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El tromboembolismo pulmonar es la manifestación más grave de la enfermedad tromboembólica venosa y la tercera causa de mortalidad cardiovascular. Su sintomatología puede ir desde un cuadro asintomático o con síntomas leves, hasta el paro cardiaco. Dentro del enfoque de esta patología es importante tener en cuenta escalas que permiten estimar la probabilidad de que determinado paciente con ciertos signos, síntomas y factores de riesgo presente un tromboembolismo pulmonar, así como escalas diseñadas para valorar el riesgo de morir, en pacientes en los que ya se estableció este diagnóstico. Los pilares del tratamiento son la anticoagulación y la trombólisis, sin embargo, esta última está indicada únicamente en algunos casos. La presente revisión tiene como objetivo presentar una actualización de la evidencia sobre el enfoque diagnóstico y terapéutico del tromboembolismo pulmonar agudo, desde el ingreso del paciente al servicio de urgencias.

Pulmonary embolism is the most severe manifestation of venous thromboembolic disease and the third cause of cardiovascular mortality. Its symptoms can range from asymp-tomatic or mild symptoms to cardiac arrest. The approach to patients with suspected pulmonary embolism includes scores that allow estimating the clinical probability that a certain patient with certain signs, symptoms and risk factors will present a pulmonary thromboembolism, as well as scores that classify patients by severity and risk of hemody-namic decompensation. Treatment is based on anticoagulation and thrombolysis, which is used only in certain patients. The goal of this review is to present updated evidence regarding diagnosis and treatment of acute pulmonary embolism from the moment the patient arrives at the emergency room.

A embolia pulmonar é a manifestação mais grave da doença tromboembólica venosa e a terceira principal causa de mortalidade cardiovascular. Seus sintomas podem variar de sintomas assintomáticos ou leves a parada cardíaca. No enfoque desta patologia, é importante levar em consideração escalas que permitem estimar a probabilidade de um determinado paciente com determinados sinais, sintomas e fatores de risco apresentar tromboembolismo pulmonar, bem como escalas destinadas a avaliar o risco de morrer, em pacientes nos quais esse diagnóstico já foi estabelecido. Os pilares do tratamento são a anticoagulação e a trombólise, porém, esta última está indicada apenas em alguns casos. A presente revisão tem como objetivo apresentar uma atualização das evidências sobre a abordagem diagnóstica e terapêutica do tromboembolismo pulmonar agudo, desde a admissão do paciente no pronto-socorro.

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Knowledge of dispersal and spatial dynamics of pest populations is fundamental for implementation of integrated pest management and integrated resistance management. This study evaluated 1) the effectiveness of egg white albumin protein to mark larvae and adults of two polyphagous and highly mobile pests, Spodoptera frugiperda (J.E. Smith) (fall armyworm) and Helicoverpa zea (Boddie) (corn earworm) (Lepidoptera: Noctuidae), and 2) the sensitivity of polyvinylidene difluoride membrane (dot blot) in detecting albumin on marked insects. Laboratory and field experiments tested egg albumin as a protein marker, which was detected using two enzyme-linked immunosorbent assay (ELISA), microplate, and dot blot. In the laboratory, 100% of the moths sprayed with 20% egg white solution acquired the albumin marker, which was detected through the last time point tested (5 d) after application. Egg albumin was not effective at long-term marking of larvae, detected only prior the molting to the next instar. Albumin application in field cages resulted in a high percentage of moths detected as marked at 24 h and 5 d for both species. Egg albumin applied in the open field resulted in 15% of the recaptured corn earworm moths marked with most of them collected 150 m from the application area, although some were captured as far as 1,600 m within approximately 6 d after adult emergence. The results indicated egg albumin is a suitable marker to study the dispersion of fall armyworm and corn earworm in the agroecosystem and dot blot was as effective to detect egg albumin as was indirect ELISA.

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INTRODUCTION: Bipolar hemiarthroplasty is an alternative for the treatment of displaced femoral neck fractures in elderly patients with low functional demand and associated comorbidities. The goal was to describe functionality in patients over 65 years of age with intracapsular fractures of the hip. MATERIAL AND METHODS: Retrospective review of patients over 65 years of age between January 2012 and May 2017. It was evaluated with the Harris Hip Score (HHS) and Oxford scale at six months and the year after surgery. Complications and mortality were documented during the first post-surgical year. RESULTS: 48 cases (12 men; 36 women), average age of 80.8 ± 7.7 years. Most common diseases: high blood pressure (77.1%), osteoporosis (37.5%), diabetes (33.3%) hypothyroidism (29.2%). The percentage of associated postoperative complications was 8.3% (four cases). The median HHS at six and 12 months was: 90.5 (DE: 77.5-96.0) and 96 (DE: 92-98), respectively. The Oxford scale was 45.5 (DE: 38.5-48.0) at six months and 47.0 (DE: 43.5-48.0) per postoperative year. 4.2% (two cases) died during the first post-surgical year and none were associated with the procedure. DISCUSSION: HA provides good functional outcomes in patients over 65 years of age, with a low rate of complications. No mortality associated with the surgical procedure was observed in our series and in the short term.

INTRODUCCIÓN: La hemiartroplastía bipolar (HA) es una alternativa para el tratamiento de las fracturas desplazadas de cuello femoral en pacientes de edad avanzada con baja demanda funcional y comorbilidades asociadas. El objetivo fue describir la funcionalidad en pacientes mayores de 65 años con fracturas intracapsulares de cadera tratados con HA. MATERIAL Y MÉTODOS: Revisión retrospectiva de pacientes mayores de 65 años entre Enero de 2012 y Mayo de 2017. Se evaluó con la escala de Harris (HHS) y Oxford a los seis meses y al año posterior a la cirugía. Se documentaron las complicaciones y la mortalidad durante el primer año postquirúrgico. RESULTADOS: 48 casos (12 hombres; 36 mujeres), edad promedio de 80.8 ± 7.7 años. Comorbilidades más frecuentes: hipertensión arterial (77.1%), osteoporosis (37.5%), diabetes (33.3%) e hipotiroidismo (29.2%). El porcentaje de complicaciones postoperatorias asociadas fue de 8.3% (cuatro casos). La mediana del HHS a los seis y 12 meses fue de: 90.5 (DE: 77.5-96.0) y 96 (DE: 92-98), respectivamente. La escala de Oxford fue de 45.5 (DE: 38.5-48.0) a los seis meses y de 47.0 (DE: 43.5-48) al año postoperatorio. El 4.2% (dos casos) fallecieron durante el primer año postquirúrgico y ninguno estuvo asociado al procedimiento. DISCUSIÓN: La HA ofrece buenos resultados funcionales en pacientes mayores de 65 años, con una tasa baja de complicaciones. En nuestra serie y en el corto plazo no se observó mortalidad asociada al procedimiento quirúrgico.

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BACKGROUND: We have previously reported that about 30% of patients affected by a new variant of endemic pemphigus foliaceus (EPF) in El Bagre, Colombia (termed El Bagre-EPF or pemphigus Abreu-Manu) have systemic compromise. In the current study, we focused on studying autoreactivity to the kidney and its pathological correlations. AIM: To investigate patients with El Bagre-EPF for renal compromise. METHODS: We performed a case-control study, enrolling 57 patients with El Bagre-EPF and 57 controls from the endemic area, matched by age, sex, race, work activity, demographics and comorbidities. We took skin and renal biopsies; performed direct and indirect immunofluorescence, immunohistochemistry (IHC), confocal microscopy, immunoblotting, direct and indirect immune electron microscopy; and tested kidney function in all living patients. We also used IHC to study seven kidney autopsy samples. RESULTS: Of the 57 patients, 19 had autoantibodies to kidney, with polyclonal reactivity (P < 0.01). Most cases were positive along the basement membrane of the proximal tubules, but in some cases there was also positivity against the glomeruli and/or mixed patterns. Fifteen patients had increases in serum urea and creatinine compared with controls (P < 0.01). The autoantibodies colocalized with commercial antibodies to desmoplakins I and II, p0071, armadillo repeat gene deleted in velo-cardio-facial syndrome (ARCVF) and myocardium-enriched zonula occludens-1-associated protein (MYZAP) (P < 0.01). All of the kidney disease autopsies showed alterations, mostly in the vessels. CONCLUSION: We demonstrate for the first time that one-third of patients with El Bagre-EPF have polyclonal autoantibodies to kidney. The kidneys showed a mixed histological pattern resembling lupus nephritis, with a diffuse proliferative Class IV (G) global diffuse pattern in active lesions, and additional interposition of membranoproliferative glomerulonephritis.

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BACKGROUND: We identified a new variant of endemic pemphigus foliaceus in El Bagre, Colombia, South America, which we term El Bagre-EPF, and observed reactivity to arrector pili muscle (APM), thus we tested for autoimmunity to APM. METHODS: We took skin biopsies from 30 patients with El Bagre-EPF and 30 healthy controls (HCs) matched by age, sex and occupation, who were all from the endemic area, and tested these using direct immunofluorescence (DIF), confocal microscopy, immunohistochemistry and immunoblotting (IB). RESULTS: Of the 30 patients with El Bagre-EPF, 27 had autoantibodies to APM that colocalized with commercial antibodies to myocardium-enriched zonula occludens-1-associated protein (MYZAP), desmoplakin (DP)1 and DP2, plakophilin 4, and Armadillo repeat gene deleted in velo-cardio-facial syndrome (ARVCF) (P < 0.001, Fisher exact test). The positive staining also colocalized with Junctional Adhesion Molecule 1 (JAM-A), a control antibody for gap cell junctions. No HC samples were positive. In 27 of the 30 patients, serum that was APM-positive also displayed IB colocalization of their autoantibody molecular weights with the Progen antibodies (P < 0.001, Fisher exact test). CONCLUSIONS: Patients affected by El Bagre-EPF have autoantibodies to APM, colocalizing with the antibodies MYZAP, ARVCF, p0071, DP1 and DP2, suggesting that these molecules are El Bagre-EPF antigens. Further, all of these antigens represent components of cell junctions, indicating that the immune response is directed, at least partially, against cell junctions. The immune response in patients affected by El Bagre-EPF is polyclonal, and it includes B and T lymphocytes, mast cells, IgG, IgA, IgM, IgD, IgE, fibrinogen, albumin, complement/C1q, C3c and C4.

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The development of a new method to determine the presence of the organoarsenic additives p-arsanilic acid (ASA), roxarsone (ROX) and nitarsone (NIT) in livestock feeds by high performance liquid chromatography coupled to ultraviolet oxidation hydride generation atomic fluorescence spectrometry (HPLC-UV/HG-AFS) after microwave assisted extraction (MAE) was proposed. Chromatographic separation was achieved on a C18 column with 2% acetic acid/methanol (96:4, v/v) as the mobile phase. The limits of detection (LODs) were 0.13, 0.09 and 0.08mgL-1, and the limits of quantification (LOQs) were 0.44, 0.30 and 0.28mgL-1. The relative standard deviations (RSDs) for ASA, ROX and NIT determined from five measurements of the mixed calibration standard were 3.3, 5.3, and 5.4%, respectively. MAE extraction of phenylated arsenic compounds using 1.5M H3PO4 at 120°C for 45min allowed for maximum recoveries (%) of total arsenic (As) and organoarsenic species, with no degradation of these compounds. The extraction of total As was approximately 97%, and the As species recoveries were between 95.2 and 97.0%. The results of the analysis were validated using mass balance by comparing the sum of extracted As with the total concentration of As in the corresponding samples. The method was successfully applied to determine the presence of these compounds in feed samples. ASA was the only As species detected in chicken feed samples, with a concentration between 0.72 and 12.91mgkg-1.

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Las relaciones familiares representan un aspecto importante del apoyo social en la pre-adolescencia y adolescencia inicial, el objetivo del estudio fue determinar la funcionalidad familiar y su relación con las dimensiones afectivas de los estilos de vida en adolescentes escolarizados residentes en la zona urbana del municipio de Villamaría (Caldas-Colombia). Se diseñó un análisis descriptivo correlacional transversal con 809 estudiantes de instituciones públicas y privadas empleando el APGAR familiar ajustado para escolares colombianos y el instrumento FANTÁSTICO, versión chilena adaptada para la población de estudio. Los resultados mostraron 22,2 por ciento de disfunción familiar entre moderada y severa en los adolescentes participantes, se encontraron diferencias significativas entre la edad, el sexo con el funcionamiento familiar (p=0,003; y p=0,001 respectivamente) y una asociación estadísticamente significativa entre el funcionamiento familiar y dimensiones afectivas de los estilos de vida (p<0,05). Los resultados permiten concluir que en la adolescencia el funcionamiento familiar se relaciona directamente con el puntaje de las dimensiones afectivas de los estilos de vida de los adolescentes.

Family relationships signify an important aspect of social support in pre-adolescence and early adolescence; the study objective was to determine the familiar functionality and its relationship with the affective dimensions of the lifestyles in adolescents enrolled in schools living in the urban area of the municipality of Villamaría (Caldas-Colombia). A cross-sectional descriptive correlational analysis with 809 students from public and private institutions was designed, using the familiar APGAR adjusted for Colombian schoolchildren and the instrument FANTÁSTICO, Chilean version adapted for the study of this population. The results showed 22.2 percent of family dysfunction, from moderate to severe in adolescent participants; significant differences were found between age, sex with family functioning (p = 0.003; p = 0.001 respectively) and a statistically significant association between family functioning and emotional dimensions of lifestyle was also found (p <0.05). The results show that in adolescence the family functioning is directly related to the score of the affective dimensions of the lifestyles of adolescents.

As relações familiares são um aspecto importante de apoio social na pré-adolescência e início da adolescência, o objetivo do estudo foi determinar a funcionalidade familiar e sua relação com as dimensões afetivas dos estilos de vida em adolescentes escolares que vivem na área urbana do município Villamaría (Caldas-Colômbia). Uma análise de correlação descritiva transversal com 809 estudantes de instituições públicas e privadas usando o APGAR familiar ajustado para escolares colombianos e o instrumento FANTÁSTICO, versão chilena adaptado para a população do estudo foi projetada. Os resultados mostraram 22,2 por cento de disfunção familiar moderada a grave nos adolescentes participantes, encontraram-se diferenças significativas entre a idade, sexo com o funcionamento familiar (p = 0,003 e p = 0,001, respectivamente) e uma associação estatisticamente significativa entre funcionamento familiar e dimensões afetivas dos estilos de vida (p <0,05). Os resultados permitem concluir que, durante a adolescência, o funcionamento familiar está diretamente relacionado com a contagem das dimensões afetivas dos estilos de vida dos adolescentes.

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OBJETIVOS: establecer la relación entre los determinantes sociales de la salud y la discapacidad en Santiago de Cali. METODOLOGIA: estudio descriptivo correlacional. Se incluyeron para el análisis 38.071 personas registradas en la base de datos del DANE (Cali); la información se procesó en SPSS 19.0: determinantes estructurales, género, edad, nivel educativo, raza, zona de residencia, estrato y determinantes intermedios como trabajo y vivienda; se realizó análisis univariado y bivariado empleando la prueba de x2. RESULTADOS : el 52% de las personas pertenecía al género femenino; el promedio de la edad fue de 48 años +/- 24,1 años y la raza predominante, la mestiza. El 28% de las personas registradas no tenía ningún nivel de estudio; un 76% de las personas pertenecen a estratos 1 y 2. El 100% tienen al menos una deficiencia y una discapacidad y el 25% presentan restricción en la participación. El género femenino presenta menos restricción en la participación, comparado con el masculino (71,2% y 66,8% respectivamente). Se encontró asociación entre los determinantes sociales estructurales e intermedios y la restricción en la participación p < 0,05. CONCLUSIONES :existe interacción de los determinantes sociales de la salud, como género, educación, empleo, barreras arquitectónicas y servicios de salud, entre otros, con la restricción en la participación.

OBJECTIVE:Establish the relationship between social determinants of health and disability in Santiago de Cali. METHODOLOGY A correlational descriptive study. For analysis were included a total of 38,071 people registered DANE database (Cali). The information was processed using SPSS 19.0. Structural Determinants gender, age, education, race, area of residence, and intermediate stratum jobs, housing, was performed using univariate and bivariate X2 test. RESULTS : It was established that 52% reviewed belonged to females, the average age 48 years + / - 24.1 years, the predominant race is mestizo and the 28% of respondents said they haven't done any level of studies. The 100% of respondents have at least one impairment or disability and the 25% have social participation restriction. The female has less restriction in social participation compared to male (71.2% vs. 66.8%) CONCLUSIONS : athere is an association between structural social determinants and intermediate and participation restriction p < 0,05. Conclusions: There is interaction of the Social Determinants of Health as gender, education, employment, architectural barriers, health services, and others with the participation restriction.

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Transgenic maize, Zea maize L., expressing the Cry1F protein from Bacillus thuringiensis has been registered for Spodoptera frugiperda (J. E. Smith) control since 2003. Unexpected damage to Cry1F maize was reported in 2006 in Puerto Rico and Cry1F resistance in S. frugiperda was documented. The inheritance of Cry1F resistance was characterized in a S. frugiperda resistant strain originating from Puerto Rico, which displayed >289-fold resistance to purified Cry1F. Concentration-response bioassays of reciprocal crosses of resistant and susceptible parental populations indicated that resistance is recessive and autosomal. Bioassays of the backcross of the F1 generation crossed with the resistant parental strain suggest that a single locus is responsible for resistance. In addition, cross-resistance to Cry1Aa, Cry1Ab, Cry1Ac, Cry1Ba, Cry2Aa and Vip3Aa was assessed in the Cry1F-resistant strain. There was no significant cross-resistance to Cry1Aa, Cry1Ba and Cry2Aa, although only limited effects were observed in the susceptible strain. Vip3Aa was highly effective against susceptible and resistant insects indicating no cross-resistance with Cry1F. In contrast, low levels of cross-resistance were observed for both Cry1Ab and Cry1Ac. Because the resistance is recessive and conferred by a single locus, an F1 screening assay was used to measure the frequency of Cry1F-resistant alleles from populations of Florida and Texas in 2010 and 2011. A total frequency of resistant alleles of 0.13 and 0.02 was found for Florida and Texas populations, respectively, indicating resistant alleles could be found in US populations, although there have been no reports of reduced efficacy of Cry1F-expressing plants.

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El nódulo de la Hermana María José se refiere a una metástasis de una neoplasia visceral a ombligo más común de origen gastrointestinal. La importancia de esta lesión es que es de fácil aproximación por el examen físico y su alta asociación con neoplasias malignas intra abdominales y la sencillez para hacer el diagnóstico con métodos como la biopsia aspiración con aguja fina.

Sister Mary Joseph's nodule refers to the metastasis of visceral malignancy to the umbilicus, most commonly of gastrointestinal origin. The noteworthy characteristics of this lesion are its more approachable diagnosis on physical examination, its high association with intra-abdominal malignancy, and its faculty to provide a diagnosis with easily performed methods such as fine needle aspiration biopsy.

O nódulo da irmã Maria José se refere como uma metástase de uma neoplasia visceral a umbigo mais comum de origem gastrointestinal. A importância desta lesão é que é de fácil aproximação pelo exame físico, e sua alta associação com neoplasias malignas intra abdominais e a facilidade para realizar o diagnostico com métodos fáceis de realizar como a biopsia aspiração com agulha fina.

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El objetivo de la investigación es describir la experiencia de sufrimiento de los cuidadores informales de pacientes con dolor oncológico y no oncológico de tres instituciones de salud de Medellín. Es una investigación cualitativa de tipo fenomenológico. La muestra estuvo conformada por 16 cuidadores de pacientes con dolor oncológico y no oncológico. La información se recolectó a través de una entrevista semiestructurada y se cuantificó el nivel de sufrimiento por medio del termómetro emocional como complemento al enfoque cualitativo. Los datos obtenidos se analizaron por medio de categorías y perfiles previamente definidos, lo cual dio cuenta del significado, el nivel y los factores de sufrimiento más comunes en los cuidadores entrevistados.Los resultados evidenciaron que la mayoría de los cuidadores experimentaron altos niveles de sufrimiento. Reportaron sentimientos de tristeza y satisfacción contradictoriamente. En la esfera cognitiva, asociaron el sufrimiento con dolor y con el hacer bien su actividad; y en el área conductual, refirieron que el sufrimiento se relacionaba con la dificultad para el control de los síntomas físicos del paciente, y con el aplazamiento de actividades propias de su vida.En conclusión, el apoyo psicosocial recibido por los cuidadores no fue percibido como factor protector para la disminución del sufrimiento; el tipo de dolor estaba relacionado con la experiencia de sufrimiento y el rol de cuidadores, quienes en su mayoría eran mujeres cuidadoras de pacientes con dolor oncológico. Los cuidadores entrevistados estaban en riesgo de presentar Burnout debido a las múltiples demandas propias de su rol.

The purpose of the study is to describe the experience of suffering among informal care takers of patients with cancer-pain and non-cancer pain at three health institutions of Medellín-Colombia.It is a qualitative study of phenomenological type. The sample consisted of 16 care takers of patients who suffered cancer-pain and non-cancer pain. The information was gathered through a semi-structured interview, the level of suffering was quantified through the emotional thermometer as a complementing element to the qualitative approach. The data obtained were analyzed through categories and profiles previously defined which showed the most common meaning, level and factors of suffering among the interviewed care takers.The results showed that the majority of care takers experienced high levels of suffering. They reported feelings of sadness and satisfaction in a contradictory manner. In the cognitive realm, they associated suffering with pain and the good execution of their activity; in the behavioral field, they expressed that suffering was related to the difficulty in controling the patient’s physical symptoms, and with the deferral of their own life activities.In conclusion, the psychological support received by the care takers was perceived as a protecting factor to reduce suffering; the type of pain was related to the experience of suffering and the care taker’s role, who were mostly female care takers of patients with cancer pain. The interviewed care takers were at risk of presenting Burnout due to the multiple demands inherent to their role.

A pesquisa visa descrever a experiência de sofrimentos dos cuidadores informais de pacientes com oncológica e não oncológica em três instituições de saúde em Medellín.É uma pesquisa qualitativa de tipo fenomenológico. A amostra esteve conformada por 16 cuidadores de pacientes com dor oncológica e não oncológica. A informação foi coletada através de uma entrevista semi-estruturada e se quantificou o nível de sofrimento por meio do termômetro emocional como complemento à abordagem qualitativa. Os dados obtidos foram analisados mediante categorias e perfis previamente definidos que dão conta do significado, do nível e dos fatores de sofrimento mais comuns nos cuidadores entrevistados.Os resultados evidenciaram que os níveis de sofrimento na maioria dos cuidadores eram altos. Também, observaram-se sentimentos contraditórios de tristeza e satisfação. No âmbito cognitivo, associaram o sofrimento com dor e com o fato de fazerem bem sua atividade; e na parte comportamental apontaram que o sofrimento estava ligado à dificuldade para controlar os sintomas físicos do paciente, e com o adiamento de atividades próprias de sua vida.Em conclusão, o apoio psicossocial recebido pelos cuidadores não foi percebido como fator protetor para a diminuição do sofrimento; o tipo de dor estava relacionado com a experiência de sofrimento e o papel de cuidadores, que eram maiormente pacientes com dor oncológica. Os cuidadores entrevistados estavam em risco de apresentar Burnout por causa das múltiples demandas de sua função.

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The aim of this study was to evaluate the effectiveness of physiotherapy to improve the head posture and reduce the signs of bruxism in a group of bruxist children. A single-blind randomized clinical trial was performed. All the subjects were 3- to 6-year old, had complete primary dentition, dental and skeletal class I occlusion and were classified as bruxist according to the minimal criteria of the ICSD for bruxism. For each child, a clinical, photographic and radiographic evaluation of the head and cervical posture were realized with standardized techniques. The children were randomized in an experimental (n = 13) and a control (n = 13) group. A physiotherapeutic intervention was applied to the children of the experimental group once a week, until 10 sessions were completed. Afterwards, the cephalogram and the clinical and photographic evaluation of the head posture were measured again. The data were analysed with the t-test and Mann-Whitney test. The subjects of the experimental group showed statistically significant improvement in the natural head posture. The physiotherapeutic intervention showed to be efficient to improve the head posture at the moment of measurement in the studied children. The relationship between bruxism and head posture, if exists, seems to be worthwhile to examine.

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UNLABELLED: The aim of the present study was to compare the head position and dental wear of bruxist and non-bruxist children with primary dentition. METHODS: All the subjects had complete primary dentition, dental and skeletal class I occlusion and were classified as bruxist or non-bruxist according to their anxiety level, bruxism described by their parents and signs of temporomandibular disorders. The dental wear was drawn in dental casts and processed in digital format. Physiotherapeutic evaluation and a cephalometric radiograph with natural head position were also performed for each child to evaluate the cranio-cervical position for the bruxist group (n = 33) and the control group (n = 20). The variables of the two groups were compared, using the Student t-test and Mann-Whitney U-test. RESULTS: A more anterior and downward head tilt was found in the bruxist group, with statistically significant differences compared with the controls. More significant dental wear was observed in the bruxist children. CONCLUSIONS: Bruxism seems to be related to altered natural head posture and more intense dental wear. Further studies are necessary to explore bruxism mechanisms.

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El presente artículo llama la atención sobre la importancia de incorporar una nueva área del saber en los planes de estudio de las facultades de la salud que integre campos como el de la ciencia política, las políticas públicas y la gestión de las políticas públicas. Si se parte de un proceso salud enfermedad de carácter dinámico, influenciado por una amplia gama de factores: sociales, ambientales, económicos, culturales y políticos, entre otros y entendiendo el problema de salud-enfermedad como un proceso social, se evidencia la necesidad de una reconceptualización en el saber de las profesiones de la salud. Hoy en día es imperativo asumir otros papeles de liderazgo social en los diferentes ámbitos, se requiere liderazgo en la formulación, implementación y en la evaluación de políticas, que incidan positivamente en el bienestar de los ciudadanos, políticas públicas que a su vez impacten positivamente el sector salud y que fijen reglas claras por parte de las autoridades gubernamentales en torno al alcance de metas de universalidad, equidad y calidad, propósitos explícitos del sistema general de seguridad social actual y en general de las reformas de salud que se implementan en los diferentes países. El tema de la ciencia política y su expresión más real, el de las políticas públicas como evidencia del accionar del Estado, es actualmente campo de interés de muchas profesiones: las económicas, las ciencias jurídicas, las sociales y desde luego deben serlo en las áreas de la salud. El campo es de interés además en las agendas de investigación en sistemas y servicios de salud así como, en las políticas de ciencia y tecnología. Resulta entonces necesario que se abran espacios currículares desde la docencia, la investigación y la proyección que impulsen la discusión en torno a este tipo de temáticas. El artículo presenta los conceptos básicos de la ciencia política, la política como conjunto de prácticas, hechos, instituciones y determinaciones del gobierno de un estado o de una sociedad, su relación con las políticas públicas entendidas como programas de acción del Estado y las políticas en salud y, cómo este tipo de saberes debe introducirse en las discusiones académicas e investigativas de las profesiones de la salud de tal manera,que se brinden herramientas a los futuros profesionales para ser 26gestores y líderes en la formulación, implementación y evaluación de políticas públicas que incidan en metas de mejoramiento de la calidad de vida de la población

The present article calls the attention on the importance of incorporating a new area of knowledge in the study plans of health faculties by integrating fields such as political science, public policies and public policies management. Starting from a health-disease process of dynamical character, influenced by a wide scale of social, environmental, economic, cultural and political factors, among others, and understanding the problem of health-disease as a social process, the need of a reconceptualization in the knowledge of health professions arises. Nowadays, it is imperative to assume other roles of social leadership in different areas; leadership is needed in the formulation, implementation and evaluation of policies that positively affect the well-being of citizens. These are public policies that also have a constructive influence on the health sector and that fix clear rules on behalf of the governmental authorities concerning the scope of goals of universality, equity and quality, explicit intentions of the general system of current social safety and of the general health reforms that are implemented in different countries. The topic of political science and its most real expression, public policies as evidence of the State's gesticulation, is nowadays a field of interest of many professions: economical ones, juridical sciences, social professions and certainly they must be in health areas. The field is also of interest in the investigation agendas in health systems and services, as well as in science and technology policies. It is necessary then, that curricular spaces are opened from the teaching, investigation and projection areas, in order to stimulate discussion concerning this kind of subjects. The article presents the basic concepts of political science; politics as a set of practices, facts, institutions and determinations of the government of a state or a society; its relation to public policies, understood as action programs of the State and the health politics; and, since this type of knowledge must be entered in the academic and investigative discussions of health professions, tools must be offered to future professionals so that they can become agents and leaders in the formulation, implementation and evaluation of public policies that affect the goals to improve the population's quality of life

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Se presenta el caso de una paciente de 36 años quien presenta múltiples lesiones óseas líticas multifocales, cuyo diagnóstico definitivo fue difícil desde los puntos de vista clínico, radiológico y patológico. Debido a los pocos casos reportados de angiomatosis esquelética, se hace una corta revisión de los aspectos generales, clínicos e imaginológicos

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Introducción: Las infecciones por bacterias Gram-positivas multirresistentes han aumentado en los últimos años en Colombia y en el mundo. Quinupristin / Dalfopristin (Q/D, Synercid), un antibiótico de la familia de las estreptograminas, ha demostrado una potenta actividad in vitro e in vivo contra estos gérmenes. Objetivos: determinar en nuestro medio kla actividad in vitro de Q/D en aislamientos hospitalarios de cocos Gram-positivos y Haemophilus influenzae, y compararla con la de otros antibióticos usados en estas circunstancias. Diseño: estudio de sensibilidad in vitro por Concentración Inhibitoria Miníma (CIM) a través del método de microdilución en caldo. Lugar: Corporación para Investigaciones Biológicas (CIB). Población del Estudio: cien aislamientos hospitalarios, distribuídos así: Staphylococcus aureus resistente a meticilina -SARM -(n=25), estafilococo coagulasa - negativa resistente a meticilina -ECNRM - (n=25) Enterococcus spp (n=20). Resultados: Q/D se mostró altamente eficaz en los aislamientos de SARM (S = 100 por ciento), S. pneumoniae (S 0 100 por ciento), S. viridans (CIM subíndice 90 = 0.25 amstrong /mL) y H influenzae (CIM subíndice 90) = 1.0 amstrong /mL) Su actividad frente a ECNRM fue aceptable (S = 72 por ciento) y mala contra E. faecalis (S = 0 por ciento). Vancomicina, rifampicina y ceftriaxona tuvieron 100 por ciento de actividad en las especies en las cuales se probaron. Conclusiones: Q/D (Synercid) fue efectivo in vitro contra la mayoría de los cocos Gram-positivos de origen hospitalario, excepto E. faecalis. es pues una buena alternativa en infecciones producidas por estos gérmenes, especialmente si son multirresistentes, y cuando se presentan reacciones adversas a otros fármacos.

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El carcinoma papilar del tiroides, variante de celulas altas, fue descrito en 1976 como un tumor agresivo, con una incidencia de recurrencia y mortalidad mayor que la variante usual. Ocurre entre el 7 y el 9.1 por ciento del total de los carcinomas papilares, pero no es frecuentemente descrito en los estudios de carcinomas tiroideos bien diferenciados. Presentamos 1 caso en una mujer de 55 años, con un tumor de esta variante con un comportamiento agresivo y hacemos una revision de la literatura reciente sobre esta neoplasia.

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OBJECTIVES: A Centers for Disease Control and Prevention deviation bar chart (Statistical Software for Public Health Surveillance) and laboratory-based surveillance data were evaluated for their utility in detecting dengue outbreaks in Puerto Rico. METHODS: A significant increase in dengue incidence was defined as an excess of suspected cases of more than 2 SDs beyond the mean for all 4-week periods from April through June (the period of lowest seasonal incidence), 1989 through 1993. An outbreak was defined as a cumulative annual rate of reported dengue greater than 3 per 1000 population. RESULTS: Retrospective application of the system to 1994 data showed agreement with previous analyses. In 1995 and 1996, 36.4% and 27.3%, respectively, of municipalities with a significant increase in reports for 2 or more consecutive weeks before the first week of September had an outbreak, compared with 9.0% (in 1995, P = .042) and 6.0% (in 1996, P = .054) of towns without a significant increase. The system showed sensitivity near 40%, specificity near 89%, and accuracy in classifying municipalities near 84%. CONCLUSIONS: This method provides a statistically based, visually striking, specific, and timely signal for dengue control efforts.

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