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Human tuberculosis is still a major world health concern. In Uruguay, contrary to the world trend, an increase in cases has been observed since 2006. Although the incidence of MDR-resistant strains is low and no cases of XDR-TB were registered, an increase in the number of patients with severe tuberculosis requiring critical care admission was observed. As a first aim, we performed the analysis of the genetic structure of strains isolated from patients with severe tuberculosis admitted to an intensive care unit. We compared these results with those corresponding to the general population observing a statistically significant increase in the Haarlem genotypes among ICU patients (53.3% vs 34.7%; p;<;0.05). In addition, we investigated the association of clinical outcomes with the genotype observing a major incidence of hepatic dysfunctions among patients infected with the Haarlem strain (p;<;0.05). The cohort presented is one of the largest studied series of critically ill patients with tuberculosis.

La tuberculosis (TB) aún representa un problema mayor de salud pública. En Uruguay, contrariamente a la tendencia mundial, se ha observado un incremento en el número de casos desde 2006. Aunque la incidencia de casos de multidrogorresistencia (MDR) es baja y no se han reportados casos de resistencia a fármacos de primera y segunda línea de tratamiento (XDR), se ha observado un incremento en el número de casos con TB grave, que requieren internación en unidad de terapia intensiva (CTI). Como primer objetivo del presente trabajo, se analizó la estructura genética de cepas de Mycobacterium tuberculosis aisladas de pacientes internados en CTI. Comparamos estos resultados con los obtenidos con cepas circulantes en la comunidad. Observamos un incremento estadísticamente significativo del genotipo Haarlem en los pacientes internados en CTI (53,3 vs. 34,7%; p;<;0,05). Además, investigamos la asociación del desenlace clínico con el genotipo, y encontramos una mayor incidencia de disfunción hepática en los pacientes infectados con la cepa Haarlem (p;<;0,05). La cohorte presentada en este trabajo corresponde a una de las series con mayor número de pacientes con tuberculosis que requirieron internación en CTI.

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BACKGROUND: Major depressive disorder (MDD) is highly prevalent among medical students (MS). Abuse experiences, as well as stress, are among the factors associated with MDD. However, their association with MDD in MS has been scarcely addressed. METHODS: A cross-sectional study design was used to evaluate the association between MDD and possible risk factors, focusing on current and past abuse experiences inside and outside the academic setting in a large representative MS sample (n = 1,068) using self-report instruments to assess MDD (PHQ-9) and perceived academic stress levels during exam season. RESULTS: Depressive symptom severity directly correlates with levels of perceived academic stress. The prevalence of MDD was 16.2%. A history of emotional abuse during childhood or adolescence, as well as most types of current abuse were associated with MDD. Multiple logistic regression analysis showed that current emotional abuse outside school had the strongest association with MDD in MS, followed by a personal history of depression and suicide attempt, a family history of depression, and perceived academic stress levels. LIMITATIONS: Cross-sectional design, participants represent a specific population, and other variables that could be associated with MDD: comorbid psychiatric disorders, current antidepressant treatment and protective factors (resilience and health-promoting coping strategies) were not evaluated. CONCLUSIONS: MDD is strongly associated with several risk factors that include most types of current and past abuse experiences. Timely identification of individuals at-risk will be critical to establish preventive strategies to limit the impact of MDD in MS and offer prompt therapeutic alternatives when needed.

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Objetivo: estudiar las experiencias vitales y el proceso de adaptación social de las personas mayores que viven en hogares para ancianos. Metodología: estudio cualitativo basado en los procedimientos propios de la teoría fundamentada. El emplazamiento han sido los 6 hogares para ancianos de la comarca de la campiña sur de Córdoba, en el sur de España. Los participantes han sido 16 residentes de estos centros. La recogida de información se ha realizado a través de entrevistas en profundidad. Resultados: la categoría central que emerge de los datos se ha denominado teoría de las "díadas de intercambio": en el seno de los hogares para ancianos se establece una situación de intercambio, en la que la persona mayor cede la totalidad o parte de una serie de cualidades, obteniendo a cambio otras que son características de este tipo de instituciones. Estas cualidades que se intercambian pueden organizarse en forma de díadas, siendo la principal la cesión del poder de decisión, a cambio de la obtención de unas condiciones más óptimas de seguridad, díada a través de la cual, incluso, se puede explicar el proceso de ingreso en la institución.

Objective: To study the life experiences and the process of social adaptation of older people living in nursing homes. Method: A qualitative study based on the procedures of grounded theory. The locations were in the 6 nursing homes in a region of the countryside of Cordoba in southern Spain. The participants were 16 residents of these centers. The collection of information has been carried through in-depth interviews. Results: The main category emerging from the data is called "Exchange Dyads Theory": within nursing homes an exchange situation is established. In this one, the older person yields all or part of a series of qualities, obtaining in return other qualities that are typical of this kind of institution. These qualities that are exchanged can be organize in the form of dyads, being the most important the assignment of decision-making power for obtaining a more optimal safety conditions, dyad through which even can explain the process of admission to the institution.

Objetivo: estudar as experiências vitais e o processo de adaptação social das pessoas idosas que vivem em casas de repouso. Método: estudo qualitativo baseado nos procedimentos próprios da teoria fundamentada. Foram escolhidas seis casas de repouso da comarca da campina sul de Córdoba, no sul da Espanha. Os participantes foram 16 residentes desses centros. A coleta de informação se realizou por meio de entrevistas em profundidade. Resultados: a categoria central que emerge dos dados se denominou Teoria das "Trocas Diádicas": no seio das casas de repouso, estabelece-se uma situação de intercâmbio, na qual a pessoa idosa cede a totalidade ou parte de uma série de qualidades, obtendo em troca outras que são características desse tipo de instituições. Essas qualidades que se intercambiam podem se organizar em forma de díadas, sendo a principal cessão do poder de decisão, em troca da obtenção de umas condições melhores de segurança, díada pela qual, inclusive, pode-se explicar o processo de ingresso na instituição.

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Objetivo: describir que tipo de cuidados y de interacción humana demandan de sus enfermeras las personas mayores que viven en un hogar para ancianos, a partir de la síntesis y el reanálisis de los datos proporcionados por una serie de estudios primarios que han abordado la experiencia de vivir en un hogar para ancianos. Antecedentes: los estudios de tipo cualitativo que han tratado el tema de las experiencias vitales en un hogar para ancianos se han centrado en aspectos como la vida diaria, la calidad de vida, las experiencias de sufrimiento, los cuidados recibidos, la proximidad de la muerte y las relaciones personales. Materiales y métodos: metaestudio cualitativo de tipo análisis de metadatos. Las bases de datos empleadas han sido: ISI Web of Knowledge, CINAHL, EMBASE, LILACS y CUIDEN PLUS. Se han seleccionado 29 estudios. Resultados: las categorías centrales emergentes de los datos han sido: las cualidades personales demandadas al personal cuidador, las intervenciones cuidadoras, la relación personal con los cuidadores y la influencia de la relación persona mayor-cuidador en otros aspectos. Conclusión: con este trabajo hemos pretendido sintetizar las evidencias proporcionadas por una serie de investigaciones primarias tratando de proporcionar un nivel de conocimientos mayor sobre las necesidades de atención de las personas residentes en un hogar para ancianos, siempre a partir de los testimonios, las experiencias y las vivencias de los protagonistas.

Objective: The purpose of the study was to describe the type of care and human interaction required from nurses by elderly persons living in a nursing home, based on a synthesis and reanalysis of data from a number of primary studies on the experience of living in such a facility. Background: Qualitative studies on the experience of living in a nursing home have focused on aspects such as daily life, quality of life, experiences of suffering, the care received, proximity to death and personal relationships. Materials and methods: This is a qualitative meta-study based on meta-data-analysis. ISI Web of Knowledge, CINAHL, EMBASE, LILACS and CUIDEN PLUS were the databases used. Twenty-nine (29) studies were selected. Results: The emerging central data categories were: the personal qualities required of the care-giving staff, the care and attention provided, the personal relationship with caregivers, and the influence the elderly person-caregiver relationship has on other aspects. Conclusion: In synthesizing evidence from by a number of primary studies, this research attempts to provide a higher level of knowledge about the care needs of residents in a nursing home, based invariably on the testimonies, episodes and life experiences of the protagonists.

Objetivo: descrever que tipo de cuidados e de interação humana as pessoas idosas que moram em um lar para anciãos exigem de suas enfermeiras, a partir da síntese e da reanálise dos dados proporcionados por uma série de estudos primários que abordam a experiência de morar em um lar para anciãos. Antecedentes: os estudos de tipo qualitativo que tratam o tema das experiências vitais em um lar para anciãos se centram em aspectos como a vida diária, a qualidade de vida, as experiências de sofrimento, os cuidados recebidos, a proximidade da morte e as relações pessoais. Materiais e métodos: metaestudo qualitativo de tipo análise de metadados. As bases de dados empregadas foram: ISI Web of Knowledge, CINAHL, EMBASE, LILACS e CUIDEN PLUS. Foram selecionados 29 estudos. Resultados: as categorias centrais emergentes dos dados foram: as qualidades pessoais exigidas do pessoal cuidador, as intervenções cuidadoras, a relação pessoal com os cuidadores e a influência da relação pessoa idosa-cuidador em outros aspectos. Conclusão: com este trabalho pretendemos sintetizar as evidências proporcionadas por uma série de pesquisas primárias tentando proporcionar um nível de conhecimentos maior sobre as necessidades de atendimento das pessoas residentes em um lar para anciãos, sempre a partir dos testemunhos, das experiências e das vivências dos protagonistas.

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OBJECTIVE: This study aimed at investigating the significance of the skin-to-skin contact method with fathers, looking at their own experiences with their newborns. METHODS: The information was collected through in-depth interviews with 14 fathers who had used the skin-to-skin contact method with their newborns, after a cesarean delivery. The technique utilized for data analysis was the qualitative method of content analysis. RESULTS: Four principal themes emerged from the data: the preparation for the skin-to-skin method, the experiences of the fathers, the father's role, and effects of the method on the baby. CONCLUSIONS: The investigations performed highlighted the importance of the involvement of health professionals in the use of this method, which leads to a series of positive results for the organization related to satisfaction. We conclude that the skin-to-skin method is a simple technique, recommended for positive results for fathers and their babies.

OBJETIVO: Este estudo tem como objetivo investigar o significado do método "pele a pele" com pais, olhando para as suas próprias experiências com seus recém-nascidos. MÉTODOS: A informação foi coletada a través de "entrevistas em profundidade" em 14 pais que tinham usado o método de "pele a pele", com seus recém-nascidos após um parto por cesariana. A técnica utilizada no análise dos dados foi o método qualitativo de "análise de conteúdo". RESULTADOS: Quatro temas principais emergiram a partir dos dados: a preparação para o método "pele a pele", as experiências dos pais, o papel do pai e os efeitos do método no bebê. CONCLUSÕES: As investigações feitas destacam a importância do envolvimento dos profissionais da saúde na utilização deste método, o qual leva a uma série de resultados positivos para a organização relacionados com a satisfação. Concluímos que o método de "pele a pele" é uma técnica simples e recomendada com resultados positivos também para os pais e os seus bebês.

OBJETIVO: En este estudio se tuvo como objetivo investigar el significado del método "piel a piel" con padres, mirando hacia sus propias experiencias con sus recién nacidos. MÉTODOS: La información fue recolectada por medio de "entrevistas en profundidad" realizada a 14 padres que habían usado el método de "piel a piel", con sus recién nacidos después de un parto por cesárea. La técnica utilizada en el análisis de los datos fue el método cualitativo de "análisis de contenido". RESULTADOS: Emergieron cuatro temas principales a partir de los datos: la preparación para el método "piel a piel", las experiencias de los padres, el papel del padre los efectos del método en el bebé. CONCLUSIONES: Las investigaciones realizadas destacan la importancia del involucramiento de los profesionales de la salud en la utilización de este método, lo cual lleva a una serie de resultados positivos para la organización relacionados con la satisfacción. Concluimos que el método de "piel a piel" es una técnica simple y recomendada con resultados positivos también para los padres y sus bebés.

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Presence and spatio-temporal habitat characterization of Dermatemys mawii (Testudines: Dermatemydidae) in the Grijalva-Usumacinta watershed, Tabasco, Mexico. The Central American River Turtle (Dermatemys mawii) is an endangered species that has been poorly studied. There are no reports on their population status, habitat condition, and the species distribution area is still unknown. This study analyzes the seasonal and spatial variations of their habitat and the presence/absence of D. mawii in three rivers within the Pantanos de Centla Biosphere Reserve (Tabasco, Mexico). For habitat characterization, natural segmentation of rivers was used and three sites per segment were identified, 9 in each rivers (Grijalva and Usumacinta) and 6 in Tabasquillo. Additionally, the evaluation of 11 environmental variables such as water hydrological, physicochemical characteristics and riparian and hydrophytic vegetation were carried out during two different seasons (dry and rainy). The presence/absence of species was assessed with eight fike nets that were set per segment, with a capture effort of 384 hours per trap. The capture per unit effort (CPUE) was used as an indicator of relative abundance. The results indicated spatio-temporal variations in habitat characteristics and the presence of environmental gradients. The principal components analysis (PCA) applied allowed us to determine that the first three components explained 67.8% of the environmental variability. The species presence was confirmed in all rivers, however significant differences exists in their relative abundance: the highest was registered in the Tabasquillo River where the species was present in both seasons and in all segments. Of the 11 environmental variables analyzed, the gradient, shelter and depth were the most indicative of species presence. The obtained results evidenced the importance of riparian vegetation as habitat for Dermatemys. This represents the first approach towards an action plan for a species and its habitat protection within the Pantanos de Centla Biosphere Reserve. Rev. Biol. Trop. 58 (4): 1247-1260. Epub 2010 December 01.

La tortuga centroamericana (Dermatemys mawii) es una especie en peligro de extinción pobremente estudiada. En el presente trabajo se analizaron las variaciones estacionales y espaciales del hábitat y se relacionaron con la presencia/ausencia de D. mawii en tres ríos de la Reserva de la Biosfera Pantanos de Centla (Tabasco, México). Para caracterizar el hábitat se evaluaron 11 variables (hidrológicas, fisicoquímicas del agua y de la vegetación) en dos temporadas (seca y lluviosa). Para determinar la presencia/ ausencia de la especie se colocaron 8 trampas de desvío acuáticas, empleando la captura por unidad de esfuerzo (CPUE) como indicador de la abundancia relativa. Los resultados indicaron variaciones espacio-temporales. El análisis de componentes principales (ACP) permitió determinar la variabilidad ambiental. La presencia de la especie se confirmó en los tres ríos, sin embargo la mayor abundancia relativa se registró en el Río Tabasquillo. Cuatro variables tuvieron el mayor peso como variables predictoras de la presencia de la especie. Con los resultados obtenidos, es evidente la importancia que tiene el ambiente ribereño como hábitat para Dermatemys, asimismo es posible hacer el primer acercamiento a un plan de acción para la protección de la especie y su hábitat en esta reserva.

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We report alopecic syndrome (hair loss in areas of the body, including chest, abdomen, and back) in four frugivorous bat species (Artibeus jamaicensis, Artibeus lituratus, Sturnira lilium, and Sturnira ludovici) within urban and periurban areas of Villahermosa, Tabasco, México, during 2007 and 2008. The overall prevalence of alopecic syndrome was 5.25% (135/2,567 bats). The highest prevalence was found in A. lituratus (5.6%; 62/1,105), followed by A. jamaicensis (5%; 3/1,462). We found a higher prevalence in the dry season, when more than 90% of the alopecic individuals (n=122) were captured. Higher prevalence of alopecia was recorded in urban areas (80% of captured alopecic bats, n=108) than in periurban areas (20%, n=27). Histopathologic studies revealed no evidence of infectious agents. The syndrome may be related to nutritional or endocrinal deficiencies. Spatial and seasonal aggregation in urban areas suggests that anthropogenic activities may interfere with nutritional processes. Further studies are needed to confirm the etiology of the syndrome as well as its impact on population dynamics. This is the first report of alopecic syndrome in sylvatic bats.

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The Central American River Turtle (Dermatemys mawii) is an endangered species that has been poorly studied. There are no reports on their population status, habitat condition, and the species distribution area is still unknown. This study analyzes the seasonal and spatial variations of their habitat and the presence/absence of D. mawii in three rivers within the Pantanos de Centla Biosphere Reserve (Tabasco, Mexico). For habitat characterization, natural segmentation of rivers was used and three sites per segment were identified, 9 in each rivers (Grijalva and Usumacinta) and 6 in Tabasquillo. Additionally, the evaluation of 11 environmental variables such as water hydrological, physicochemical characteristics and riparian and hydrophytic vegetation were carried out during two different seasons (dry and rainy). The presence/absence of species was assessed with eight fike nets that were set per segment, with a capture effort of 384 hours per trap. The capture per unit effort (CPUE) was used as an indicator of relative abundance. The results indicated spatio-temporal variations in habitat characteristics and the presence of environmental gradients. The principal components analysis (PCA) applied allowed us to determine that the first three components explained 67.8% of the environmental variability. The species presence was confirmed in all rivers, however significant differences exists in their relative abundance: the highest was registered in the Tabasquillo River where the species was present in both seasons and in all segments. Of the 11 environmental variables analyzed, the gradient, shelter and depth were the most indicative of species presence. The obtained results evidenced the importance of riparian vegetation as habitat for Dermatemys. This represents the first approach towards an action plan for a species and its habitat protection within the Pantanos de Centla Biosphere Reserve.

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El albinismo es un fenómeno que rara vez se presenta en murciélagos. En México solo se tienen registradas nueve especies de murciélagos en la que se ha documentado esta condición, cinco han presentado albinismo total y las cuatro restantes albinismo parcial. Hasta la fecha el fenómeno de albinismo en el género Glossophaga solo se ha registrado en dos ocasiones a lo largo de todo su rango de distribución. En este estudio presentamos el primer registro de albinismo parcial (pelaje blanco y ojos rojos) de una hembra de Glossophaga soricina registrada en el estado de Tabasco, ubicado al sureste de México. La captura se realizó en una pequeña extensión de cultivo de cacao que se encuentra rodeada por la mancha urbana de la capital del Estado.

The albinism is a phenomenon that rarely occurs in bats. In Mexico only have recorded in nine species of bats that have been documented this condition, five have presented total albinism and the remaining four partial albinism. The phenomenon of albinism in the genera Glossophaga only have recorded in two occasions along all distribution range. In this study we present the first record of partial albinism (white hair and red eyes) from a female of Glossophaga soricina registered in the state of Tabasco, located in the southeast of Mexico. The capture was carried out in a small extension of cocoa (Theobroma cacao) that is surrounded by the urban stain of the capital of the State.

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El albinismo es un fenómeno que rara vez se presenta en murciélagos. En México solo se tienen registradas nueve especies de murciélagos en la que se ha documentado esta condición, cinco han presentado albinismo total y las cuatro restantes albinismo parcial. Hasta la fecha el fenómeno de albinismo en el género Glossophaga solo se ha registrado en dos ocasiones a lo largo de todo su rango de distribución. En este estudio presentamos el primer registro de albinismo parcial (pelaje blanco y ojos rojos) de una hembra de Glossophaga soricina registrada en el estado de Tabasco, ubicado al sureste de México. La captura se realizó en una pequeña extensión de cultivo de cacao que se encuentra rodeada por la mancha urbana de la capital del Estado.

The albinism is a phenomenon that rarely occurs in bats. In Mexico only have recorded in nine species of bats that have been documented this condition, five have presented total albinism and the remaining four partial albinism. The phenomenon of albinism in the genera Glossophaga only have recorded in two occasions along all distribution range. In this study we present the first record of partial albinism (white hair and red eyes) from a female of Glossophaga soricina registered in the state of Tabasco, located in the southeast of Mexico. The capture was carried out in a small extension of cocoa (Theobroma cacao) that is surrounded by the urban stain of the capital of the State.

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