-QS activity of plants containing quercetin in its native glycosylated forms. This study aimed to evaluate the antimicrobial and anti-QS potential of organic extracts of onion varieties and its representative phenolic compounds quercetin aglycone and quercetin 3-ß-D-glucoside in the QS model bacteria Chromobacterium violaceum ATCC 12472, Pseudomonas aeruginosa PAO1, and Serratia marcescens MG1. Three phenolic extracts were obtained: red onion extract in methanol acidified with 2.5% acetic acid (RO-1), white onion extract in methanol (WO-1) and white onion extract in methanol ammonium (WO-2). Quercetin 4-O-glucoside and quercetin 3,4-O-diglucoside were identified as the predominant compounds in both onion varieties using HPLC-DAD and LC-ESI-MS/MS. However, quercetin aglycone, cyanidin 3-O-glucoside and quercetin glycoside were identified only in RO-1. The three extracts showed minimum inhibitory concentration (MIC) values equal to or above 125 µg/ml of dried extract. Violacein production was significantly reduced by RO-1 and quercetin aglycone, but not by quercetin 3-ß-D-glucoside. Motility in P. aeruginosa PAO1 was inhibited by RO-1, while WO-2 inhibited S. marcescens MG1 motility only in high concentration. Quercetin aglycone and quercetin 3-ß-D-glucoside were effective at inhibiting motility in P. aeruginosa PAO1 and S. marcescens MG1. Surprisingly, biofilm formation was not affected by any extracts or the quercetins tested at sub-MIC concentrations. In silico studies suggested a better interaction and placement of quercetin aglycone in the structures of the CviR protein of C. violaceum ATCC 12472 than the glycosylated compound which corroborates the better inhibitory effect of the former over violacein production. On the other hand, the two quercetins were well placed in the AHLs binding pockets of the LasR protein of P. aeruginosa PAO1. Overall onion extracts and quercetin presented antimicrobial activity, and interference on QS regulated production of violacein and swarming motility.

Autopercepción de capacidades de autocuidado para prevención de enfermedades crónicas no transmisibles en estudiantes universitarios / Self-perception on self-care capacity in preventing noncommunicable chronic diseases among university students / Autopercepção de capacidades de autocuidado para prevenção de doenças crónicas não transmissíveis em estudantes universitários

Introducción: La incidencia de enfermedades crónicas no transmisibles (ECNT), va en aumento entre la población más joven. La autopercepción de capacidades de autocuidado (CAC), es un punto de partida para el desarrollo de habilidades y destrezas para el propio cuidado. Objetivo: Identificar el nivel de autopercepción de CAC para la prevención de enfermedades crónicas no transmisibles en estudiantes universitarios de nuevo ingreso, para establecer estrategias que permitan un mejor conocimiento de su salud. Métodos: Estudio cuantitativo, descriptivo, transversal y analítico. Muestra aleatorizada, obtenida por cálculo de poblaciones finitas. Se aplicó el Instrumento para identificar las capacidades de autocuidado en enfermedades crónico-degenerativas, salud sexual-reproductiva y prevención de adicciones; análisis descriptivo y analítico, con pruebas paramétricas y no paramétricas. Resultados: La autopercepción de CAC fue muy buena en un 8%, buena en 54%, regular en 36% y mala en 2%. Las diferencias entre áreas de conocimiento y el nivel de autopercepción fueron significativas (p=0.025). La licenciatura en medicina tuvo mejor puntaje de autocuidado ( x -=27.51). Discusión: Los principales resultados encontrados coinciden con diversos estudios que evalúan la dimensión de autopercepción. Existen claras divergencias entre el autocuidado percibido y el realizado, lo que hace evidente la necesidad de desarrollo de CAC. Conclusiones: Es necesario promover estilos saludables para mitigar efectos, costos e implicaciones sociales. Se puede incidir desde la consultoría de enfermería, para favorecer el desarrollo de capacidades de autocuidado en estudiantes universitarios.

Introduction: The incidence of non-communicable chronic diseases among younger populations is on the rise. Self-perception of self-care capacity is a beginning point to develop abilities and skills to address the own care. Objective: To identify the level of self-perception of self-capacity to prevent non-communicable chronic diseases among newly enrolled university students in order to establish strategies which convey a better understanding of this population's health. Methods: This is a quantitative, descriptive, transversal, and analytic study which used a random sample gathered by finite populations calculation. The Identification instrument on the capacity of self-care regarding chronic-degenerative diseases, sexual-reproductive health, and addiction prevention was administered. A descriptive and analytic analysis calculating parametric and non-parametric tests was carried out. Results: Self-perception on self-capacity showed to be very good in 8% of the sample, good in 54%, fair in 36%, and poor in 2%. The differences between the knowledge level and the self-perception level were significant (p=0.025). Students enrolled in Medicine had the highest mean score. Discussion: The main results of this study reflect agreement with other studies assessing the dimension of self-perception; nevertheless, a clear gap between perceived self-care and performed self-care, still remains. Conclusions: It is necessary to promote healthy lifestyles among university students in order to enhance their health self-perception and consequent self-care.

Introdução: A incidência de doenças crónicas não transmissíveis (ECNT), vai em aumento entre a população mais jovem. A autopercepção de capacidades de autocuidado (CAC), é um ponto de partida para o desenvolvimento de habilidades e destrezas para o cuidado próprio. Objetivo: Identificar o nível de autopercepção de CAC para a prevenção de doenças crónicas não transmissíveis em estudantes universitários de ingresso novo, para estabelecer estratégias que permitam um melhor conhecimento de sua saúde. Métodos: Estudo quantitativo, descritivo, transversal e analítico. Amostra aleatorizada, obtida por cálculo de populações finitas. Aplicou-se o Instrumento para identificar as capacidades de autocuidado em doenças crônico-degenerativas, saúde sexual-reprodutiva e prevenção de dependência; análise descritiva e analítica, com probas paramétricas e não paramétricas. Resultados: A autopercepção de CAC foi muito boa em um 8%, boa em 54%, regular em 36% e precária em 2%. As diferenças entre áreas de conhecimento e o nível de autopercepção foram significativas (p=0.025). A licenciatura em medicina teve melhor pontuação de autocuidado ( x -=27.51). Discussão: Os principais resultados encontrados coincidem com diversos estudos que avaliam a dimensão de autopercepção. Existem divergências manifestas entre o autocuidado percebido e o realizado, o que faz evidente a necessidade de desenvolvimento de CAC. Conclusões: É necessário promover estilos saudáveis para mitigar consequências, custos e implicações sociais. Pode influir desde a consultoria de enfermagem, para favorecer o desenvolvimento de capacidades de autocuidado em estudantes universitários.

An impressive case of chromoblastomycosis due to Fonsecaea pedrosoi in a patient with a long history of fungal infection.

Chromoblastomycosis is defined as a chronic cutaneous and subcutaneous fungal infection caused by melanized or brown-pigmented fungi. A 63-year-old man farmer showed on external and internal part of the right arm, a well-delimited verrucous and hyperkeratotic plaque, with atrophic and cicatricial areas. Direct examination of skin scrapings samples showed the presence of muriform cells, a classic feature of chromoblastomycosis. Fungal isolation was performed in Sabouraud dextrose agar, and dark olivaceous colonies were isolated. Skin biopsy samples were obtained for histopathological and molecular diagnosis. DNA extracted from both, paraffin-embedded skin biopsy samples and fungal colonies, was used for molecular identification by 18S-ITS1-5.8S-ITS2-28S rRNA amplification and sequencing. Fonsecaea pedrosoi was identified from paraffin-embedded skin samples and fungal colonies. A combined therapy with terbinafine and itraconazole, plus cryotherapy was applied with an important improvement. Herein, we report an impressive case of chromoblastomycosis due to Fonsecaea pedrosoi with a successful outcome.

Psychosis management in patients with hiv: case report.

Human immunodeficiency virus (HIV) infection can cause neuropsychiatric disorders such as cognitive impairment, behavioural difficulties or psychiatric symptoms –for instance, mania and psychosis. HIV patients with psychiatric comorbidities need an appropriate treatment which tackles the HIV infection as much as the particular mental symptoms. Here we present the case of a patient suffering from delusions, which turned out to be caused by encephalitis secondary to a previously unknown HIV infection. A review of psychosis in HIV-infected patients is also presented. This review is focused on the epidemiology, etiopathogenesis and clinical presentation of HIV-induced psychosis, as well as the recommended pharmacological treatment (antiretroviral therapy and antipsychotic medication) and the expected treatment response. We also present wide information concerning pharmacological interactions between antiretroviral and antipsychotic medications that we hope will help the clinician to better manage this complex condition.

The Mexican consensus on probiotics in gastroenterology. / Consenso mexicano sobre probióticos en gastroenterología.

INTRODUCTION: Probiotics are frequently prescribed in clinical practice. Their efficacy in treating gastrointestinal disorders is supported by a significant number of clinical trials. However, the correct prescription of these agents is hampered due to a lack of knowledge of the scientific evidence and to the different presentations and microbial compositions of the probiotics that are currently available. AIM: To provide the clinician with a consensus review of probiotics and recommendations for their use in gastroenterology. MATERIALS AND METHODS: Controlled clinical trials, meta-analyses, and systematic reviews published up to 2015 were selected, using the MESH terms: probiotics, gastrointestinal diseases, humans, adults, AND children. The Delphi method was employed. Eighteen gastroenterologists treating adult patients and 14 pediatric gastroenterologists formulated statements that were voted on until agreement>70% was reached. The level of evidence based on the GRADE system was evaluated for each statement. RESULTS AND CONCLUSIONS: Eleven statements on the general concepts of probiotics and 27 statements on the use of probiotics in gastrointestinal diseases in both adults and children were formulated. The consensus group recommends the use of probiotics under the following clinical conditions: the prevention of diarrhea associated with antibiotics, the treatment of acute infectious diarrhea, the prevention of Clostridium difficile infection and necrotizing enterocolitis, the reduction of adverse events from Helicobacter pylori eradication therapy, relief from irritable bowel syndrome symptoms, the treatment of functional constipation in the adult, and the induction and maintenance of remission in patients with ulcerative colitis and pouchitis, and the treatment of covert and overt hepatic encephalopathy.

Conocimiento y perfil de uso de la biblioteca Cochrane en médicos asistentes a un congreso de Medicina Interna / Knowledge and use profile of the Cochrane library in doctors attendees of an Internal Medicine congress

Introducción: las Revisiones Sistemáticas (RS) son herramientas para practicar Medicina Basada en la Evidencia. La Colaboración Cochrane genera RS, pero el conocimiento y uso de la Biblioteca Cochrane (BC) es heterogéneo. Nuestro objetivo fue describir el nivel de conocimiento y el perfil de uso de la BC entre asistentes a una Conferencia Mundial de Medicina Interna (WCIM). Método:estudio transversal vía encuesta electrónica entre asistentes al XXXI WCIM, recabando información demográfica de los participantes; su conocimiento, acceso y usos de la BC. Resultados: 413 asistentes aceptaron participar y 198 (47,9 por ciento) de 24 países respondieron. 91,4 por ciento eran Latinoamericanos, 50,5 por ciento eran internistas. El conocimiento de la BC fue del 96,5 por ciento. El 76% de quienes respondieron usaban la BC al menos una vez al mes. No encontramos diferencias en la frecuencia de uso según edad o ámbito académico. Las principales razones para utilizar RS-BC fueron: toma de decisiones clínicas (67,6 por ciento), actualización (64,2 por ciento) y docencia (31,8 por ciento); 46 por ciento consideraron la BC muy útil para sus propósitos. Los <35 años utilizaban significativamente más la BC para guiar las decisiones clínicas que los >35 años (70 por ciento vs 53 por ciento, p: 0,017). Quienes consideraron muy útil la BC la utilizaron significativamente más para propósitos docentes (41 por ciento vs. 24 por ciento, p: 0,019) y toma de decisiones clínicas (79 por ciento vs. 58 por ciento, p: 0,003) que quienes la declararon como a veces útil o no útil. Hubo también diferencias estadísticamente significativas en la distribución del acceso a la BC según región geográfica (p: 0,001). Conclusiones: encontramos un alto nivel de conocimiento de la BC entre los asistentes a WCIM. Los usuarios describen un uso frecuente para diversos propósitos, considerándola útil para estos. (AU)

Introduction: Systematic Reviews (SR) are tools for practicing Evidence Based Medicine. Cochrane Collaboration generates SRs, but awareness and uses of Cochrane SR, changes over time and across different countries and medical specialties. We aimed to describe awareness and user's profile of Cochrane Library (CL) SR among attendants to a World Conference of Internal Medicine (WCIM). Methods: Cross sectional online survey study among attendants to the XXXI WCIM asking about demographic information, awareness of, access to and uses of CL-SRs. Results: 413 attendants to WCIM volunteered to participate and 198 (47.9 percent) from 24 countries replied; 91.4 percent) were from Latin-America. Mean age was 37 years and 50.5 percent) were general internists or internal medicine subspecialists. Awareness of the CL was 96.5 percent). The frequency of CL-SR use was at least once a month for 76 percent) of responders. We found no difference in frequency of use according to age or academic setting. Main reasons to use CL-SR were: guide clinical decisions (67.6 percent)), personal update (64.2 percent) and teaching (31.8 percent)); 46 percent) considered CL-SR very useful to their purposes. People <35y used CL-SR significantly more for guiding clinical decisions than those >35y (70 percent) vs 53 percent), p: 0.017). Users who considered CL-SR very useful use it significantly more for teaching purposes (41 percent) vs 24 percent), p: 0.019) and for clinical decision-making (79 percent) vs 58 percent), p: 0.003) than those declaring CL-SR as sometimes useful or not useful. Also there was statistically significant difference in distribution of access to CL by geographic region (p: 0.001). Conclusions: We found high awareness of CL-SRs among attendants to WCIM. Users describe frequent use, for several purposes and find it helpful for their purposes; however, access varied across regions. (AU)

[Late presentation of traumatic diaphragmatic hernia]. / Presentación tardía de hernia diafragmática traumática.

Four years old male, who was operated four months ago to present chest injuries caused by a firearm projectile, where injuries in the diaphragm were not observed. Now is admitted because of an intestinal obstruction. By medial laparotomy, a defect of 3 cm in diameter was exposed in the left diaphragm, containing a transverse colonic segment of 5 cm and omentum. The treatment performed is described.

Varón de cuatro años de edad que hace cuatro meses fue intervenido por presentar lesiones en el tórax producidas por un proyectil de arma de fuego, sin que se observaran lesiones en el diafragma. Ahora ingresa por un cuadro de obstrucción intestinal. Por laparotomía media, se expuso un defecto de 3 cm de diámetro, en el diafragma izquierdo, que contenía un segmento de 5 cm de colon transverso y omento. Se describe el tratamiento efectuado.