"I left my shyness behind": Sustainable community-led development and processes of motivation among rural Nicaraguan women.

This paper explores motivational changes of Nicaraguan women involved in sustainable community-led development. Sustainability is the goal of many organizations engaged with capacity development interventions. Research on what such sustainability entails point to a correlation between sustained action by communities, postintervention, and high levels of social capital, collective agency, and efficacy. But what factors motivate people to develop the social capital, self-efficacy, and agency that enable them to sustain their actions towards their communities' well-being? Using Self-Determination Theory as framework, and drawing from interview data, this qualitative paper explores the psychosocial processes rural Nicaraguan women undergo when initially engaging in, and eventually committing to community-led projects. Types of motivation in combination with shifts from initial to more sustained forms of motivation, we conclude, can inform current and future community development interventions on the role motivation plays toward establishing agency, efficacy, and relationships-that is, essential components of sustainable community development.

Management and perioperative outcomes of traumatic brain injury: retrospective study / Manejo y desenlaces perioperatorios del traumatismo craneoencefálico: estudio retrospectivo

Abstract Introduction: Cranioencephalic traumatism (CET) is a cause of mortality and morbidity in the surgical patient. However, the perioperative management of this entity has not been evaluated in the country's health institutions, despite its high disease burden and potential adverse clinical outcomes. Objective: To evaluate the clinical characteristics of surgical TBI and perioperative outcomes. Methods: Descriptive study of historical review conducted at the Hospital San Vicente Fundación, Medellín, Colombia. Data were collected from the medical records of patients over 13 years of age diagnosed with moderate-severe TBI between 2011 and 2014. Clinical variables, perioperative management, and clinical outcomes up to discharge were analyzed. An exploratory analysis was performed between perioperative management and postoperative mortality or neurological dysfunction. Results: CET was most common in the young male population (89.3%). Severe trauma occurred in 71.1% of patients. Perioperative mortality was 16%, and 54% presented neurological disability at discharge. A strong association was found between mortality or neurological dysfunction and severity of injury and perioperative hypotension. Conclusion: The study found that surgical CET was a high morbidity and perioperative mortality event, highly related to the severity of the injury and the hemodynamic stability of the patient. Despite this, intraoperative hemodynamic and metabolic monitoring remains limited in more than 50% of these patients' surgical procedures.

Resumen Introducción: El traumatismo craneoencefálico (TEC) es una causa de mortalidad y morbilidad en el paciente quirúrgico. No obstante, el manejo perioperatorio de esta entidad no ha sido evaluado en las instituciones de salud del país, a pesar de su alta carga de enfermedad y potenciales desenlaces clínicos adversos. Objetivo: Evaluar las características clínicas del TEC quirúrgico y de los desenlaces perioperatorios. Método: Estudio descriptivo de revisión histórica realizado en el Hospital San Vicente Fundación, de Medellín, Colombia. Se recolectaron datos a partir de las historias clínicas de los pacientes mayores de 13 años con diagnóstico de TEC moderado-grave entre 2011 y 2014. Se analizaron las variables clínicas, el manejo perioperatorio y los desenlaces clínicos hasta el alta. Se realizó un análisis exploratorio entre el manejo perioperatorio y mortalidad o disfunción neurológica posquirúrgica. Resultados: El TEC fue más común en la población masculina joven (89,3%). El traumatismo grave ocurrió en el 71,1% de los pacientes. La mortalidad perioperatoria fue del 16%, y el 54% presentó discapacidad neurológica al alta. Se encontró una asociación fuerte entre mortalidad o disfunción neurológica y gravedad de la lesión e hipotensión perioperatoria. Conclusión: El estudio encontró que el TEC quirúrgico fue un evento con alta morbilidad y mortalidad perioperatoria, altamente relacionado con la gravedad de la lesión y la estabilidad hemodinámica del paciente. A pesar de ello, la monitoria intraoperatoria de tipo hemodinámico y metabólico sigue siendo limitada en más del 50% de los procedimientos quirúrgicos de estos pacientes.

In vitro culture of L3 larvae of nematodes obtained from the African giant snail Lissachatina fulica (Mollusca: Gastropoda) in Santa Fe de Antioquia.

INTRODUCTION: Over 170 municipalities in Colombia have been invaded by Lissachatina fulica, an African snail that can carry larvae of nematodes of interest in human and veterinary health. Nematodes enter the host snail as larvae L1 and then change to L2 and L3, the infectious form for vertebrates. OBJECTIVE: To standardize culture in vitro of L3 carried by L. fulica from Santa Fe de Antioquia. MATERIALS AND METHODS: Between July and November, 2014, 10 snails were collected, killed, and conserved with HCl 0.7%. Larvae were recovered using the Baermann technique and cultured for 36 days in Schneider, DMEM and RPMI media, with and without SFB 20% and distilled water with SFB 20%. Replacements were made every 36 hours; larvae were measured with an ocular micrometer on a microscope. Summary statistics were estimated; box and whisker plots were made; the t Student test was performed in SPSS 18™. A p-value below 0.05 was assumed as significant. RESULTS: Fifty per cent of the larvae survived. The highest survival and growth was 85% in supplemented DMEM. The final average length of larvae in supplemented media exceeded the initial one. There were significant differences between the average length of larvae cultured in supplemented media and the initial length. The initial width of larvae did not change. CONCLUSIONS: The best medium for the culture of L3 larvae was supplemented DMEM. The length provided more information than the width for the larval growth evaluation. The larvae studied did not correspond to Angiostrongylus cantonensis, A. costaricensis or Aelurostrongylus abstrusus.

Cultivo in vitro de larvas L3 de nematodos obtenidas del caracol gigante africano Lissachatina fulica (Mollusca: Gastropoda) en Santa Fe de Antioquia / In vitro culture of L3 larvae of nematodes obtained from the African giant snail Lissachatina fulica (Mollusca: Gastropoda) in Santa Fe de Antioquia

Introducción. Más de 170 municipios colombianos están invadidos por Lissachatina fulica, caracol africano que puede portar larvas de nematodos de interés en salud humana y veterinaria. Los parásitos entran al caracol huésped intermediario en el estadio de larva L1, y allí cambian a L2 y L3, formas estas capaces de infectar a vertebrados. Objetivo. Estandarizar el cultivo in vitro de las L3 portadas por especímenes de L. fulica recolectados en Santa Fe de Antioquia. Materiales y métodos. Entre julio y noviembre de 2014 se recolectaron 10 caracoles, se sacrificaron y se digirieron con ácido clorhídrico al 0,7 %. Las larvas se recuperaron mediante la técnica de Baermann; se cultivaron 36 días en los medios Schneider, mínimo esencial de Eagle modificado por Dulbecco (Dulbecco's Modified Eagles Minimal Essential Medium, DMEM), y Roswell Park Memorial Institute (RPMI), con suero fetal bovino (SFB) al 20 % y sin este, y agua destilada con SFB al 20 %. Los medios de cultivo se cambiaron cada 36 horas. Las larvas se midieron con el microscopio utilizando reglilla ocular, y se evaluaron la supervivencia, la longitud y el ancho. Se calcularon datos estadísticos de resumen y se hicieron gráficos de cajas y bigotes, así como la prueba t de Student. El nivel de significación (p) se estableció como menor de 0,05. Resultados. El 50 % de las larvas sobrevivió, 85 % en DMEM con SFB al 20 %, el 70 % con RPMI más SFB al 20 %, el 60 % en RPMI, el 50 % en Schneider más SFB al 20 %, el 45 % en Schneider y el 40 % en DMEM. El control sobrevivió diez días. Hubo diferencias significativas entre la longitud inicial promedio de las larvas y la longitud final promedio en los medios con suplementos: inicial, 645,83 µm; final en DMEM más SFB al 20 %, 732,65 µm (p<0,001); en RPMI más SFB al 20 %, 718,79 µm (p<0,001), y en Schneider más SFB al 20 %, 696,12 µm (p<0,01). No hubo diferencias significativas entre la anchura inicial promedio, de 24,99 µm, y la final. Conclusiones. El mejor medio para cultivar las L3 de L. fulica fue el DMEM más SFB al 20 %. En la evaluación del crecimiento larval, la longitud fue más informativa que la anchura. Las larvas estudiadas no correspondieron a Angiostrongylus cantonensis, A. costaricensis ni Aelurostrongylus abstrusus.

Introduction: Over 170 municipalities in Colombia have been invaded by Lissachatina fulica, an African snail that can carry larvae of nematodes of interest in human and veterinary health. Nematodes enter the host snail as larvae L1 and then change to L2 and L3, the infectious form for vertebrates. Objective: To standardize culture in vitro of L3 carried by L. fulica from Santa Fe de Antioquia. Materials and methods: Between July and November, 2014, 10 snails were collected, killed, and conserved with HCl 0.7%. Larvae were recovered using the Baermann technique and cultured for 36 days in Schneider, DMEM and RPMI media, with and without SFB 20% and distilled water with SFB 20%. Replacements were made every 36 hours; larvae were measured with an ocular micrometer on a microscope. Summary statistics were estimated; box and whisker plots were made; the t Student test was performed in SPSS 18™. A p-value below 0.05 was assumed as significant. Results: Fifty per cent of the larvae survived. The highest survival and growth was 85% in supplemented DMEM. The final average length of larvae in supplemented media exceeded the initial one. There were significant differences between the average length of larvae cultured in supplemented media and the initial length. The initial width of larvae did not change. Conclusions: The best medium for the culture of L3 larvae was supplemented DMEM. The length provided more information than the width for the larval growth evaluation. The larvae studied did not correspond to Angiostrongylus cantonensis, A. costaricensis or Aelurostrongylus abstrusus.

[Standardization of a multiplex real-time PCR test for the identification of Angiostrongylus cantonensis, A. costaricensis and A. vasorum].

INTRODUCTION: Angiostrongyliasis is a disease caused by Angiostrongylus nematodes that is present worldwide. The infections with the highest impact on human and animal health are caused by A. cantonensis, A. costaricensis, and A. vasorum. Clinical forms of the disease in humans are eosinophilic meningitis and abdominal angiostrongyliasis, while the most common effect on dogs are cardiopulmonary damages. It is deemed as an emerging disease as the result of the global dissemination of the African snail Lissachatina fulica, an intermediary host of these parasites. The few diagnostic methods for Angiostrongylus spp. are unspecific, costly, and not very sensitive. It is urgent to develop a sensitive, specific and accessible diagnostic tool for the control of human and animal angiostrongyliasis. OBJECTIVE: To develop a qPCR multiple test to identify the three pathogenic species of Angiostrongylus. MATERIALS AND METHODS: Through a bio-informatic analysis, we selected a sequence of the ITS-2 region of the Angiostrongylus genome to guarantee the specificity of primers and probes. We extracted DNA from adult parasites as positive control, and from larvae using the DNeasy Blood&Tissue® kit. Quantitative PCR reactions were conducted on a Smartcycler Cepheid® thermocycler using a master mix QuantiTect® kit. DNA from human beings, other parasites and the African snail was used as negative control. RESULTS: The threshold cycle values for positive DNA controls were: 21 for Angiostrongylus cantonensis, 22 for A. costaricensis, and 31 for A. vasorum. In negative controls, the threshold cycle was zero. qPCR showed an amplification efficiency of 2 (100%). CONCLUSIONS: A multiple qPCR was standardized at the laboratory for three clinically significant species of Angiostrongylus.

Estandarización de una prueba múltiple de reacción en cadena de la polimerasa en tiempo real para la identificación de Angiostrongylus cantonensis, A. costaricensis y A. vasorum / Standardization of a multiplex real-time PCR test for the identification of Angiostrongylus cantonensis, A. costaricensis and A. vasorum

Resumen Introducción. En el mundo, las angiostrongilosis de mayor impacto en salud humana y animal son ocasionadas por Angiostrongylus cantonensis, A. costaricensis y A. vasorum. En las personas, las formas clínicas son la meningitis eosinofílica y la angiostrongilosis abdominal, y, en los mamíferos cánidos, el daño cardiopulmonar. Se las consideran enfermedades emergentes debido a la propagación mundial del caracol africano Lissachatina fulica, un huésped intermediario de los parásitos. Los escasos métodos de identificación de Angiostrongylus spp. no son muy específicos ni sensibles y son costosos. Se necesita urgentemente una herramienta diagnóstica asequible, sensible y específica para el manejo de las angiostrongilosis humana y la animal. Objetivo. Desarrollar una prueba de PCR múltiple en tiempo real (qPCR) para identificar las tres especies patógenas de Angiostrongylus. Materiales y métodos. Mediante un análisis bioinformático se seleccionó una secuencia del genoma ITS-2 de Angiostrongylus para garantizar la especificidad del cebador y las sondas. El ADN de los parásitos adultos (control positivo) y de las larvas se extrajo con el estuche DNeasyBlood & Tissue®. Las reacciones de la PCR cuantitativa se ejecutaron en un termociclador Smartcycler Cepheid®, usando el estuche de mezcla maestra QuantiTect®. Como control negativo, se utilizó ADN humano, de otros parásitos y del caracol africano. Resultados. Los valores del ciclo umbral para los controles positivos de ADN fueron: 21 para Angiostrongylus cantonensis, 22 para A. costaricensis y 31 para A. vasorum. En los controles negativos, el ciclo umbral fue cero. La qPCR mostró una eficiencia de amplificación de 2 (100 %). Conclusiones. En el laboratorio se estandarizó una qPCR múltiple para tres especies clínicamente significativas de Angiostrongylus.

Abstract Introduction: Angiostrongyliasis is a disease caused by Angiostrongylus nematodes that is present worldwide. The infections with the highest impact on human and animal health are caused by A. cantonensis, A. costaricensis, and A. vasorum. Clinical forms of the disease in humans are eosinophilic meningitis and abdominal angiostrongyliasis, while the most common effect on dogs are cardiopulmonary damages. It is deemed as an emerging disease as the result of the global dissemination of the African snail Lissachatina fulica, an intermediary host of these parasites. The few diagnostic methods for Angiostrongylus spp. are unspecific, costly, and not very sensitive. It is urgent to develop a sensitive, specific and accessible diagnostic tool for the control of human and animal angiostrongyliasis. Objective: To develop a qPCR multiple test to identify the three pathogenic species of Angiostrongylus. Materials and methods: Through a bio-informatic analysis, we selected a sequence of the ITS-2 region of the Angiostrongylus genome to guarantee the specificity of primers and probes. We extracted DNA from adult parasites as positive control, and from larvae using the DNeasy Blood&Tissue® kit. Quantitative PCR reactions were conducted on a Smartcycler Cepheid® thermocycler using a master mix QuantiTect® kit. DNA from human beings, other parasites and the African snail was used as negative control. Results: The threshold cycle values for positive DNA controls were: 21 for Angiostrongylus cantonensis, 22 for A. costaricensis, and 31 for A. vasorum. In negative controls, the threshold cycle was zero. qPCR showed an amplification efficiency of 2 (100%). Conclusions: A multiple qPCR was standardized at the laboratory for three clinically significant species of Angiostrongylus.

Tratamiento quirúrgico de la enfermedad metastasica del síndrome carcinoide: hepatectomía parcial usando un bypass veno-venoso y posterior cambio valvular tricúspide. Reporte de caso / Surgical treatment of carcinoid syndrome metastatic disease: Partial hepatectomy with veno-venous bypass and subsequent tricuspid valve replacement. Case report

Abstract Introduction: Carcinoid syndrome is a relatively rare condition that may affect the liver and the right heart. Some of these cases may require surgical treatment with a multidisci-plinary approach. Case report: We report the case of a patient with progressive dyspnoea, arterial hypotension and facial flushing, diagnosed with liver and cardiac involvement from carcinoid syndrome. The patient was taken to surgery in two different occasions, first for metastatic liver resection, and then to subsequent cardiac surgery for tricuspid valve replacement. Conclusions: We report here a case review, including the clinical course, the intra-operative management, and the information available in the literature regarding which procedure to perform initially in these types of cases which are not very common in clinical practice.

Resumen Introducción: El síndrome carcinoide es una condición relativamente rara que puede afectar el hígado y el corazón derecho. En algunos pacientes se requiere tratamiento quirúrgico y un manejo multidisciplinario. Presentación del caso: Presentamos una paciente con diagnóstico de síndrome carcinoide con compromiso hepático y cardíaco, quien inició con disnea progresiva hasta el reposo, hipotensión arterial y rubor facial. La paciente fue llevada a cirugía en dos tiempos: la resección de las metástasis hepáticas inicialmente y, en un segundo tiempo, cirugía cardíaca para el cambio de la válvula tricúspide. Ambas intervenciones se realizaron con éxito y sin complicaciones. Conclusión: Presentamos aquí una revisión del caso, la evolución y el manejo intraoperatorio y la información disponible en la literatura para decidir qué procedimiento se debe realizar en primera instancia, ya que estos casos no son frecuentes en la práctica clínica.

Evaluación de la técnica modificada de Dennis para el diagnóstico de fasciolosis bovina / Evaluation of modified Dennis parasitological technique for diagnosis of bovine fascioliasis

Introducción. La fasciolosis bovina genera cuantiosas pérdidas económicas, que en Colombia se estiman en COP$12.483 millones anuales, y tiene una prevalencia de 25 % en vacunos lecheros. La enfermedad se diagnostica mediante pruebas parasitológicas. En el país se utiliza la técnica de Dennis modificada en el 2002, pero su sensibilidad, especificidad y validez se desconocen. Objetivo. Evaluar la validez y el desempeño de la técnica modificada de Dennis para el diagnóstico de fasciolosis bovina, usando como prueba de referencia la observación de parásitos en el hígado. Materiales y métodos. Se hizo un estudio de evaluación diagnóstica. Se seleccionaron por conveniencia bóvidos de descarte sacrificados entre marzo y junio de 2013 en Frigocolanta; de cada ejemplar se recolectaron 25 g de heces y se examinaron los conductos biliares y el hígado en busca de Fasciola hepatica . Se estimaron los valores de sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo e índice de validez, con intervalos de confianza de 95 %. Como prueba de referencia se usó la evaluación post mortem. Resultados. Se analizaron 180 bóvidos. La sensibilidad y la especificidad de la técnica modificada de Dennis fueron de 73,2 % (IC 95% 58,4-87,9) y 84,2 % (IC 95% 77,7-90,6), respectivamente. El valor predictivo positivo fue de 57,7 % (IC 95% 43,3-72,1) y el negativo fue de 91,4 % (IC 95% 86,2-96,6). La prevalencia de fasciolosis bovina fue de 22,8 % (IC 95% 16,4-29,2). Conclusión. La validez y el desempeño de la técnica modificada de Dennis fueron superiores a los de la técnica tradicional, por lo que constituye una buena heramienta de tamización para el diagnóstico de la fasciolosis en estudios poblacionales y de prevalencia, así como en jornadas de salud animal.

Introduction: Bovine fascioliasis causes important economic losses, estimated at COP$ 12,483 billion per year; its prevalence is 25% in dairy cattle. Parasitological techniques are required for it diagnosis. The Dennis technique, modified in 2002, is the one used in Colombia, but its sensitivity, specificity and validity are not known. Objective: To evaluate the validity and performance of the modified Dennis technique for diagnosis of bovine fascioliasis using as reference test the observation of parasites in the liver. Materials and methods: We conducted a diagnostic evaluation study. We selected a convenience sample of discarded bovines sacrificed between March and June, 2013, in Frigocolanta for the study. We collected 25 g of feces from each animal and their liver and bile ducts were examined for Fasciola hepatica . The sensitivity, specificity, predictive positive value, predictive negative value, and validity index were calculated with 95% confidence intervals. The post-mortem evaluation was used as the gold standard. Results: We analyzed 180 bovines. The sensitivity and specificity of the modified Dennis technique were 73.2% (95% CI=58.4% - 87.9%) and 84.2% (95% CI= 77.7% - 90.6%), respectively. The positive predictive value was 57.7% (95% CI= 43.3% - 72.1%) and the negative one 91.4% (95% CI= 86.2% - 96.6%). The prevalence of bovine fascioliasis was 22.8% (95% CI= 16.4% - 29.2%). Conclusion: The validity and the performance of the modified Dennis technique were higher than those of the traditional one, which makes it a good screening test for diagnosing fascioliasis for population and prevalence studies and during animal health campaigns.

Evaluation of modified Dennis parasitological technique for diagnosis of bovine fascioliasis.

INTRODUCTION: Bovine fascioliasis causes important economic losses, estimated at COP$ 12,483 billion per year; its prevalence is 25% in dairy cattle. Parasitological techniques are required for it diagnosis. The Dennis technique, modified in 2002, is the one used in Colombia, but its sensitivity, specificity and validity are not known.  OBJECTIVE: To evaluate the validity and performance of the modified Dennis technique for diagnosis of bovine fascioliasis using as reference test the observation of parasites in the liver.  MATERIALS AND METHODS: We conducted a diagnostic evaluation study. We selected a convenience sample of discarded bovines sacrificed between March and June, 2013, in Frigocolanta for the study. We collected 25 g of feces from each animal and their liver and bile ducts were examined for Fasciola hepatica. The sensitivity, specificity, predictive positive value, predictive negative value, and validity index were calculated with 95% confidence intervals. The post-mortem evaluation was used as the gold standard.  RESULTS: We analyzed 180 bovines. The sensitivity and specificity of the modified Dennis technique were 73.2% (95% CI=58.4% - 87.9%) and 84.2% (95% CI= 77.7% - 90.6%), respectively. The positive predictive value was 57.7% (95% CI= 43.3% - 72.1%) and the negative one 91.4% (95% CI= 86.2% - 96.6%). The prevalence of bovine fascioliasis was 22.8% (95% CI= 16.4% - 29.2%).  CONCLUSION: The validity and the performance of the modified Dennis technique were higher than those of the traditional one, which makes it a good screening test for diagnosing fascioliasis for population and prevalence studies and during animal health campaigns.

Bloqueo axilar guiado por ultrasonido y neuroestimulador / Ultrasound and nerve stimulation-guided axillary

Introduction: The axillary block of the brachial plexus is widely used as an anaesthesia and analgesia technique in upper limb surgery, specifically for hand, wrist and forearm procedures. The use of nerve stimulation and ultrasound guidance has increased the rate of success with this block. Objective: This article presents a non-systematic review of the most recent literature on axillary block of the brachial plexus using ultrasound and peripheral nerve stimulation. Materials and methods: A search for a non-systematic review was conducted in the Cochrane, Pubmed/Medline, Embase and OVID databases. Conclusion: The axillary block of the brachial plexus is an anaesthetic and analgesic technique for upper limb surgery that has a high percentage of success, with a low degree of difficulty for the procedure.

Introducción: El bloqueo axilar del plexo braquial es un bloqueo anestésico ampliamente utilizado como técnica anestésica y analgésica en cirugía de miembro superior, específicamente para mano, muñeca y antebrazo. El uso de neuroestimulador y ultrasonido ha aumentado la tasa de éxito de éste bloqueo. Objetivo: El presente artículo hace una revisión no sistemática de la literatura más reciente relacionada con el bloqueo axilar del plexo braquial utilizando ultrasonido y estimulación de nervio periférico. Métodos y Materiales: Se hizo una búsqueda en las bases de datos de Cochrane, Pubmed/Medline, Embase y OVID para la realización de una revisión no sistemática. Conclusión: El bloqueo del plexo braquial a nivel axilar es una técnica anestésica y analgésica para cirugía de miembro superior con alto porcentaje de éxito y bajo grado de dificultad en cuanto a realización del procedimiento.

[Lymnaea cousini , intermediate host of Fasciola hepatica in the Colombian high tropical Andes, and its new haplotypes confirmed with the mitochondrial marker cytochrome oxidase I]. / Lymnaea cousini , huésped de Fasciola hepatica en el trópico alto andino de Colombia, y sus nuevos haplotipos, confirmados con el marcador mitocondrial del gen de la citocromo oxidasa I.

INTRODUCTION: Fasciolosis is the disease transmitted by vectors with the highest latitudinal, longitudinal, and altitudinal distribution due to the colonizing capacity of the parasite Fasciola hepatica and its intermediate hosts, Lymnaeidae mollusks. These snails are under research due to their epidemiological importance, but their taxonomic identification is difficult given their interspecific phenotypical similarity. For this reason, there is uncertainty regarding Lymnaea cousini -a host of F. hepatica in Colombia- due to the morphological similarity it has with Lymnaea meridensis , recently described for Venezuela. OBJECTIVE: To confirm with the COI marker (ADNmt) the taxonomic status of individuals morphologically identified as L. cousini from Nariño, Norte de Santander, and Santander (Colombia), deposited in the Vector Mollusks Collection VHET No. 37 of Universidad de Antioquia. MATERIALS AND METHODS: The amplification of the mitochondrial COI required total DNA extraction of each individual´s foot using the DNeasy Blood and Tissue Kit (Qiagen®). Products amplified were sent for sequencing to Macrogen Inc., Korea. Twenty seven sequences generated in this research were compared to sequences published in the GenBank, including sequences of the type locality of L. cousini . RESULTS: Two new haplotypes of L. cousini were obtained for Colombia. Specimens from Nariño correspond to haplotype A, referenced for Ecuador, and specimens from Santander and Norte de Santander belong to a new haplotype we called haplotype D. CONCLUSION: By using the mitochondrial COI marker, we confirmed that the species under study did correspond to L. cousini . The number of known haplotypes of the species for Colombia has been duplicated and its geographical distribution has been extended to the southwest and northeast of the Colombian high Andean region.

Lymnaea cousini , huésped de Fasciola hepatica en el trópico alto andino de Colombia, y sus nuevos haplotipos, confirmados con el marcador mitocondrial del gen de la citocromo oxidasa I / Lymnaea cousini , intermediate host of Fasciola hepatica in the Colombian high tropical Andes, and its new haplotypes confirmed with the mitochondrial marker cytochrome oxidase I

Institución donde se ejecutó el trabajo: Programa de Estudio y Control de Enfermedades Tropicales, PECET, Unidad de Malacología Médica y Trematodos (UMMT), Sede de Investigación Universitaria, Universidad de Antioquia, Medellín, Colombia Introducción. La fasciolosis es la enfermedad transmitida por vectores con mayor distribución latitudinal, longitudinal y altitudinal, debido a la capacidad colonizadora del parásito Fasciola hepatica y de sus huéspedes intermediarios, los moluscos limneidos. Estos caracoles se investigan por su importancia epidemiológica, pero su identificación taxonómica es difícil por la similitud fenotípica entre especies. En este sentido, con respecto a Lymnaea cousini , un huésped de F. hepatica en Colombia, existe incertidumbre en razón de su similitud morfológica con L. meridensis , descrita recientemente en Venezuela. Objetivo. Confirmar con el marcador del gen de la citocromo oxidasa I en el ADN mitocondrial COI (ADNmt), el estatus taxonómico de ejemplares morfológicamente caracterizados como L. cousini provenientes de Nariño, Norte de Santander y Santander (Colombia), depositados en la Colección de Moluscos Vectores de la Universidad de Antioquia, VHET N° 37. Materiales y métodos. Para la amplificación del COI mitocondrial, se extrajo ADN total del pie de cada ejemplar con el estuche DNeasy Blood and Tissue (Qiagen ® ). Los productos amplificados se enviaron a secuenciar a Macrogen Inc., Corea. Las 27 secuencias generadas en esta investigación se compararon con secuencias publicadas en el GenBank, incluidas las secuencias de la localidad tipo de L. cousini. Resultados. Se encontraron dos nuevos haplotipos de L. cousini para Colombia. Los especímenes de Nariño correspondían al haplotipo A, referenciado en Ecuador, y los especímenes de Santander y Norte de Santander, a un nuevo haplotipo al que se denominó D. Conclusión. Mediante el marcador mitocondrial del COI , se confirmó que los especímenes pertenecían a la especie L. cousini . Con el hallazgo se duplicó el número de haplotipos conocidos de la especie en Colombia y se amplió su distribución geográfica al suroeste y nordeste de la región altoandina colombiana.

Introduction: Fasciolosis is the disease transmitted by vectors with the highest latitudinal, longitudinal, and altitudinal distribution due to the colonizing capacity of the parasite Fasciola hepatica and its intermediate hosts, Lymnaeidae mollusks. These snails are under research due to their epidemiological importance, but their taxonomic identification is difficult given their interspecific phenotypical similarity. For this reason, there is uncertainty regarding Lymnaea cousini -a host of F. hepatica in Colombia- due to the morphological similarity it has with Lymnaea meridensis , recently described for Venezuela. Objective: To confirm with the COI marker (ADNmt) the taxonomic status of individuals morphologically identified as L. cousini from Nariño, Norte de Santander, and Santander (Colombia), deposited in the Vector Mollusks Collection VHET No. 37 of Universidad de Antioquia. Materials and methods: The amplification of the mitochondrial COI required total DNA extraction of each individual´s foot using the DNeasy Blood and Tissue Kit (Qiagen®). Products amplified were sent for sequencing to Macrogen Inc., Korea. Twenty seven sequences generated in this research were compared to sequences published in the GenBank, including sequences of the type locality of L. cousini . Results: Two new haplotypes of L. cousini were obtained for Colombia. Specimens from Nariño correspond to haplotype A, referenced for Ecuador, and specimens from Santander and Norte de Santander belong to a new haplotype we called haplotype D. Conclusion : By using the mitochondrial COI marker, we confirmed that the species under study did correspond to L. cousini . The number of known haplotypes of the species for Colombia has been duplicated and its geographical distribution has been extended to the southwest and northeast of the Colombian high Andean region.

Caracterización del gen mecA de Staphylococcus aureus resistentes a meticilina aislados de tres grupos poblacionales de la ciudad de Medellín / Characterization of mecA gene of methicillin-resistant Staphylococcus aureus Isolated from three population groups in Medellín

Introducción: Staphylococcus aureus resistente a la meticilina (SARM) es responsable de infecciones intrahospitalarias, las que constituyen una importante causa de morbilidad y mortalidad en nuestro medio, por lo cual la rápida identificación y tipificación molecular de la resistencia como el complejo SSCmec es esencial para entender la epidemiología de la infección. Objetivo: Caracterizar fenotípicamente la resistencia a meticilina y genotípicamente el casete cromosomal SSCmec en cepas de S. aureus aislados de individuos de la ciudad de Medellín mediante PCR múltiple. Materiales y métodos: A 41 aislamientos (hospitalarios y de la comunidad) de S. aureus se les estableció la resistencia a cefoxitin mediante la técnica de Kirby-Bauer y la concentración inhibitoria mínima para oxacilina. Mediante PCR convencional se les confirmó la presencia del gen mecA. Para la tipificación del complejo SSCmec se utilizó PCR múltiple para amplificar 6 loci diferentes de este gen. Resultados: A todos los aislamientos se les confirmó resistencia a meticilina y la presencia del gen mecA, de los cuales 17 fueron clasificados como SSC mec I, 1 como SSC mec II, 21 como SSC mecIV; dos aislamientos no fue posible clasificarlos. Conclusiones: Con el uso de esta técnica clasificamos el 95% de los aislamientos del estudio, encontrando una mayor prevalencia de los SSCmec I y IV. La implementación de esta técnica permite una fácil caracterización de los aislamientos SARM y un apropiado manejo de la información de los integrantes de los comités de infecciones hospitalarios, lo cual podría impactar positivamente en el tratamiento a los pacientes y el control de enfermedades infecciosas intrahospitalarias.

Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) is involved in nosocomial infections, representing an important cause of morbidity and mortality. The rapid identification and molecular classification of resistance, such as the SSCmec complex, is essential to understanding the epidemiology of infection. Objective: To phenotypically characterize methicillin resistance and to genotype the SSCmec complex in S. aureus isolates collected from a cohort of patients from Medellín, Colombia. Materials and Methods: Cefoxtin resistance was evaluated in 41 S. aureus isolates, using the Kirby-Bauer method and determining the minimal bactericidal concentration of oxacillin. To confirm the presence of the mecA gene, conventional PCR was performed. The classification of the SSCmec complex was carried out by multiple PCR, amplifying 6 different loci in this gene. Results: Methicillin resistance and the presence of the mecA gene were confirmed in all isolates. A total of 17 were classified as SSCmec I, one as SSCmec II, and 21 SSCmec IV (only two isolates were not classified). Conclusions: Using this method, it was possible to classify 95% of the studied isolates, with a higher prevalence of SSCmec I and IV. The implementation of this technique allows the characterization of MRSA isolates and an appropriate management of the information by the members of the Hospital Infection Committee. Altogether, this method may have a positive impact on the treatment of patients with MRSA infections.

Climate-based risk models for Fasciola hepatica in Colombia.

A predictive Fasciola hepatica model, based on the growing degree day-water budget (GDD-WB) concept and the known biological requirements of the parasite, was developed within a geographical information system (GIS) in Colombia. Climate-based forecast index (CFI) values were calculated and represented in a national-scale, climate grid (18 x 18 km) using ArcGIS 9.3. A mask overlay was used to exclude unsuitable areas where mean annual temperature exceeded 25 °C, the upper threshold for development and propagation of the F. hepatica life cycle. The model was then validated and further developed by studies limited to one department in northwest Colombia. F. hepatica prevalence data was obtained from a 2008-2010 survey in 10 municipalities of 6,016 dairy cattle at 673 herd study sites, for which global positioning system coordinates were recorded. The CFI map results were compared to F. hepatica environmental risk models for the survey data points that had over 5% prevalence (231 of the 673 sites) at the 1 km2 scale using two independent approaches: (i) a GIS map query based on satellite data parameters including elevation, enhanced vegetation index and land surface temperature day-night difference; and (ii) an ecological niche model (MaxEnt), for which geographic point coordinates of F. hepatica survey farms were used with BioClim data as environmental variables to develop a probability map. The predicted risk pattern of both approaches was similar to that seen in the forecast index grid. The temporal risk, evaluated by the monthly CFIs and a daily GDD-WB forecast software for 2007 and 2008, revealed a major July-August to January transmission period with considerable inter-annual differences.

The disease is another: therapeutic itinerary of bovine fascioliosis inRionegro (Antioquia) / La enfermedad es otra: itinerario terapéutico de la fasciolosis bovina enRionegro (Antioquia) / A doença é outra: itinerário terapêutico de fasciolose bovina em Rionegro(Antioquia)

This article presents results of an anthropological research project that was carried out in the municipality ofRionegro in the department of Antioquia, Colombia. The disease caused by hepatic fasciola, a parasite native toEurope, and is now present on every continent and is considered to be the pathogenic disease with the greatestlatitudinal, longitudinal, and altitudinal distribution. There are no specific observable symptoms in infected animals that allow a diagnosis, which must be done in veterinary laboratories, which is scarcely ever the case given that thedisease rarely causes death. Through the use of ethnographic methods the researchers accessed various interlocutors linked to the pecuary field, which relayed their interpretations about bovine fasciolosis and about the common practices dealing with it ranging from lay knowledge to dialogues with expert and professional understanding. Thetext illustrates the therapeutic itinerary that is undertaken when certain changes in behavior and appearance areperceived, it describes the course of action that is followed in order to restore the animals’ health, and it considers the decisions that livestock farmers take when cures fail, all of which are the result of the fact that it is not mandatory to declare bovine fasciolosis. Academics in the field of national veterinary medicine who research the basic aspects related to the parasite’s life cycle are not familiar with the lay knowledge produced about this disease. An analysis of this knoweldge could contribute to the design of control strategies given that it presents in detail the doubts anduncertainties that have historically surrounded fasciolosis. The tendency to conceive it as a “new” disease, and the scarce attention that it has received in comparison with other livestock diseases that are well-defined in sanitation plans work against the control and prevention of fasciolosis in social practices of bovine livestock management inthe area under study.

Se presentan resultados de una investigación antropológica realizada en el municipio de Rionegro, departamentode Antioquia, Colombia. La enfermedad ocasionada por Fasciola hepatica, un parásito originario de Europa, seencuentra en la actualidad en todos los continentes y es considerada la enfermedad patogénica transmitida porvectores de mayor distribución latitudinal, longitudinal y altitudinal. En los animales infectados no se observansíntomas específicos que faciliten el diagnóstico, este debe hacerse en un laboratorio veterinario, al que en muypocas ocasiones se recurre, debido a que la dolencia rara vez causa la muerte. Mediante el método etnográfico los investigadores accedieron a diferentes interlocutores ligados al ámbito pecuario que expresan sus interpretaciones acerca de la fasciolosis bovina y de las prácticas corrientes para enfrentarla desde el conocimiento lego, en diálogo con el conocimiento profesional o experto. El texto ilustra el itinerario terapéutico iniciado al percibir ciertos cambios en el comportamiento y en el aspecto de los animales, describe el curso de acción para restituír la salud de éstos y se detiene en las decisiones que toman los ganaderos ante el fracaso de la cura, todo ello a expensas de que la fasciolosis bovina no constituye una enfermedad de declaración obligatoria.

No presente artigo apresentam-se resultados de uma pesquisa antropológica no município de Rionegro, departamentoou província de Antioquia, Colômbia. A doença produzida pela fasciola hepatica, um parasita originário da Europa,encontra-se atualmente em todos os continentes, sendo considerada uma doença patogênica transmitida por vetores de maior distribuição latitudinal, longitudinal e altitudinal. Nos animais infetados não se observam sintomas específicosque facilitem o diagnóstico, sendo que este dever ser realizado em um laboratório veterinário. Contudo, o diagnóstico é feito com pouca frequência devido a que a doença raramente causa a morte. Mediante o método etnográfico, ospesquisadores entraram em contato com diferentes interlocutores ligados ao âmbito pecuário que expressam suasinterpretações acerca da fasciolose bovina e das práticas mais comuns para enfrentá-la a partir de um conhecimentoleigo que dialoga com o conhecimento profissional ou especializado. Isto tudo à custa do fato de a fasciolose bovina não constituir uma doença que deva ser declarada. Os acadêmicos, no âmbito da medicina veterinária na Colômbia,conhecem os aspectos básicos relacionados com o ciclo de vida do parasita, mas não estão familiarizados como o conhecimento leigo da doença. Um olhar a partir deste aspecto poderia contribuir para a criação de estratégias de controle visto que apresenta, para um público mais amplo, um mundo de dúvidas e incertezas que foi construídohistoricamente em torno da fasciolose. A tendência a concebê-la como uma doença “nova” e a pouca atenção dada,quando comparada com outras doenças do gado definidas nos programas e planos da saúde pública, desfavorecemo controle a prevenção da fasciolose nas práticas sociais de manejo do gado bovino observadas na área de estudo.

Biodiversidad y endemismo de los caracoles terrestres Megalobulimusy Systrophia en la Amazonia occidental / Biodiversity and endemism of the western Amazonia land snails Megalobulimus and Systrophia

En este trabajo realizamos un estudio biogeográfico de dos géneros de caracoles terrestres amazónicos, Megalobulimus (Strophocheilidae) y Systrophia (Scolodontidae). Se utilizaron individuos colectados en diversas localidades de la Amazonia peruana así como información bibliográfica. Se utilizaron los marcadores moleculares 5.8S-ITS2-28S rRNA y 16S rRNA para reconstruir filogenias y obtener hipótesis sobre las relaciones evolutivas entre los géneros amazónicos y otras especies de distribución global. La filogenia nuclear permitió determinar la posición evolutiva de ambos géneros y la filogenia mitocondrial permitió la diferenciación de las especies a nivel intragenérico. Megalobulimus formó parte del clado no-achatinoideo en la filogenia de los gastrópodos Stylommatophora, como lo esperado, pero no pudo ser demostrada su cercanía a la familia Acavidae, mientras que Systrophia quedó fuera de los dos clados establecidos, formando uno basal dentro de los Stylommatophora. El gen mitocondrial 16S rRNA permitió diferenciar a las especies de Megalobulimus, actuando como código de barras de ADN de estos caracoles comestibles. El análisis de distribución geográfica reveló varios endemismos para la Amazonia peruana para especies de ambos géneros, resaltando las unidades biogeográficas de Chanchamayo e Inambari.

In this work we performed a biogeographic study of two genera of Amazonian land snails, Megalobulimus (Strophocheilidae) and Systrophia (Scolodontidae). We used samples from different regions of the Peruvian Amazon, as well as bibliographic information. We analyzed both nuclear (5.8S-ITS2-28S rRNA) and mitochondrial (16S rRNA) genes to reconstruct phylogenies and obtain hypotheses concerning the evolutionary relationships among Amazonian genera and other species with global distribution. The nuclear phylogeny allowed us to determine the evolutionary position of both genera, and the mitochondrial phylogeny permitted the differentiation of species at the intrageneric level. We found that Megalobulimus clustered with the non-achatinoid clade within Stylommatophora, as expected, but its relationship to family Acavidae could not be demonstrated. Systrophiadid not cluster with any of the two established clades, but formed a basal one within Stylommatophora. The mitochondrial gene 16S rRNA allowed us to differentiate Megalobulimus species, and performed well for DNA barcoding of these edible snails. Biogeographical analysis revealed several endemic species in the Peruvian Amazon within both genera, highlighting the Chanchamayo and Inambari biogeographic units.

[Paragonimus sp. in crabs and awareness of the educational community to aquatic ecosystems in La Miel and La Clara, Caldas, Antioquia]. / Paragonimus sp. en cangrejos y sensibilización de la comunidad educativa hacia los ecosistemas acuáticos de La Miel y La Clara, Caldas, Antioquia.

INTRODUCTION: Previous research has demonstrated the presence of Paragonimus spp. in crabs of three municipalities located in the Medellín river basin. To design a plan for the control and prevention of paragonimosis, parasite presence must be demonstrated in the upper area of the river, and an awareness campaign of its risks must involve the participation of the educational community in focusing attention on the local aquatic resources. OBJECTIVE: The presence of Paragonimus spp. metarcercariae was established in freshwater crabs from La Miel and La Clara streams, and an awareness campaign created public awareness to management of the aquatic ecosystems for risk reduction. MATERIALS AND METHODS: Nine crabs were collected from streams of La Miel and La Clara villages in 2007 and 2008. The crabs were indentified, sacrificed in the laboratory and examined for presence of Paragonimus spp. metacercariae. Five workshops were conducted with students of educational institutions of the two villages to improve the student perception of paragonimosis risks associated with the local streams. RESULTS: The crabs were identified as Hypolobocera bouvieri. One crab was found with Paragonimus spp. in La Miel. A mollusk, Aroapyrgus colombiensis, another host of the parasite was found in La Clara. That aquatic ecosystems are a great attraction for the local was well established. CONCLUSIONS: Foci of Paragonimus spp. flatworms are present in the upper area of Medellín river which includes Caldas. However, local school children were uninformed about the risk of paragonimosis associated with the local aquatic ecosystem. Therefore this province must be included in programs for prevention and control of paragonimosis. The prevalence of this disease recommends educational programs that promote awareness of local aquatic ecosystems and their parasitic inhabitants.

Morphological and molecular characterization of Neotropic Lymnaeidae (Gastropoda: Lymnaeoidea), vectors of fasciolosis.

Lymnaeidae play a crucial role in the transmission of fasciolosis, a disease of medical and veterinary importance. In the Neotropic, a region where fasciolosis is emergent, eight Lymnaeidae species are currently considered valid. However, our knowledge of the diversity of this taxon is hindered by the fact that lymnaeids exhibit extremely homogeneous anatomical traits. Because most species are difficult to identify using classic taxonomy, it is difficult to establish an epidemiological risk map of fasciolosis in the Neotropic. In this paper, we contribute to our understanding of the diversity of lymnaeids in this region of the world. We perform conchological, anatomical and DNA-based analyses (phylogeny and barcoding) of almost all species of Lymnaeidae inhabiting the Neotropic to compare the reliability of classic taxonomy and DNA-based approaches, and to delimitate species boundaries. Our results demonstrate that while morphological traits are unable to separate phenotypically similar species, DNA-based approaches unambiguously ascribe individuals to one species or another. We demonstrate that a taxon found in Colombia and Venezuela (Galba sp.) is closely related yet sufficiently divergent from Galba truncatula, G. humilis, G. cousini, G. cubensis, G. neotropica and G. viatrix to be considered as a different species. In addition, barcode results suggest that G. cubensis, G. neotropica and G. viatrix might be conspecifics. We conclude that conchological and anatomical characters are uninformative to identify closely related species of Lymnaeidae and that DNA-based approaches should be preferred.

Paragonimus sp. en cangrejos y sensibilización de la comunidad educativa hacia los ecosistemas acuáticos de La Miel y La Clara, Caldas, Antioquia / Paragonimus sp. in crabs and awareness of the educational community to aquatic ecosystems in La Miel and La Clara, Caldas, Antioquia

Introducción. Estudios previos demostraron la presencia de Paragonimus sp. en cangrejos de tres municipios en la cuenca del río Medellín. Para diseñar un plan para el control y la prevención de la paragonimosis, es necesario determinar la presencia del parásito en la parte alta del río, con la participación de la comunidad educativa, para dirigir su atención hacia el recurso hídrico. Objetivo. Establecer la presencia de metacercarias de Paragonimus sp. en cangrejos de las quebradas La Miel y La Clara, y sensibilizar a la comunidad educativa hacia el manejo adecuado de sus ecosistemas acuáticos. Materiales y métodos. En 2007 y 2008 se recolectaron cangrejos de quebradas de las veredas La Miel y La Clara. En el laboratorio se relajaron y sacrificaron para buscar metacercarias de Paragonimus sp. y determinar la especie. Con estudiantes de instituciones educativas de ambas veredas, se llevaron a cabo cinco talleres lúdicos, para mejorar la percepción de su relación con sus quebradas. Resultados. Se capturaron nueve cangrejos Hypolobocera bouvieri. En La Miel se halló uno con Paragonimus sp. En La Clara se encontró, además, Aroapyrgus colombiensis, molusco huésped del parásito. Con los estudiantes se estableció que los ecosistemas acuáticos ejercen una gran atracción sobre ellos; sin embargo, desconocen los riesgos y no sostienen una relación responsable. Conclusiones. Se señala la presencia de focos de Paragonimus sp. en la parte alta del río Medellín; por lo tanto, el municipio de Caldas debe incluirse en los programas de prevención y control. La población estudiantil requiere nuevos programas educativos para mejorar la interacción con los ecosistemas acuáticos y disminuir el deterioro de su salud.

Introduction. Previous research has demonstrated the presence of Paragonimus spp. in crabs of three municipalities located in the Medellín river basin. To design a plan for the control and prevention of paragonimosis, parasite presence must be demonstrated in the upper area of the river, and an awareness campaign of its risks must involve the participation of the educational community in focusing attention on the local aquatic resources. Objective. The presence of Paragonimus spp. metarcercariae was established in freshwater crabs from La Miel and La Clara streams, and an awareness campaign created public awareness to management of the aquatic ecosystems for risk reduction. Materials and methods. Nine crabs were collected from streams of La Miel and La Clara villages in 2007 and 2008. The crabs were indentified, sacrificed in the laboratory and examined for presence of Paragonimus spp. metacercariae. Five workshops were conducted with students of educational institutions of the two villages to improve the student perception of paragonimosis risks associated with the local streams. Results. The crabs were identified as Hypolobocera bouvieri. One crab was found with Paragonimus spp. in La Miel. A mollusk, Aroapyrgus colombiensis, another host of the parasite was found in La Clara. That aquatic ecosystems are a great attraction for the local was well established. Conclusions. Foci of Paragonimus spp. flatworms are present in the upper area of Medellín river which includes Caldas. However, local school children were uninformed about the risk of paragonimosis associated with the local aquatic ecosystem. Therefore this province must be included in programs for prevention and control of paragonimosis. The prevalence of this disease recommends educational programs that promote awareness of local aquatic ecosystems and their parasitic inhabitants.

Colonización por Staphylococcus aureus en una población de pacientes VIH positivos de la ciudad de Medellín: perfil de sensibilidad antimicrobiana y caracterización de la resistencia a la meticilina / Colonization by Staphylococcus aureus in an HIV-positive patient population of the city of Medellín: antimicrobial susceptibility patterns and characterization of resistance to methicillin

El objetivo del estudio fue determinar prevalencia de colonización nasal por S. aureus, así como el perfil de sensibilidad antimicrobiana, resistencia a meticilina en las cepas aisladas y relación entre el estado de portador, estado inmunológico y administración de antimicrobianos en un grupo de pacientes infectados con el virus de inmunodeficiencia humana (VIH) en la ciudad de Medellín. De esta forma, se tomaron muestras nasales de 151 pacientes ambulatorios VIH positivos. A los aislamientos de Staphylococcus aureus se les evaluó el perfil de sensibilidad antimicrobiana utilizando la técnica de Kirby-Bauer. A los aislamientos resistentes a cefoxitin, se les determinó concentración inhibitoria mínima para oxacilina y vancomicina. A las cepas de S. aureus meticilino resistentes (SARM) se les realizó reacción en cadena de la polimerasa (PCR) para confirmar la presencia del gen MecA. Se encontró una prevalencia de colonización nasal por S. aureus en 37.7% de los pacientes; la colonización por SARM fue 1.9% y por S. aureus sensible a meticilina (SASM) de 35.7%. Los aislamientos SARM se observó sensibilidad para eritromicina 66.6%, clindamicina 100%, gentamicina 100%, tetraciclina 66.6% y vancomicina 100%. La PCR mostró el gen MecA en los aislamientos SARM. Se determinó la prevalencia de colonización por S. aureus en la población estudiada, no se observó relación estadísticamente significativa entre el estado de portador, estado inmunológico, administración de antimicrobianos, períodos previos de hospitalización o sexo en la población estudiada. Los hallazgos microbiológicos se correlacionaron con la presencia del gen Mec A. No se detectaron cepas con sensibilidad disminuida a glicopéptidos ni resistentes a vancomicina.