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In 2022, Mexico registered an increase in dengue cases compared to the previous year. On the other hand, the amount of precipitation reported annually was slightly less than the previous year. Similarly, the minimum-mean-maximum temperatures recorded annually were below the previous year. In the literature, it is possible to find studies focused on the spread of dengue only for some specific regions of Mexico. However, given the increase in the number of cases during 2022 in regions not considered by previously published works, this study covers cases reported in all states of the country. On the other hand, determining a relationship between the dynamics of dengue cases and climatic factors through a computational model can provide relevant information on the transmission of the virus. A multiple-learning computational approach was developed to simulate the number of the different risks of dengue cases according to the classification reported per epidemiological week by considering climatic factors in Mexico. For the development of the model, the data were obtained from the reports published in the Epidemiological Panorama of Dengue in Mexico and in the National Meteorological Service. The classification of non-severe dengue, dengue with warning signs, and severe dengue were modeled in parallel through an artificial neural network model. Five variables were considered to train the model: the monthly average of the minimum, mean, and maximum temperatures, the precipitation, and the number of the epidemiological week. The selection of variables in this work is focused on the spread of the different risks of dengue once the mosquito begins transmitting the virus. Therefore, temperature and precipitation were chosen as climatic factors due to the close relationship between the density of adult mosquitoes and the incidence of the disease. The Levenberg-Marquardt algorithm was applied to fit the coefficients during the learning process. In the results, the ANN model simulated the classification of the different risks of dengue with the following precisions (R2): 0.9684, 0.9721, and 0.8001 for non-severe dengue, with alarm signs and severe, respectively. Applying a correlation matrix and a sensitivity analysis of the ANN model coefficients, both the average minimum temperature and precipitation were relevant to predict the number of dengue cases. Finally, the information discovered in this work can support the decision-making of the Ministry of Health to avoid a syndemic between the increase in dengue cases and other seasonal diseases.

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Background: Hemifacial spasm (HFS) is characterized by involuntary, progressive, and intermittent spasms in the upper and lower facial muscles. Due to the high success rate, microvascular decompression (MVD) is the treatment of choice, and intraoperative neuromonitoring (INM) is considered useful for achieving safe surgery. Still, most centers do not have this technology. Methods: We analyzed 294 patients with HFS treated with MVD without INM. We only included patients with a neurovascular etiology while excluding other causes, such as tumors. As part of the postoperative evaluation, we assessed preoperative magnetic resonance imaging and pure-tone audiometry. Results: The main complication was peripheral facial paralysis in 50 patients, followed by hypoacusis in 22 patients and deafness in 17 patients, associated with a failed surgical outcome (P = 0.0002). The anterior inferior cerebellar artery (AICA) was an offending vessel, and the involvement of more than one vessel was significantly associated with the development of facial nerve palsy (P = 0.01). AICA was also associated with hearing impairment (P = 0.04). Over 90% of immediate complications improve in the follow-up (6 months), and one patient did not show a cure for initial HFS. Conclusion: MVD is the method with the highest long-term cure rates for treating HFS; however, we must inquire into the multiple factors of the patient and the surgeon to predict surgical outcomes. INM is not a must during MVD for HFS. We recommend its use depending on the availability and mainly on the surgeon's skills, for surgeons.

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INTRODUCTION: Family centered developmental care (FCDC) are a philosophy of care in the neonatal care units (NICU), based on the control of sensory stimulation the adequate position and of newborn and the family involvement of cares. Nursing staff are the main providers of this care. Sanitary measure to control of the COVID-19, such as the use of masks, isolation of positive cases and capacity limit, conditioned the implementation of FCDC. OBJECTIVES: To understand the meaning of the experience of the nursing staff of a neonatal intensive care unit (NICU) on the implementation of the FCDC, under the sanitary measures imposed for the containment of COVID-19. METHODS: A qualitative study was conducted from the descriptive phenomenological paradigm in which NICU nurses were recruited. The qualitative data collection was carried out through open-ended and semi-structured interviews. These were analyzed respectively through a preliminary narrative analysis and a thematic analysis of the informant nurses' narratives and discourses. RESULTS: Three open-ended and 7 semi-structured interviews were conducted from which three main topics emerged: 1) changes in the FCDC derived from the sanitary restrictions implemented for the containment of COVID-19; 2) changes in interpersonal relationships in the context of a pandemic, and 3) transition to normality. CONCLUSIONS: The nurses of NICU perceived changes in the implementation of the FCDC due to the containment of COVID-19, that modified the relationship with the parents of NB, accelerating their training as caregivers, and involved the implementation of new measures such as video calls.

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Galena is the most important mineral for lead production, as it is the main source of lead in the world. Currently, the concentrates of this mineral are mainly treated using pyrometallurgical methods, creating several environmental problems, such as the generation of toxic and greenhouse gases. In addition, these processes involve high energy consumption, which limits their applicability. Hydrometallurgical routes are proposed as alternative processes for obtaining some metals such as silver, copper, gold, etc. The drawback of these processes is that the minerals tend to be passive in aqueous media. To mitigate this issue, researchers have used extreme conditions of pressure and temperature (6 atm. and 155 °C) or the use of very corrosive conditions. In this sense, the use of complexing agents that dissolve the metals of interest has been proposed. Citrate ion is one of the most promising complexing agents for galena leaching, obtaining high percentages of dissolution in relatively short times. Unfortunately, there has not been enough investigation about the concentration optimization of the complexing in the pH range from 5 to 9. In this sense, thermodynamic diagrams, such as the Pourbaix diagrams, are very useful for this purpose. Therefore, in this work, the effects of pH and temperature on the leaching of galena in citrate ion solutions are studied thermodynamically and experimentally. The experimental work was carried out with pure galena samples with a particle size of +149 - 74 µm (-100 + 200 mesh). The results show that higher recoveries were obtained working at a pH of 8 and at temperatures of 30 and 40 °C. The thermodynamic and experimental data demonstrated that the existence of an optimal concentration of citrate ion, due the extraction of lead from galena, has a greater reaction rate at a relatively low initial concentration of 0.3 M. This is due the formation of the complex lead citrate 1 (Pb(cit)-).

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Various environmental alterations resulting from the current global change compromise the persistence of species in their habitual environment. To cope with the obvious risk of extinction, plastic responses provide organisms with rapid acclimatization to new environments. The premise of plastic rescue has been theoretically studied from mathematical models in both deterministic and stochastic environments, focusing on analyzing the persistence and stability of the populations. Here, we evaluate this premise in the framework of a consumer-resource interaction considering the energy investment towards reproduction vs. maintenance as a plastic trait according to positive/negative variation of the available resource. A basic consumer-resource mathematical model is formulated based on the principle of biomass conversion that incorporates the energy allocation toward vital functions of the life-cycle of consumer individuals. Our mathematical approach is based on the impulsive differential equations at fixed moments considering two impulsive effects associated with the instants at which consumers obtain environmental information and when energy allocation strategy change occurs. From a preliminary analysis of the non-plastic temporal dynamics, namely when the energy allocation is constant over time and without experiencing changes concerning the variation of resources, both the persistence and stability of the consumer-resource dynamic are dependent on the energy allocation strategies belonging to a set termed stability range. We found that the plastic energy allocation can promote a stable dynamical pattern in the consumer-resource interaction depending on both the magnitude of the energy allocation change and the time lag between environmental sensibility instants and when the expression of the plastic trait occurs.

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The goal of the present study was to propose a set of preliminary regional diagnostic reference levels (DRLs) for pediatric interventional cardiology (IC) procedures in Latin America and the Caribbean countries, classified by age and weight groups. The study was conducted in the framework of the Optimization of Protection in Pediatric Interventional Radiology in Latin America and the Caribbean program coordinated by the World Health Organization and the Pan American Health Organization in cooperation with the International Atomic Energy Agency. The first step of the program was focused on pediatric IC. Dose data from diagnostic and therapeutic procedures were collected between December 2020 and December 2021. Regional DRLs were set as the third quartile of patient dose data (kerma area product) collected in 18 hospitals from 10 countries in an initial sample of 968 procedures. DRLs were set for four age bands and five weight ranges. The values obtained for the four age bands (<1 yr, 1 to <5 yr, 5 to <10 yr and 10 to <16 yr) were 2.9, 6.1, 8.8 and 14.4 Gy cm2for diagnostic procedures, and 4.0, 5.0, 10.0 and 38.1 Gy cm2for therapeutic procedures, respectively. The values obtained for the five weight bands (<5 kg, 5 to <15 kg, 15 to <30 kg, 30 to <50 kg and 50 to <80 kg) were 3.0, 4.5, 8.1, 9.2 and 26.8 Gy cm2for diagnostic procedures and 3.7, 4,3, 7.3, 16.1 and 53.4 Gy cm2for therapeutic procedures, respectively. While initial data were collected manually as patient dose management systems (DMSs) were not available in most of the hospitals involved in the program, a centralized automatic DMS for the collection and management of patient dose indicators has now been introduced and is envisaged to increase the sample size. The possibility of alerting on high dose values and introducing corrective actions will help in optimization.

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The present work is focused on modeling and predicting the cumulative number of deaths from COVID-19 in México by comparing an artificial neural network (ANN) with a Gompertz model applying multiple optimization algorithms for the estimation of coefficients and parameters, respectively. For the modeling process, the data published by the daily technical report COVID-19 in Mexico from March 19th to September 30th were used. The data published in the month of October were included to carry out the prediction. The results show a satisfactory comparison between the real data and those obtained by both models with a R2 > 0.999. The Levenberg-Marquardt and BFGS quasi-Newton optimization algorithm were favorable for fitting the coefficients during learning in the ANN model due to their fast and precision, respectively. On the other hand, the Nelder-Mead simplex algorithm fitted the parameters of the Gompertz model faster by minimizing the sum of squares. Therefore, the ANN model better fits the real data using ten coefficients. However, the Gompertz model using three parameters converges in less computational time. In the prediction, the inverse ANN model was solved by a genetic algorithm obtaining the best precision with a maximum error of 2.22% per day, as opposed to the 5.48% of the Gompertz model with respect to the real data reported from November 1st to 15th. Finally, according to the coefficients and parameters obtained from both models with recent data, a total of 109,724 cumulative deaths for the inverse ANN model and 100,482 cumulative deaths for the Gompertz model were predicted for the end of 2020.

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Resumen El bruxismo es una condición que se observa frecuentemente en los pacientes y estos a menudo consultan por sus consecuencias físicas, como pueden ser el desgaste o destrucción dentaria, el dolor orofacial, así como también por el deterioro de la calidad de vida tanto de ellos mismos como de las personas cercanas. En la última década han aumentado en forma importante las investigaciones en torno a esta condición, así como los consensos en cuanto a su definición, clasificación y manejo clínico. Los dentistas son quienes actualmente reconocen esta actividad parafuncional y manejan estos problemas, pero es importante que los profesionales de otras áreas de la salud, como médicos y en especial otorrinolaringólogos, puedan identificar los signos, síntomas y consecuencias del bruxismo, ayudando en la detección de esta condición. Así, el objetivo de esta revisión es establecer un estado del arte sobre bruxismo e incentivar la formación de equipos multidisciplinares que ayuden en el diagnóstico y la terapéutica de esta condición.

Abstract Bruxism is a condition that is frequently observed in patients, and they often consult for physical consequences, such as teeth wear or destruction, orofacial pain, as well as for the decrease of the quality of life, of both patients and their loved ones. In the last decade, research on this phenomenon has increased significantly, as well as the consensus in terms of definition, classification and clinical management. Dentists are those who at present recognize this parafunctional activity and manage these problems, but it is important that professionals from other health areas, such as medical doctors, and specially otolaryngologists, can identify signs, symptoms and consequences of bruxism, helping in the detection of this condition. Thus, the objective of this review is to establish a state of the art about bruxism and encourage the formation of multidisciplinary teams that help to in the diagnosis and better management of this condition.

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AIM: To determine the percentages of (CD19 + CD24 + CD38+, CD19 + CD24 + CD27+, CD19 + IL-10+)-Breg cells, IL-17 single and IL-17+/IFN-γ double producers T cells and IFN-γ+ T cells, in normal-glycemic individuals, prediabetes and T2DM patients, and to analyze the association of Breg cells with metabolic parameters of T2DM. METHODS: percentages of Breg cells, IL-17+ and IL-17 + IFN-γ+ T cells, IFN-γ+ T cells and IL-10 were determined by flow cytometry. IL-6 levels were evaluated by ELISA assay. RESULTS: increased IL-6 levels, IL-17+ and IL-17 + IFN-γ+ T cells and a diminution of IL-10 levels and CD19 + IL-10+ cells in T2DM patients were observed. We found that CD19 + CD24 + CD27+ cells and CD19 + CD24 + CD38+ cells were increased in T2DM patients. The percentages of CD19 + CD24 + CD38+ cells were associated with HOMA-B, TyG index, HDL and cholesterol values. In normal-glycemic individuals, CD19 + CD24 + CD27+ cells were inversely associated to triglycerides and TyG index. In prediabetes patients, CD19 + CD24 + CD38+ cells were inversely related with cholesterol and LDL. Finally, CD19 + CD24 + CD38+ cells were inversely related with HDL values in T2DM patients. CONCLUSION: Our results suggest that increased percentages of IL-17 single and IL-17/IFN-γ double producers T cells in T2DM patients may be a consequence of the initial CD19 + IL-10+ cells reduction. Furthermore, dyslipidemia could play an important role in percentages and activity of B regulatory cells.

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In recent decades, the vegetarian dietary option has been increasing in the general population, in cluding the pediatric age group. This has led to numerous questions regarding the benefits and risks that may arise from its implementation. Food restriction implies the potential deficiency of several nutrients, establishing some of them as critical for this period of development and rapid growth, so the safety of vegetarian diets has not been fully established worldwide. The main critical nutrients are iron, zinc, calcium, vitamin B12, and omega-3 fatty acids. The groups most at risk of nutritional deficiencies are infants, adolescents, more restrictive vegetarian options, and those who do not have adequate professional nutritional counseling. Therefore, vegetarian diets should be strictly supervi sed. Scientific societies such as the American, Canadian, Italian, and British nutrition societies recog nize vegetarian diets as healthy in the pediatric age as long as they are supervised by qualified health professionals. However, there are others that do not support it as the French one, while the Spanish one supports it with restrictions in the infant period. The objective of this publication is to describe potential nutritional deficiencies and to provide recommendations to follow a balanced and safe ve getarian diet in the pediatric population according to the available information, paying attention to the limitations that we may have in the implementation of this diet in our population, especially in critical stages such as infants and adolescents.

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Occupational and environmental exposures in the agricultural industry have been associated with several illnesses and poor health outcomes. Information regarding the characteristics and health status of the labor force working in the agricultural sector in Puerto Rico is limited. The overall objective of this study was to increase the available information on agricultural workers health and needs by ascertaining the potential differences in characteristics and health status of farmworkers when compared to the general population in rural Puerto Rico This cross-sectional study used the collection and analysis of medical records of agricultural workers and non-agricultural workers in Hospital General Castañer, located in Lares, Puerto Rico. The research period was five years, from 2012 to 2016. This research described agricultural workers' demographic and socioeconomic profile and evaluated relationships between one or more demographic variables and farmer's health. Agricultural workers presented alower prevalence of hypertensive disease (69.4%) and ahigher prevalence of cerebrovascular disease (3.4%) when compared to non-agricultural workers. In other words, agricultural workers were 21% less likely to have hypertensive disease as compared to non-agricultural workers. Results for agricultural workers showed that 4.0% of the workers were diagnosed with arthritis, and 48.8% had suffered at least one type of dorsopathy. The results from this research provide useful information for developing an appropriate framework to address Puerto Rican agricultural worker's health while promoting the agricultural industry development on the island. Finally, this study provided insight into the prevalence and demographic characteristics of agriculture workers in acentral region of Puerto Rico. Further efforts are needed to better define the agricultural workers and farming communities in Puerto Rico that may be exposed to related hazards.

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Dar a conocer una presentación inusual de una patología frecuente. Se presenta caso de paciente masculino de 27 años con cuadro clínico de apendicitis aguda. Se realiza apendicetomía abierta en la cual se identifican dos apéndices vermiformes. Se confirma el diagnóstico por medio de anatomía patología, una con apendicitis aguda perforada y otra con peri-apendicitis. Es importante el conocimiento de esta patología para que se pueda reconocer y evitar errores de juicio durante el procedimiento quirúrgico y futuras complicaciones para el paciente. (AU)

Report an unusual presentation of a common pathology. A case of a 27-year-old male with a clinical picture of acute appendicitis is presented. An open appendectomy is performed in which two vermiform appendages are identified. The diagnosis is confirmed by pathology, one with perforated acute appendicitis and the other with peri-appendicitis. Knowledge of this pathology is important so that errors of judgment can be recognized and avoided during the surgical procedure and future complications for the patient. (AU)

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This work presents the modeling and prediction of cases of COVID-19 infection in Mexico through mathematical and computational models using only the confirmed cases provided by the daily technical report COVID-19 MEXICO until May 8th. The mathematical models: Gompertz and Logistic, as well as the computational model: Artificial Neural Network were applied to carry out the modeling of the number of cases of COVID-19 infection from February 27th to May 8th. The results show a good fit between the observed data and those obtained by the Gompertz, Logistic and Artificial Neural Networks models with an R2 of 0.9998, 0.9996, 0.9999, respectively. The same mathematical models and inverse Artificial Neural Network were applied to predict the number of cases of COVID-19 infection from May 9th to 16th in order to analyze tendencies and extrapolate the projection until the end of the epidemic. The Gompertz model predicts a total of 47,576 cases, the Logistic model a total of 42,131 cases, and the inverse artificial neural network model a total of 44,245 as of May 16th. Finally, to predict the total number of COVID-19 infected until the end of the epidemic, the Gompertz, Logistic and inverse Artificial Neural Network model were used, predicting 469,917, 59,470 and 70,714 cases, respectively.

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Juvenile-onset systemic lupus erythematosus (JSLE) presents with an aggressive course and high morbidity associated with disease and treatment. JSLE patients have a poorer health-related quality of life (HRQoL) when compared with age-matched patients with other rheumatologic disorders. We aim to summarize the impact of current pharmacological therapies on the HRQoL of JSLE patients. Search strategies were developed across seven databases. Randomized clinical trials (RCTs) and cohort studies comparing interventions to standard therapy, placebo or pre-post cohort comparisons for more than 4 weeks were included. The outcome included self-reported scales compared at baseline and a therapeutic time point. Risk of bias was evaluated by using the Cochrane risk of bias tool and the Newcastle-Ottawa quality assessment scale. A total of 2812 articles were narrowed down to 309 for full-text screening. Four RCTs and one prospective cohort study, with a total of 634 JSLE patients, met the inclusion criteria. Four of the studies had a controlled intervention plus standard therapy compared with standard therapy alone or placebo. Multiple indices were used to evaluate HRQoL. These included the Pediatric Quality of Life Inventory, Childhood Health Assessment Questionnaire, Simple Measure of Impact of Lupus Erythematosus in Youngsters tool, Kids Fatigue Severity Scale and Child Depression Inventory. A single study reported a significant improvement while remaining studies reported no difference or failed to report the statistical analysis. Although HRQoL is significantly impaired in JSLE, evidence regarding its improvement is limited due to the small number of eligible studies, heterogeneity in scales, and HRQoL domains. A universal HRQoL questionnaire for JSLE needs to be established and used in both the research and clinical setting. All studies should adhere to reporting guidelines.

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Groundwater pollution in tropical and human-altered coastal landscapes is receiving novel attention due to decreasing in annual recharge as a consequence of recurrent droughts and overexploitation, whereby saline intrusion, point and diffuse source contamination, and water conflicts are common denominators. This study presents a detailed groundwater evaluation in a coastal aquifer within the central Pacific coast of Costa Rica. Three sampling campaigns including major ions, heavy metals, and fecal coliform analyses were conducted between July 2013 and March 2014 across 17 wells within the alluvial and fissured units of the Jacó aquifer. The groundwater system is classified as mixed HCO3--Ca2+-Mg2+ type. Coliforms presence was found in two wells, nearby Mona Creek headwaters and near the coastal line. Heavy metal concentrations were below quantification limits in most of the wells; however, chromium concentrations up to 6.56 µg/L were quantified within the coastal line and central portion of the alluvial aquifer in 20 out of the 48 samples. The spatial distribution of major ions (K+, Na+, Ca2+, Mg2+, Cl-, SO42-, and HCO3-) exhibited an increasing trend towards the central portion of the alluvial aquifer, which may be potentially associated with the large unregulated urban expansion, invoking a need of a continuous water quality monitoring program in this touristic hot spot. This study provides useful information for other similar coastal aquifers in Central America, whereby increasing population growth and unregulated touristic, industrial, and agricultural activities are posing a truly challenge to ensure water security and sustainability parallel to the economic development in a changing climate.

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PURPOSE: The effect of the sodium-glucose 2 (SGLT-2) inhibitors on microvascular complications remains uncertain. We performed a systematic review to determine the efficacy of the SGLT-2 inhibitors on microvascular outcomes in patients with type 2 diabetes. METHODS: A comprehensive search was performed using Ovid, MEDLINE, EMBASE, Web of Science, and Scopus from inception to May 2019. Randomized trials comparing SGLT-2 inhibitors with placebo or other medication for type 2 diabetes for ≥ 4 weeks were included. Diabetes-related microvascular complications such as nephropathy, retinopathy, neuropathy, and peripheral vascular disease were evaluated. A random-effect model using mean differences for continuous outcomes and risk ratio for dichotomous outcomes was used to synthesize data. PROSPERO (CRD 42017076460). RESULTS: A total of 40 RCTs with overall moderate quality of evidence were included. SGLT-2 inhibitors reduced the risk of renal-replacement therapy (0.65; 95% CI 0.54-0.79), renal death (0.57; 95% CI 0.49-0.65), and progression of albuminuria (0.69; 95% CI 0.66-0.73). Conversely, they appeared ineffective in maintaining eGFR (0.33; 95% CI - 0.74 to 1.41) or reducing serum creatinine (- 0.07; 95% CI - 0.26 to 0.11), whereas urine albumin-creatinine ratio (- 23.4; 95% CI - 44.6 to - 2.2) was reduced. Risk of amputation was non-significant (1.30; 95% CI 0.93-1.83). No available data were found regarding neuropathy and retinopathy to perform a quantitative analysis. CONCLUSION: SGLT-2 inhibitors may reduce the risk of renal patient-important outcomes but fail to improve surrogate outcomes. Apparently, no increased risk of amputations was observed with these medications. No data were available regarding other microvascular complications.

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This work examines aquaculture-related activities in the commercial exploitation of fish reproduction. Fisheries' problem of maximizing utility is modeled for the state of Puebla, Mexico, to determine optimal fish production. The problem of maximizing utility subject to the fish production function is solved using an approach based on Euler's equation. The theoretical results are then applied, using data on aquaculture production and tilapia sales prices in the state of Puebla, Mexico. A logarithmic regression is used to approximate the utility function. The optimal fishing production and utility functions are thus explicitly obtained. Furthermore, this work shows how to obtain greater profits from the amount of fish that can be extracted without reducing the fish population.

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El estrés es hoy en día, es una problemática a la que se está prestando una atención creciente. Sin embargo, el estrés académico no recibe la suficiente atención en el ámbito de la investigación. Es por eso que con la presente investigación se determinará el nivel de estrés académico en estudiantes de la Universidad Mayor Real y Pontificia de San Francisco Xavier de Chuquisaca, ya que al seguir una Carrera Universitaria se tiende a desarrollar algún nivel de estrés que puede desencadenar problemas emocionales, cognitivos y fisiológicos. En el estudio participaron 332 estudiantes de todas las Facultades y Carreras en general, a quienes se les aplicó el inventario SISCO de Barraza. Los resultados mostraron que la mayoría de los estudiantes presenta un estrés patológico que consta los niveles, mediano, alto y máximo que representan un 92,4% de los individuos y el porcentaje restante presentan un estrés fisiológico. De acuerdo a los resultados obtenidos concluimos que el estrés académico es un fenómeno de frecuencia elevada. Su carácter multidimensional presenta manifestaciones fisiológicas, conductuales y cognitivas, que están asociadas a variables como la edad y el sexo siendo estas las de mayor nivel de expresión. Es importante generar el interés de realizar futuras investigaciones en la que el estrés académico sea centro de atención.

Stress is today, it is a problem that is being given increasing attention. However, academic stress does not receive sufficient attention in the field of research. That is why with the present investigation the level of academic stress will be determined in students of the Universidad Mayor Real y Pont ificia de San Francisco Xavier de Chuquisaca, since following a University Degree there is a tendency to develop some level of stress that can cause problems Emotional, cognitive and physiological. The study involved 332 students from all faculties and careers in general, to whom the SISCO inventory of Barraza was applied. The results showed that the majority of the students present a pathological stress that consists of the medium, high and maximum levels that represent 92.4% of the individuals and the remaining percentage presents a physiological stress. In the study we conclude that academic stress is a phenomenon of high frequency. Its multidimensional character presents physiological, behavioral and cognitive manifestations, which are associated with variables such as age and sex, these being the highest level of expression. It is important to generate interest in conducting future research in which academic stress is the center of attention.

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BACKGROUND AND AIMS: Experience in the region shows that in some countries there is very good surveillance of Healthcare-associated infections (HAIs) in health services, but there is no national data consistently in all countries. Therefore, we set to estimate the total burden of HAIs and antimicrobial use in acute care hospitals in Brazil, Venezuela, Mexico, and Colombia using the one-day point prevalence methodology. METHODS: The survey was conducted between June and July 2016. In each ward or unit, HAIs and antimicrobial use data were collected on a single day by a trained team of researchers. Also, for each patient, we collected data on risk factors for infections. RESULTS: One out of ten individuals surveyed had at least one healthcare-associated infection (HAI). Pneumonia and surgical site infections were the most relevant among the surveyed countries. Most of the surveyed participants, regardless of their HAI status, received antibiotics except the individuals managed in Brazil. Carbapenems and third-generation Cephalosporins were among the most frequently used antibiotics. CONCLUSION: Our results add to WHO's recent efforts to understand HAIs prevalence and antibiotic consumption in low and middle-income countries, of which we studied three that were not included in their last report.

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