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INTRODUCTION: Outcomes of human immunodeficiency virus (HIV) infected patients admitted to intensive care units (ICU) have improved with antiretroviral therapy (ART). However, whether the outcomes have improved in low- and middle-income countries, paralleling those of high-income countries is unknown. The objective of this study was to describe a cohort of HIV-infected patients admitted to ICU in a middle-income country and identify the risk factors associated with mortality. METHODOLOGY: A cohort study of HIV-infected patients admitted to five ICUs in Medellín, Colombia, between 2009 and 2014 was done. The association of demographic, clinical and laboratory variables with mortality was analyzed using a Poisson regression model with random effects. RESULTS: During this time period, 472 admissions of 453 HIV-infected patients were included. Indications for ICU admission were: respiratory failure (57%), sepsis/septic shock (30%) and central nervous system (CNS) compromise (27%). Opportunistic infections (OI) explained 80% of ICU admissions. Mortality rate was 49%. Factors associated with mortality included hematological malignancies, CNS compromise, respiratory failure, and APACHE II score ≥ 20. CONCLUSIONS: Despite advances in HIV care in the ART era, half of HIV-infected patients admitted to the ICU died. This elevated mortality was associated to underlying disease severity (respiratory failure and APACHE II score ≥ 20), and host conditions (hematological malignancies, admission for CNS compromise). Despite the high prevalence of OIs in this cohort, mortality was not directly associated to OIs.

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The 1,3 dipolar cycloaddition reactions of münchnones and alkenes provide an expedite synthetic way to substituted pyrroles, an exceedingly important structural motif in the pharmaceutical and material science fields of research. The factors governing their regioselectivity rationalization are not well understood. Using several approaches, we investigate a set of 14 reactions (featuring two münchnones, 12 different alkenes, and two alkynes). The Natural Bond Theory and the Non-Covalent Interaction Index analyses of the noncovalent interaction energies fail to predict the experimental major regioisomer. Employing global cDFT descriptors or local ones such as the Fukui function and dual descriptor yields similarly inaccurate predictions. Only the local softness pairing, within Pearson's Hard and Soft Acids and Bases principle, constitutes a reliable predictor for the major reaction product. By taking into account an estimator for the steric effects, the correct regioisomer is predicted. Steric effects play a major role in driving the regioselectivity, as was corroborated by energy decomposition analysis of the transition states.

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Visceral leishmaniasis (VL) is a fatal disease caused by the protozoa Leishmania infantum for which dogs are the main reservoirs. A vaccine against canine visceral leishmaniasis (CVL) could be an important tool in the control of human and CVL by reducing the infection pressure of L. infantum. Despite the CVL vaccine available on the market, the Brazilian Ministry of Health did not implement the use of it in their control programs. In this sense, there is an urgent need to develop more efficient vaccines. In this study, the association between two polymeric nanoformulations, (poly (D, L-lactic) acid (PLA) polymer) loading Leishmania amazonensis antigens, was evaluated as a potential immunobiological agent against VL using golden hamsters as an experimental model. The results indicated that no significant adverse reactions were observed in animals vaccinated with LAPSmP. LAPSmP presented similar levels of total anti-Leishmania IgG as compared to LAPSmG. The LAPSmP and LAPSmG groups showed an intense reduction in liver and spleen parasitic load by qPCR. The LAPSmP and LAPSmG vaccines showed exceptional results, indicating that they may be promising candidates as a VL vaccine.

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Imaging-guided tendon procedures aim to reduce pain and increase function by controlling inflammation and stimulating healing. Ultrasound is the preferable guiding modality due to its high resolution and real-time demonstration of the tendinous anatomy and needle positioning. The technique includes appropriate patient positioning, which varies depending on the targeted tendon, as well as sterile and proper draping. For most procedures, we prefer the "in-plane" approach, which demonstrates the entire needle as it advances through different tissue layers. Upper limb injections commonly use corticosteroids and anesthetics with different reported short- and long-term results depending on the tendon treated; better results are obtained in the treatment of tenosynovitis (sliding tendons such as trigger finger and De Quervain's tenosynovitis). Shoulder and elbow tendinopathies (anchor tendons) may also benefit from injections containing irritants or healing stimulants such as dextrose (prolotherapy) and platelet-rich plasma or by the stimulation of healing via tendon perforations (fenestration). The hyaluronic acid injection has also been used in the treatment of both tenosynovitis and tendinopathies. For tendons passing through osteofibrous tunnels, an additional release may be performed, and the techniques are discussed in this review. Therefore, this article provides practicing musculoskeletal radiologists and trainees with a comprehensive review of tendon injection musculoskeletal image-guided procedures.

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Leishmaniasis is a widespread vector-borne disease in Brazil, with Leishmania (Leishmania) infantum as the primary etiological agent of visceral leishmaniasis (VL). Dogs are considered the main reservoir of this parasite, whose treatment in Brazil is restricted to the use of veterinary medicines, which do not promote a parasitological cure. Therefore, efficient vaccine development is the best approach to Canine Visceral Leishmaniasis (CVL) control. With this in mind, this study used hamsters (Mesocricetus auratus) as an experimental model in an anti-Leishmania preclinical vaccine trial to evaluate the safety, antigenicity, humoral response, and effects on tissue parasite load. Two novel formulations of nanoparticles made from poly(D, L-lactic) acid (PLA) polymer loading Leishmania braziliensis crude antigen (LB) exhibiting two different particle sizes were utilized: LBPSmG (570 nm) and LBPSmP (388 nm). The results showed that the nanoparticles were safe and harmless to hamsters and were antigenic with the induction in LBSap, LBPSmG, and LBPSmG groups of total anti-Leishmania IgG antibodies 30 days after challenge, which persists 200 days in LBSap and LBPSmP. At the same time, a less pronounced hepatosplenomegaly in LBSap, LBPSmG, and LBPSmP was found when compared to control groups, as well as a less pronounced inflammatory infiltrate and granuloma formation in the spleen. Furthermore, significant reductions of 84%, 81%, and 90% were observed in spleen parasite burden accessed by qPCR in the LBSap, LBPSmG, and LBPSmP groups, respectively. In this way, LBSap, LBPSmG, and LBPSmP formulations showed better results in vaccinated and L. infantum-challenged animals in further reducing parasitic load in the spleen and attenuating lesions in liver and splenic tissues. This results in safe, harmless nanoformulation vaccines with significant immunogenic and infection control potential. In addition, animals vaccinated with LBPSmP had an overall reduction in parasite burden in the spleen, indicating that a smaller nanoparticle could be more efficient in targeting antigen-presenting cells.

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Colorectal cancer is one of the most common malignant neoplasms worldwide. Overall mortality is 33%. Synchronous colorectal cancer refers to more than one malignant tumor detected in different segments of the colon, simultaneously or within 6 months of initial diagnosis. The development of colorectal cancer is a multistep process that originates with a genetic mutation leading to a malignant phenotype and generating a growth advantage. Colorectal cancer presents up to 16% of hypermutations, of which 75% are characterized by microsatellite instability which in turn leads to poorer cell differentiation. Patients with synchronous tumors appear to have a higher proportion of microsatellite instability than patients with single tumors. The clinical case of a 35-year-old man with a perforated left colon tumor and a locally advanced synchronous tumor of the right colon and signs of acute abdomen is presented. The treatment should be based on the location of the synchronous tumors, stage at the time of approach, and the patient's condition. However, when faced with a complication secondary to colonic cancer, adhering to the principles of oncological surgery can be overcome by the nature of the emergency.

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INTRODUCCIÓN: el agua de los lagos volcánicos no es estéril, en ella se ha adaptado a través de milenios una microbiota con diversas capacidades metabólicas. La diversidad microbiana de los lagos volcánicos en Ecuador ha sido poco estudiada y aún se desconoce su abundancia y riqueza. OBJETIVO: el objetivo del presente estudio fue conocer la calidad microbiológica del agua del lago Quilotoa, situado en la Provincia de Cotopaxi-Ecuador. MATERIALES Y METODOS: se realizaron dos muestreos durante el año 2019, recolectando un total 32 muestras. La calidad microbiológica se cuantifico utilizando la técnica de filtración por membrana en agar R2A para bacterias heterótrofas, agar eosina azul de metileno para coliformes, agar manitol salado para Staphylococcus, agar cetrimide para Pseudomonas y agar Sabouraud con cloranfenicol para hongos. RESULTADOS: los resultados promedios fueron para bacterias heterótrofas de 2,00 x 102 UFC/mL; Pseudomonas 7,00x 10 UFC/mL, Staphylococcus 3,80 x 10 UFC/mL y hongos 1,40 x 10 UFC/mL. No se detectó la presencia de bacterias coliformes. CONCLUSIONES: los grupos microbianos presentes en bajo número son indicativos de una microbiota característica adaptada a las condiciones fisicoquímicas de este lago. Se concluye que se trata de un lago con una población microbiana escasa lo que indicaría una buena calidad microbiológica.

INTRODUCTION: the water of volcanic lakes is not sterile, native microbiota shows different metabolic capabilities established over millennia. The microbial diversity of volcanic lakes in Ecuador have been little studied and their abundance and richness are still unknown. OBJECTIVE: the objective of this study was to know the microbiological quality of water of Lake Quilotoa, located in the Province of Cotopaxi-Ecuador. MATERIALS AND METHODS: two samplings were carried out during 2019, collecting a total of 32 samples. Microbiological quality was quantified using the membrane filtration technique on R2A agar for heterotrophic bacteria, eosin blue methylene agar for coliforms, salty mannitol agar for Staphylococcus, cetrimide agar for Pseudomonas and Sabouraud agar with chloramphenicol for fungi. RESULTS: the average results were for heterotrophic bacteria 2.00 x 102 CFU/mL, Pseudomonas 7.00 x 10 CFU/mL, Staphylococcus 3.80 x 10 CFU/mL and fungi 1.40 x 10 CFU/mL. The presence of coliform was not detected. CONCLUSIONS: the microbial groups present in low numbers are indicative of a characteristic microbiota adapted to the physicochemical conditions of this lake. It is concluded that it is a lake with a few microbial populations, which might indicate a good microbiological quality.

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BACKGROUND: Tick-borne phenuivirus (TBPVs) comprise human and animal viruses that can cause a variety of clinical syndromes ranging from self-limiting febrile illness to fatal haemorrhagic fevers. OBJECTIVE: Detect Phlebovirus (Family Phenuiviridae) in ticks collected from domestic animals in Córdoba, Colombia. METHODS: We collected 2365 ticks from domestic animals in three municipalities of the Department of Cordoba, Colombia in 2016. Ticks were identified and pooled by species for RNA extraction. A nested real-time PCR with specific primers for Phlebovirus and a specific probe for Heartland virus (HRTV) formerly a Phlebovirus, now a Banyangvirus were performed. Also, a conventional nested PCR, with the same specific primers was used to detect other Phleboviruses, with positive reactions indicated by an amplified cDNA fragment of approximately 244 bp determined by gel electrophoresis. These bands were gel-purified and sequenced by the Sanger method. RESULTS: Using real-time RT-PCR, no positive results for HRTV were found. However, using conventional nested PCR 2.2% (5/229 pools) yielded a product of 244 bp. One positive sample was detected in a pool of Dermacentor nitens ticks collected from a horse, and the four remaining positive pools were from Rhipicephalus microplus collected from cattle. The five positive nucleotide sequences had identities of 93 to 96% compared to a section of the L-segment of Lihan Tick virus, a Phlebovirus originally detected in R. microplus ticks in China. The strongest identity (96-99%) was with Lihan Tick virus detected in R. microplus ticks from Brazil. CONCLUSIONS: This is the first report of viral detection in ticks in Colombia. We detected a Colombian strain of Lihan Tick virus. We recommend expanding the sampling area and carrying out more eco-epidemiological studies related to epidemiological surveillance of viruses on ticks in Colombia.

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BACKGROUND: Pediatric kidney transplantation (PKTx) is the preferred therapy for children with end-stage renal disease (ESRD) worldwide. Regrettably, in Perú, access to PKTx is extremely difficult due to recipient/donor socio-economic status, health care structure and especially, scarcity of organs. Our center (the only pediatric institute in the country) has recently started a PKTx program with good midterm results. The aim of this study was to present our outcomes. METHODS: Retrospective analysis of prospectively collected data between December 2017 and August 2019. Fourteen PKTx (< 18 years old) were achieved. As per our protocol: pre-implantation/protocol biopsies, antibody assessment (T/B cell flow cytometric plus HLA testing applying polymerase chain reaction-based technology), triple immunosuppression (tacrolimus, mycophenolate mofetil, steroids) and induction therapy was performed in every case. RESULTS: The recipient's mean age at the time of PKTx was 14.14 ± 2.62, 8/14 (57.14%) were male, 50% developed ESRD due to undetermined etiology, 11/14 (78.57%) received a deceased donor allograft, and 9/14 (64.28%) required induction with thymoglobulin. Postoperative complications included: delayed graft function (1/14, 7.14%), 1 (7.14%) developed gross hematuria associated with allograft disfunction post-protocol allograft biopsy that was managed conservatively and 1 recipient (7.14%) developed grade II oligoastrocytoma, at 10 months post PKTx. CONCLUSIONS: PKTx is the best therapeutic option for children with ESRD. Our group demonstrated that even in countries with limited resources like Perú, good midterm results can be achieved. Emphasis should be given to improve access to transplantation especially in the setting of pediatric recipients.

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The building industry is responsible for a large amount of waste, and the measurement and modelling of this waste could be used to develop better waste management plans. Several theoretical models explain the relationships between waste and building characteristics, but local practices may result in different behaviours. This study aimed to measure and analyse the waste generated through construction. It was based on the analysis of 18 building sites located in the region of Porto Alegre, Brazil. Waste was measured at these sites, and the results showed an average waste generation rate of 0.151 m3 m-2. A regression analysis of the collected data presented a satisfactory performance in two models. The first model was developed to explain total waste generation, including the effects of certain attributes, with an R2 = 0.81. The changes in waste generated during construction were estimated. The second model considered time schedules and examined the effect of the construction stage on waste generation, and reached an R2 = 0.91. The model with time indicated an S-shaped relationship. The models presented satisfactory statistical parameters and could be used to produce better waste management plans in the preconstruction stage.

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Abstract Objectives: understand the structure and content of the maternal representations of Mexican teenagers during their first pregnancy. Methods: a study was carried out with qualitative methodology based on the concept of maternal representation and the theory of social representations with 30 adolescents who attended prenatal control at the Civil Hospital of Guadalajara "Fray Antonio Alcalde", in Jalisco, Mexico. The participants were interviewed with the consent of their tutors. Classical content analysis techniques were used to obtain codes and thematic categories to develop a conceptual map that explains maternal representations. Results: the maternal representation was identified: "Pregnant but reunited, a legitimated bad decision", which was composed of social meanings towards adolescent pregnancy, family dynamics, expectations towards motherhood, and the feelings experienced by the adolescent during the pregnancy. The content of the representations was heterogeneous for most of the identified categories; however, it is identified that the desire for pregnancy guides the expectations of the adolescent about her future way of being as a mother. Conclusions: the desire of women for pregnancy, the level of participation of the couple, and the social meanings of adolescent pregnancy, have an outstanding role in the development of models of maternal representations.

Resumen Objetivos: comprender la estructura y contenido de las representaciones maternas de adolescentes mexicanas durante su primer embarazo. Métodos: se llevó a cabo un estudio con metodología cualitativa basado en el concepto de representación materna y la teoría de las representaciones sociales con 30 adolescentes que asistieron a control prenatal al Hospital Civil de Guadalajara "Fray Antonio Alcalde", ubicado en Jalisco, México. Las participantes fueron entrevistadas con previo consentimiento de sus tutores. Se utilizaron técnicas de análisis de contenido clásico para obtener códigos y categorías temáticas para desarrollar un mapa conceptual que explique las representaciones maternas. Resultados: se identificó la representación materna: "Embarazada pero juntada, una mala decisión legitimada", la cual se compuso de significados sociales hacia el embarazo adolescente, la dinámica familiar, las expectativas hacia la maternidad, y los sentimientos vividos por la adolescentedurante el embarazo. El contenido de la representación materna fue heterogéneo, empero, se identificó que el deseo por el embarazo guía las expectativas de la adolescente sobre su futura manera de ser madre. Conclusiones: el deseo de la mujer por el embarazo, el nivel de participación de la pareja, y los significados sociales del embarazo adolescente, tienen un papel sobresaliente en el desarrollo de las representaciones maternas.

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RESUMEN Objetivo Evaluar la autopercepción del estado de salud (APES) de los pensionados por complicaciones de la diabetes mellitus, y que características sociodemográficas, familiares, laborales y clínicas de éstos están asociadas a dichas variables. Métodos Estudio transversal analítico en un universo 240 pensionados que aceptaron participar. Se evaluó la APES con el Cuestionario EuroQol-5D en español, y se incluyeron variables sociodemográficas, familiares, laborales y clínicas. Resultados Se estudiaron 240 pensionados con edad media 53,43 ± 8,16 años, 94,3% masculinos y 5,7% femeninos. Se encontró que el 53,4% refiere una APES regular, mala o muy mala. Se halló asociación significativa entre mala APES y vida laboral ≤30 años OR=6,00 (IC95% 1,27, 28,26) e insuficiencia renal crónica OR=7,00 (IC95% 1,39,35,35). No se encontraron modelos explicativos mediante regresión logística. Conclusiones La frecuencia de APES mala fue elevada en la muestra de pensionados por complicaciones de la diabetes mellitus. Se requieren estudios con muestras más amplias para mejores conclusiones.(AU)

ABSTRACT Objective To evaluate self-perception of health status (APES by its Spanish acronym) of people retired due to complications of diabetes mellitus, and what socio-demographic, family, work and clinical characteristics are associated to these variables. Materials and Methods Analytical, cross-sectional study in a universe of 240 pensioners who agreed to participate. The APES was evaluated with the EuroQol-5D questionnaire in Spanish, and socio-demographic, family, work and clinical variables were included. Results 240 pensioners with a mean age of 53.43 ± 8.16 years (94.29% male and 5.71% female) were studied. It was found that 53.4% reported regular, poor or very poor APES. A significant association between poor APES and work life ≤30 years (OR=6.00; 95%CI: 1.27, 28.26) and chronic renal failure (OR=7.00; 95%CI: 1.39, 35.35) was found. No explanatory models were found through logistic regression. No explanatory models were found by logistic regression. Conclusion The frequency of poor APES was high in the sample of patients with diabetes. Studies with larger samples are required for better conclusions.(AU)

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BACKGROUND: Flaviviruses are important pathogens for humans and animals (Dengue viruses, Yellow fever virus, Zika virus and West Nile virus). Culex flavivirus (CxFV) is an insect-specific virus of the genus Flavivirus, detected in a wide variety of mosquito species. OBJECTIVE: To detect Flavivirus in mosquitoes of a tropical region of the Colombian Caribbean. METHODS: In 2014, an entomological surveillance of arboviruses was conducted in the department of Cordoba area of the Caribbean, Colombia. A total of 8270 mosquitoes were captured as follow: Mansonia (n = 3271/39.5%), Culex (n = 2668/32.26%), Anopheles (n = 840/10.15%), Aedeomyia (n = 411/4.9%), Psorophora (n = 397/4.8%), Coquilletidia (n = 369/4.46%), Uranotaenia (n = 261/3.15%) and Aedes (n = 53/0.6%). All mosquito species were collected in dry tropical forest of the Caribbean area. Universal primers for NS5 gene (958 pb), RT-PCR for flavivirus and sequencing were used for molecular identification of viruses detected. RESULTS: Two pools belonging to Culex coronator were positive for flavivirus RNA sequence by RT-PCR. The sequences of the PCR amplicons, matched that of the Culex flaviviruses, CxFv COL PM_149 (GenBank: KR014201) and CxFv COL PM_212 (GenBank: KT307717). Phylogenetic analysis of the NS5 protein sequences of the Culex flaviviruses sequences with those of reference sequences available in GenBank indicated viruses of Genotype II, closely related to the Brazilian strain, BR_SJRP_01_ (GenBank: KT726939), from Culex sp. The alignment of Culex flavivirus sequences CxFv COL_ PM 212 and CxFv COL_ PM 149 with sequences of strains detected in different geographical regions grouped the strains in a Latin American clade reported in Brazil, Argentina and Mexico. CONCLUSIONS: The present work illustrated that CxFV was circulating among vectors of human pathogenic arboviruses in Colombia, but the impact of CxFV on other flaviviruses which are endemic in the study area still remains to be explored.

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OBJECTIVE: To evaluate self-perception of health status (APES by its Spanish acronym) of people retired due to complications of diabetes mellitus, and what socio-demographic, family, work and clinical characteristics are associated to these variables. MATERIALS AND METHODS: Analytical, cross-sectional study in a universe of 240 pensioners who agreed to participate. The APES was evaluated with the EuroQol-5D questionnaire in Spanish, and socio-demographic, family, work and clinical variables were included. RESULTS: 240 pensioners with a mean age of 53.43 ± 8.16 years (94.29% male and 5.71% female) were studied. It was found that 53.4% reported regular, poor or very poor APES. A significant association between poor APES and work life ≤30 years (OR=6.00; 95%CI: 1.27, 28.26) and chronic renal failure (OR=7.00; 95%CI: 1.39, 35.35) was found. No explanatory models were found through logistic regression. No explanatory models were found by logistic regression. CONCLUSION: The frequency of poor APES was high in the sample of patients with diabetes. Studies with larger samples are required for better conclusions.

OBJETIVO: Evaluar la autopercepción del estado de salud (APES) de los pensionados por complicaciones de la diabetes mellitus, y que características sociodemográficas, familiares, laborales y clínicas de éstos están asociadas a dichas variables. MÉTODOS: Estudio transversal analítico en un universo 240 pensionados que aceptaron participar. Se evaluó la APES con el Cuestionario EuroQol-5D en español, y se incluyeron variables sociodemográficas, familiares, laborales y clínicas. RESULTADOS: Se estudiaron 240 pensionados con edad media 53,43 ± 8,16 años, 94,3% masculinos y 5,7% femeninos. Se encontró que el 53,4% refiere una APES regular, mala o muy mala. Se halló asociación significativa entre mala APES y vida laboral ≤30 años OR=6,00 (IC95% 1,27, 28,26) e insuficiencia renal crónica OR=7,00 (IC95% 1,39,35,35). No se encontraron modelos explicativos mediante regresión logística. CONCLUSIONES: La frecuencia de APES mala fue elevada en la muestra de pensionados por complicaciones de la diabetes mellitus. Se requieren estudios con muestras más amplias para mejores conclusiones.

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Objective. The aim of this study was to provide molecular evidence of C. burnetii in sheep and goats from some herds of Valledupar, Cesar, Colombia. Materials and methods. Fifteen herds of sheep and goats were chosen by convenience to investigate the infection by C. burnetii, during March and April of 2013. 328 female goats and 66 sheep from 15 herds were included in this study. Milk from ewes and vaginal mucus samples from goats were analyzed by Polymerase Chain Reaction for DNA detection of transposase gene (IS1111) of C. burnetii. Results. DNA of C. burnetii in 6% (4/66) of sheep's milk and 0.6% (2/328) vaginal mucus from goats was found. 13% (2/15) of the herds had at least one infected animal. Discussion. Our findings suggest the circulation of C. burnetii in sheep and goats from some herds of Valledupar, Colombia, and it highlights the possibility of occurrence of infections in humans and animals. Conclusions. The detection of C. burnetii in sheep milk could represent a public health risk factor for people who consuming raw milk, cheeses or people associated to agriculture and livestock handling. Further studies are necessary to evaluate other routes such as tick's bite, feces, milk from goats and vaginal mucus from sheep of this region of Colombia.

Objetivo. El objetivo de este estudio fue proporcionar evidencia molecular de infección por C. burnetii en ovinos y caprinos de algunos rebaños de Valledupar, Cesar, Colombia. Materiales y métodos. Quince rebaños de ovinos y caprinos fueron seleccionados a conveniencia para investigar la infección por C. burnetii, durante marzo y abril de 2013. En este estudio se incluyeron 328 caprinos y 66 ovinos de 15 rebaños. La leche procedente de ovinos y muestras de moco vaginal de caprinos fueron analizados mediante PCR (Reacción en Cadena de Polimerasa) para la detección de ADN del gen transposasa (IS1111) de C. burnetii. Resultados. Se encontró ADN de C. burnetii en 6% (4/66) de leche de oveja y 0,6% (2/328) de moco vaginal de cabras. El 13% (2/15) de los rebaños tenían al menos un animal infectado. Discusión. Nuestros hallazgos sugieren la circulación de C. burnetii en ovinos y caprinos de algunos rebaños de Valledupar, Colombia, y destaca la posibilidad de ocurrencia de infecciones en humanos y animales. Conclusiones. La detección de C. burnetii en la leche de oveja podría representar un factor de riesgo para la salud pública de las personas que consumen con frecuencia leche cruda, quesos o personas que trabajan en la agricultura y manipulación de ganado. Otros estudios son necesarios para evaluar otras rutas como la mordedura de la garrapata, las heces, la leche de las cabras y el moco vaginal de las ovejas de esta región de Colombia.

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ABSTRACT Objective To evaluate the effect of a participative educational intervention on the clinical competence of Mexican family physicians regarding the nutritional management of patients with diabetes mellitus Type 2. Materials and Methods Quasi-experimental study with a before-and-after control group. Convenience sample included 60 family physicians distributed in two social security primary health care units, randomly selected: 30 in the "A" unit and 30 in the "B" unit. Unit "A" was assigned randomly as control group, and "B" unit as intervention group. The intervention consisted of a theoretical-practical course-workshop that lasted six months where real cases were discussed and solved. Clinical competence was evaluated by means of an instrument designed ex professo, with a maximum theoretical value of 100 and 94% reliability according to the Kuder-Richardson test. Medians of clinical competence were compared among groups, before and after intervention, using the Mann-Whitney U test, while frequencies distribution of clinical competence level were analyzed with the Kolmogorov-Smirnov test (p≤0.05). Results Overall medians and intervals for unit "A" were 28 (9-45) pre-intervention and 34 (11-51) pos-intervention, with before-after difference p>0.05; for unit "B", values were 32 (12-50) pre-intervention, 61 (36-82) pos-intervention, and before-after difference p≤0.05. No significant differences were found among groups pre-intervention (p>0.05), although they were observed pos-intervention (p≤0.05). Conclusions The educational intervention evaluated proved to improve, in a statistically significant way, the overall and by dimensions clinical competence level of Mexican family physicians for nutritional management of patients with diabetes mellitus type 2.(AU)

RESUMEN Objetivo Evaluar el efecto de una intervención educativa participativa sobre la competencia clínica de médicos familiares mexicanos para el manejo nutricio de pacientes con diabetes mellitus Tipo 2. Método Estudio cuasiexperimental con grupo control antes-después. Se estudió una muestra por conveniencia de 60 médicos familiares distribuidos en dos unidades médicas de atención primaria de seguridad social elegidas al azar, 30 en la "A" y 30 en la "B". La unidad "A" fue designada grupo control, y la "B" de intervención. La intervención consistió en un curso-taller teórico-práctico que duró seis meses, donde se discutieron y resolvieron casos reales. La competencia clínica se evaluó mediante un instrumento diseñado ex professo, con un valor teórico máximo de 100, y una fiabilidad de 94% según prueba de Kuder-Richardson. Se compararon las medianas de competencia clínica entre grupos antes y después mediante la prueba U de Mann-Whitney, y cinco las distribuciones de frecuencias de los niveles de competencia clínica mediante la prueba de Kolmogórov-Smirnov (p≤0,05). Resultados Medianas e intervalos de la calificación global: unidad "A" 28 (9-45) pre-intervención, 34 (11-51) pos-intervención, diferencia antes-después p≤0,05; unidad "B" 32 (12-50) pre-intervención, 61 (36-82) pos-intervención, diferencia antes-después p≤0,05. No se encontró diferencia significativa entre los grupos pre-intervención (p>0,05), y si pos-intervención (p≤0,05). Conclusiones La intervención educativa evaluada demostró mejorar, de forma estadísticamente significativa, el nivel de competencia clínica global y por dimensión, de médicos familiares mexicanos para el manejo nutricio de pacientes con diabetes mellitus tipo 2.(AU)

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BACKGROUND: Dementias are rarely considered to be a main cause of death; therefore there are only few studies on Alzheimer's mortality covering long periods. OBJECTIVE: To describe mortality from Alzheimer's disease in México for the period from 1980 to 2014. METHOD: Cross-sectional study where, with official mortality data in Mexico according to codes 331.0 and G30, respectively, of the 9th and 10th revisions of the International Statistical Classification of Diseases and Related Health Problems, crude and standardized Alzheimer's disease mortality rates were obtained, both nationally and by states. RESULTS: From almost being inexistent, deaths from Alzheimer's disease went to a rate of 65.12 per 1000 females and 43.66 per 1000 males in the 2010-2014 five-year period. Throughout the study period, the age group with highest mortality rates for this cause were those older than 80 years, with 0.29 per 100,000 population in 1980-1984 and 55.02 in 100,000 in the 2010-2014 period. The region with the highest mortality was the northwest, with rates higher than 2.28 per 100,000 population. CONCLUSIONS: Mortality from Alzheimer's disease is a public health problem in Mexico with a growing trend, especially among women and older adults. Early diagnostic measures and opportune treatment are required in primary care in order to reduce this problem.

INTRODUCCIÓN: Raramente se considera a las demencias como causa principal de muerte, por consiguiente existen pocos estudios sobre la mortalidad por Alzheimer a través de largos periodos. OBJETIVO: Describir la mortalidad por enfermedad de Alzheimer en México durante el periodo 1980-2014. MÉTODO: Estudio transversal en el que, con datos oficiales de mortalidad en México según los códigos 331.0 y G30 de la novena y décima revisiones de la Clasificación Estadística Internacional de Enfermedades y Problemas Relacionados con la Salud, se obtuvieron tasas crudas y estandarizadas de mortalidad por enfermedad de Alzheimer, nacional y por entidad federativa. RESULTADOS: De ser casi inexistentes, en el quinquenio 2010-2014 se registraron tasas de 65.12 y 43.66 muertes por enfermedad de Alzheimer por cada 1000 mujeres y 1000 hombres, respectivamente. En todo el periodo estudiado, el grupo etario con las mayores tasas de mortalidad por esta causa fue el de mayores de 80 años, con 0.29 en 100 000 habitantes durante 1980-1984 y 55.02 durante 2010-2014. La región con mayor mortalidad fue la noroeste, con tasas mayores a 2.28 en 100 000 habitantes. CONCLUSIONES: La mortalidad por enfermedad de Alzheimer es un problema de salud pública en México con tendencia creciente, especialmente entre mujeres y adultos mayores. Se requieren medidas diagnósticas precoces y tratamiento oportuno en primer nivel para aminorar este problema.

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RESUMO

Resumen Se realizó una revisión narrativa con análisis temático sobre las aportaciones de los paradigmas científicos al conocimiento de la prescripción inadecuada de medicamentos. Se buscaron artículos de acceso abierto indexados en PubMed© entre 2010-2014, y se sistematizó información sobre el paradigma, tipo de publicación, perspectiva teórica, objetivo, método y resultados. De los 992 artículos encontrados, se seleccionaron 118, y se tomó una muestra propositiva de 15, según su diseño, representando los cuatro paradigmas. Los artículos positivistas reportaron prevalencia, factores asociados, efectividad de intervenciones y criterios de evaluación; los interpretativos explicaron las causas del problema según los involucrados; los críticos denunciaron la influencia de la industria farmacéutica; y el participativo abordó el problema secundariamente y lo solucionó en un escenario para una enfermedad y grupo farmacológico específicos. Se concluyó que la prescripción inadecuada de medicamentos como problema de investigación en salud pública recibe aportes de los cuatro paradigmas, con dominio del positivismo, lo que se atribuye al carácter paradigmático de la ciencia desde la que se le aborda habitualmente, y que una perspectiva multi-paradigmática es el mejor abordaje.

Abstract This study conducted a narrative review with thematic analysis about contributions of scientific paradigms to knowledge of inadequate drugs prescription. We searched open access articles indexed in PubMed© between 2010 and 2014, and we systematized information about scientific paradigm, publication type, theoretical perspective, objective, method and results. From the 992 articles found, 118 were selected. From those, we chose a purposive sample of 15, according to the design of the studies, representing the four paradigms. The positivists articles reported prevalence, associated factors, effectiveness of interventions and evaluation criteria; the interpretive explained the causes of the problem according to those involved; the critics denounced the influence of pharmaceutical industry; and the participative addressed the problem secondarily and solved it in a scenario for a specific disease and pharmacological. We concluded that the inadequate drugs prescription as research problem in public health had contributions from the four paradigms, with dominance of positivism, which is attributed to the paradigmatic perspective of the science, from which it is usually studied, and that a multi-paradigmatic perspective is the best approach to the public health issue.

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