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BACKGROUND: There is limited evidence from antimicrobial stewardship programmes in less-resourced settings. This study aimed to improve the quality of antibacterial prescriptions by mitigating overuse and promoting the use of narrow-spectrum agents in intensive care units (ICUs) in a middle-income country. METHODS: We established a quality improvement collaborative (QIC) model involving nine Argentine ICUs over 11 months with a 16-week baseline period (BP) and a 32-week implementation period (IP). Our intervention package included audits and feedback on antibacterial use, facility-specific treatment guidelines, antibacterial timeouts, pharmacy-based interventions and education. The intervention was delivered in two learning sessions with three action periods along with coaching support and basic quality improvement training. RESULTS: We included 912 patients, 357 in BP and 555 in IP. The latter had higher APACHE II (17 (95% CI: 12 to 21) vs 15 (95% CI: 11 to 20), p=0.036), SOFA scores (6 (95% CI: 4 to 9) vs 5 (95% CI: 3 to 8), p=0.006), renal failure (41.6% vs 33.1%, p=0.009), sepsis (36.1% vs 31.6%, p<0.001) and septic shock (40.0% vs 33.8%, p<0.001). The days of antibacterial therapy (DOT) were similar between the groups (change in the slope from BP to IP 28.1 (95% CI: -17.4 to 73.5), p=0.2405). There were no differences in the antibacterial defined daily dose (DDD) between the groups (change in the slope from BP to IP 43.9, (95% CI: -12.3 to 100.0), p=0.1413).The rate of antibacterial de-escalation based on microbiological culture was higher during the IP (62.0% vs 45.3%, p<0.001).The infection prevention control (IPC) assessment framework was increased in eight ICUs. CONCLUSION: Implementing an antimicrobial stewardship program in ICUs in a middle-income country via a QIC demonstrated success in improving antibacterial de-escalation based on microbiological culture results, but not on DOT or DDD. In addition, eight out of nine ICUs improved their IPC Assessment Framework Score.

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INTRODUCTION: Promptly providing new drugs to fulfill unmet medical needs requires changes in drug development and registration processes. Health Authorities (HAs) considered as reference due to their experience and acknowledgement (Food and Drug Administration [FDA] among others) already consider innovative clinical trial (CT) designs and flexible approval procedures, but Latin America (LATAM) regulations are still far. A comparison was performed to identify gaps. MATERIALS AND METHODS: CT requirements for drug Marketing Authorization Application (MAA) and CT approval regulations were compared between LATAM and reference HAs (FDA/European Medicines Agency [EMA]/Health-Canada/Swissmedic/Therapeutic Goods Administration [TGA]/Pharmaceuticals and Medical Devices Agency [PMDA]), as of August 2022. Procedure included reference HAs regulations review, item selection, identification in LATAM regulations, and International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines (ICH-E6[R2]/ICH-E8[R1]) implementation revision. RESULTS: For MAA, specific application requirements or ICH guideline M4(R4) on common technical document (CTD) adoption are generally stated, and phase-I/III performance is mandatory (explicitly/implicitly). Faster patient access procedures are infrequent: Priority-drug programs, conditional authorizations, or expedited procedures are scarce or non-existent. Regulatory reliance procedures are adopted through different pathways. Regarding CT approval, innovative/complex CT designs are not prohibited but usually omitted. Some countries implemented adapted CT conducting during the COVID-19 pandemic. Early scientific advice meetings (HA-sponsor) are occasionally considered. Most countries are not formally ICH-joined. CONCLUSIONS: LATAM regulations must adapt to new regulatory standards (FDA/EMA/ICH) through implementation of frequent updates, reliance/expedited procedures, early HA-sponsor interactions, innovative/complex CTs, mandatory phase-III reaching elimination, and decentralized elements for CT conducting.

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Multisystem inflammatory syndrome in children (MIS-C) is a postinfectious condition which usually develops 4 to 6 weeks after SARS-CoV-2 infection in a genetically predisposed individual. Clinical features are heterogeneous and include fever, respiratory compromise, mucocutaneous involvement with conjunctival abnormalities and erythematous exanthem, abdominal pain, and diarrhea. Neurologic and cardiovascular symptoms can also develop, including coronary artery dilatation. Some cases involve 2 or more organs and require critical admission. Echocardiography is the mainstay of cardiac evaluation in the acute setting as well as on outpatient follow-up. We present the case of a 4-month-old female with no past medical or surgical history who presented with a prolonged febrile syndrome associated with severe respiratory illness, gastrointestinal symptoms, and mucocutaneous abnormalities. Diagnosis of MIS-C was established based on clinical findings, persistently elevated markers of systemic inflammation and positive SARS-CoV-2 molecular test and evidence of prior SARS-CoV-2 infection with SARS-CoV-2 IgG positive. Echocardiogram evidenced myopericarditis and coronary aneurysms and patient was deemed candidate for immunomodulatory therapy with intravenous immunoglobulin (IVIg), resulting in favorable clinical and paraclinical outcomes. Few cases of giant coronary aneurysms have been reported in children. There are no existing literature reports about coronary thrombosis or thrombus formation resulting from vascular aneurysmal dilations in this population. As such, the prognosis and natural history of coronary artery aneurysms in the setting of MIS-C remain largely unknown.

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Background: Multisystemic inflammatory syndrome in children (MIS-C) is one of the most severe presentations of COVID-19 infection in pediatrics. Currently, we have few studies that describe the characteristics of this condition in Colombian children. Objective: To describe the clinical and epidemiological characteristics of children hospitalized with MIS-C in Neiva, Colombia. Methods: Observational follow-up study of a cohort of children with MIS-C for 12 months (May 15, 2020, to May 30, 2021) in two hospitals in the city of Neiva. Epidemiological data, clinical characteristics, laboratory characteristics, cardiological evaluation, treatment, and clinical outcomes were analyzed. Results: We included 34 patients who met the diagnosis of MIS-C. The median age was 68 months. Some type of nutritional issue was observed by 43.75% of those under 5 years of age and by 27.78% of those over 5 years of age. Gastrointestinal symptoms were the most frequent, with vomiting, diarrhea, and abdominal pain being the most frequent by 79, 70, and 67%, respectively. By 77% of the patients, a history of SARS-COV-2 infection was documented through IgG. In the echocardiogram, 35.4% of the patients had systolic dysfunction, followed by coronary involvement by 35%. Conclusion: This study describes a series of cases of children with MIS-C in Colombia. Gastrointestinal manifestations were predominant. Mortality was high in comparison to other countries but similar to that reported in Colombia. This fact was associated with relevant pathological background. More training is required for physicians in order to have a better understanding of the disease so as to have an early diagnosis and timely treatment.

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Los estudios dietéticos individuales y poblacionales, permiten conocer la ingesta alimentaria, la calidad de la dieta y su adecuación a las necesidades energéticas y de nutrientes, así como el patrón alimentario. En consonancia a la función básica del INCAP de Asistencia Técnica Directa, se genera el presente análisis técnico para fortalecer la capacidad operativa de las instituciones nacionales, en este caso el Programa de Seguridad Alimentaria y Nutricional (PROSAN) del Departamento de Regulación de los Programas de Atención a las Personas (DRAP) en Guatemala y la aplicación del Software NutrINCAP en la evaluación de consumo de alimentos a nivel poblacional (paso 4 para el manejo comunitario de la DA), como parte del proceso de actualización del "Protocolo para la prevención y el tratamiento de la desnutrición aguda en niños menores de 5 años a nivel comunitario" (AU)

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SUMMARY: Multisystemic inflammatory syndrome (MIS-C) can develop as a complication of SARS CoV-2 infection, involving the gastrointestinal system mainly by vasoconstriction, edema, glandular hyperplasia, and a procoagulant state leading to direct tissue injury. METHOD: ology: a series of cases including 8 patients with MIS-C treated in two highly complex institutions is presented. These patients, had abdominal symptoms of surgical management. RESULTS: The average age was 9.5 years and the most frequent symptoms were fever, abdominal pain, diarrhea (100%); in addition, 87.5% presented shock. The diagnosis of SARS CoV-2 was confirmed by RT-PCR test in 37.5%, antigen 12.5% and the rest of the patients showed IgM and IgG antibodies. In laboratories, the increase in acute phase reactants, Erythrocyte Sedimentation Rate (ESR), C-reactive protein, procalcitonin, as well as troponin, D dimer and proBNP, is highlighted. The surgical outcome documented 2 patients with a normal appendix, 3 patients with edematous appendicitis, and 3 patients with complicated appendicitis. CONCLUSIONS: patients with MIS-C display abdominal symptoms similar to those present in surgical emergencies and a non-negligible number of cases require surgical exploration. This condition poses a new differential diagnosis to the surgical abdomen in pediatric patients.

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Dengue is a single-stranded RNA virus belonging to the Flaviviridae family. It is an endemic virus in tropical countries. In Colombia, 4 serotypes are present, and the disease is a burden for public health, social programs, and the economic sectors. The main vector is Aedes aegypti, and most infections are asymptomatic or minimally symptomatic. The hemorrhagic appearances of severe dengue are due to plasma leakage as a result of increased vascular permeability, severe thrombopenia, and hemoconcentration. In 2020, 78,979 cases of dengue were reported in Colombia. 38,836 (49.2%) of them were warning-free signs, 39,246 (49.7%) with warning signs, and 897 (1.1%) of severe dengue. As it is well-known, viral diseases are immune system activators, triggering off a loss of tolerance in it. Dengue is not an exception, and it is able to explain different autoimmune phenomena including macrophage activation. Mechanisms have been described by which an exacerbated response of the disease is triggered through the increase of infected cells, formation of immune complexes, and complement pathway activation, which lead to a cross-reaction of viral antigens with epithelial cells with platelets with subsequent endothelial dysfunction and bleeds. The first description of Evans syndrome was made in 1951 by Robert Evans. This syndrome is characterized by the combination of autoimmune hemolytic anemia, immune thrombocytopenia, and, less common/usual, immune neutropenia. This disease's etiology is unknown, and the dysregulation of the immune system is among its possibilities. Here, we present the case of an unusual hematological and immunological complication of a patient who developed Evans syndrome during severe dengue, taking into account the concomitantly limited literature available for these two diseases, the need for a broader diagnostic approach, multidisciplinary intervention, and a more complex therapeutic approach.

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RESUMEN El fibroadenoma gigante juvenil es un tumor de mama benigno y una variante rara de los fibroadenomas. La presentación clínica suele ser una masa tumoral unilateral, de crecimiento rápido e indolora. En este artículo presentamos el caso de un fibroadenoma gigante juvenil de 12 cm de diámetro en la mama de una niña de 13 años. Se realiza estudio radiológico e histológico de la lesión siendo categorizada como un fibroadenoma gigante juvenil por lo que se realiza tumorectomía completa con remodelación mamaria posterior. A los dos meses de seguimiento, la paciente se encuentra sin signos de recidiva, con buena situación general y a la espera de cirugía de remodelación mamaria.

ABSTRACT Juvenile giant fibroadenoma is a benign breast tumor and a rare variant of fibroadenomas. The clinical presentation is usually a painless, fast growing, unilateral tumor mass. In this article we present the case of a giant juvenile fibroadenoma of 12 cm in diameter in the breast of a 13-year-old girl. A radiological and histological study of the lesion was carried out and it was categorized as a juvenile giant fibroadenoma, so a complete lumpectomy with posterior breast remodeling was performed. After two months of follow-up, the patient is without signs of recurrence, in good general condition and waiting for the breast remodeling surgery.

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INCAP sigue trabajando y mejorando el funcionamiento del Software NutrINCAP, como una herramienta práctica que pueda fortalecer el desarrollo profesional en el área de evaluación del consumo de alimentos en individuos o grupos de población y a partir de la versión 4.0 de NutrINCAP, se facilita el análisis nutricional con la Tabla de Composición de Alimentos del INCAP del año 2018 y, por consiguiente, con nutrientes nuevos como: azúcares (g), Cobre (mg), Selenio (mcg), Ácido pantoténico (mg) (Vit. B5), Folato alimentario (mcg), Retinol (mcg), Vitamina E (mg), Vitamina D (mcg) y Vitamina K (mcg). Con la presente nota técnica, se pretende explicar brevemente la nueva información obtenida con respecto a los azúcares y azúcares libres, y con qué módulos del Software puede obtenerse

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Pediatric elevated blood pressure (BP) and hypertension are usually defined using traditional BP tables at the 90th and 95th percentiles, respectively, based on sex, age, and height, which are cumbersome to use in clinical practice. The authors aimed to assess the performance of the static cut-points (120/80 mm Hg and 130/80 mm Hg for defining elevated BP and hypertension for adolescents, respectively; and 110/70 mm Hg and 120/80 mm Hg for children, respectively) in predicting increased arterial stiffness. Using data from five population-based cross-sectional studies conducted in Brazil, China, Korea, and New Zealand, a total of 2546 children and adolescents aged 6-17 years were included. Increased arterial stiffness was defined as pulse wave velocity ≥sex-specific, age-specific, and study population-specific 90th percentile. Compared to youth with normal BP, those with hypertension defined using the 2017 American Academy of Pediatrics guideline (hereafter referred to as "percentile-based cut-points") and the static cut-points were at similar risk of increased arterial stiffness, with odds ratios and 95% confidence intervals of 2.35 (1.74-3.17) and 3.07 (2.20-4.28), respectively. Area under the receiver operating characteristic curve and net reclassification improvement methods confirmed the similar performance of static cut-points and percentile-based cut-points (P for difference > .05). In conclusion, the static cut-points performed similarly well when compared with the percentile-based cut-points in predicting childhood increased arterial stiffness. Use of static cut-points to define hypertension in childhood might simplify identification of children with abnormal BP in clinical practice.

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Chemical communication plays an essential role in several social and reproductive behaviors of many animals. In lizards, the main sources of semiochemicals are femoral or pre-anal gland secretions and feces. In male lizards Psammodromus algirus, there are age-related differences in the chemical composition of femoral gland secretions and in the reproductive strategies, with older males defending territories and females, while younger males adopting sneak-mating strategies. Females flee more often from mating advances of young males than from those of old males, which are more successful in obtaining matings. This suggests that age discrimination of males may be important for females. We tested here whether females showed differential chemosensory responses to chemical cues (femoral gland secretion and feces) of males of two age classes, and whether females use information from substrate scent marks of males of different ages to select where to stay. We found that females elicited more tongue-flicks to the secretion and feces of old males than to control or secretion and feces of young males. Also, the time spent by females on a scented paper depended on the treatment, suggesting that females tended to spend more time on scent marks made with femoral secretions of old males. Adult females seemed capable to discriminate between young and old males based on chemical cues alone and showed more interest in scents of old males. However, substrate scent marks did not seem to entirely determine site selection by females, suggesting that females might need additional cues to perform the choice. These results can be explained by the different age-dependent reproductive strategies of males, which can affect differentially to females.

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Resumen Objetivos: Describir los patrones de prescripción de los medicamentos para la diabetes mellitus tipo 2 (DM2) y comorbilidades de pacientes atendidos en cinco instituciones prestadoras de servicios de salud de Colombia. Metodología: Estudio descriptivo transversal, en el cual se revisaron las historias clínicas de 5098 pacientes con DM2, atendidos en centros de atención ambulatoria ubicados en cinco ciudades colombianas entre el 1.º de enero y el 31 de diciembre de 2014. Cada uno de los pacientes con DM2 tenía al menos dos consultas ambulatorias registradas durante el periodo de estudio. La recolección de la información se hizo mediante una encuesta electrónica. Para la categorización de los medicamentos se usaron las guías nacionales e internacionales para el tratamiento de la diabetes. El análisis de los datos fue realizado utilizando el programa IBM SPSS® Statistics versión 21. Resultados: El medicamento de más frecuente prescripción fueron las biguanidas (59 %) y las sulfonilureas (28 %). La prescripción de inhibidores de la dipeptidil peptidasa-4 fue 7 % y la frecuencia de prescripción de agonista del receptor del péptido similar al glucagón tipo 1 (AR GLP-1) fue de 2 %. El medicamento con mayor frecuencia de prescripción como monoterapia fueron las biguanidas (22 %). La combinación más frecuente fue biguanida y las sulfonilureas (21 %), seguida de biguanida e insulina (10 %), y otras combinaciones. El 27 % pacientes con DM2 no recibió ningún tratamiento farmacológico para la diabetes. Con respecto a los medicamentos para comorbilidades, el 52 % de los pacientes utiliza al menos un tipo de antihipertensivo, el 39 % usa al menos un tipo de hipolipemiante y el 35 % utiliza ácido acetilsalicílico. Conclusiones: Las biguanidas fueron el medicamento con mayor frecuencia de prescripción, seguido de las sulfonilureas. Uno de cada cuatro pacientes no tenía registro de prescripción de medicamentos. El uso de ácido acetilsalicílico como prevención del riesgo cardiovascular fue menor al esperado.

Abstract Objetive: to describe the patterns of medicine prescriptions for diabetes mellitus type 2 (dm2) and the comorbidity of patients in five health care institutions in Colombia. Methodology: descriptive cross-sectional study carried out checking the medical records of 5098 patients with dm2 treated at the outpatient service centers in five Colombian cities between January 1 and December 31 of 2014. Each patient with dm2 had a record of at least two outpatient appointments registered during the time of this study. The information was collected through electronic surveys. National and international guides on diabetes treatment were used to categorize the medications. The spss® 21 software was used to analyze the data. Results: the most frequently prescribed medications were biguanides (59%) and sulfonylureas (28%). The prescription of inhibitors for Dipeptidyl peptidase-4 was 7% and the frequency of prescription of glucagon-like peptide-1 receptor agonists (ar glp-1) was 2%. The medication with the highest frequency of prescription as monotherapy were biguanides (22%). The most frequent combination was biguanide and sulfonylureas (21%). The second most frequent combination was biguanide with insulin (10%), and other combinations. 27% of patients with dm2 did not receive any pharmacological treatment for diabetes. Regarding the medicines for comorbidity, 52% of patients use at least one type of antihypertensive drug, 39% use at least one type of hypolipidemic drug and 35% uses acetylsalicylic acid. Conclusions: biguanides were the most frequently prescribed medication, sulfonylureas came after. One in four patients did not have a record of medicine prescription. The prescription of acetylsalicylic acid to prevent cardiovascular risk was lower than expected.

Resumo Objetivo: descrever os padrões de prescrição dos medicamen tos para a Diabetes Mellitus tipo 2 (dm2) e de comorbilidades de pacientes atendidos em cinco instituições de serviço de saú de da Colômbia. Metodologia: estudo descritivo transversal, no qual revisaram-se as histórias clínicas de 5098 pacientes com dm2, atendidos em centros de atendimento ambulatorial localizados em cinco cidades colombianas, entre 1 de janeiro e 31 de dezembro de 2014. Cada paciente com dm2 tinha pelo menos duas consultas ambulatoriais registradas durante o pe ríodo do estudo. A informação coletou-se através de inquérito eletrônico. Para a categorização dos medicamentos, utiliza ram-se os guias nacionais e internacionais para o tratamento da diabete. A análise dos dados realizou-se utilizando o progra ma spss® 21. Resultados: os medicamentos de prescrição mais frequente foram biguanidas (59%) e as sulfoniluréias (28%). A prescrição de inibidores da dipeptidil peptidase IV foi 7% e a frequência de prescrição de agonista do receptor do péptido si milar ao glucagão tipo 1 (ar glp-1) foi de 2%. O medicamento com mais frequência de prescrição como monoterapia foi as biguanidas (22%). A combinação mais frequente foi biguanida e sulfoniluréias (21%). A segunda combinação mais frequente foi biguanida com insulina (10%), e outras combinações. 27% dos pacientes com dm2 não recebeu tratamento farmacológi co nenhum para a diabetes. Respeito dos medicamentos para comorbilidades, 52% dos pacientes utiliza pelo menos um tipo de anti-hipertensivo, 39% utiliza pelo menos um tipo de hi polipemiante e 35% utiliza ácido acetilsalicílico. Conclusões: as biguanidas foram o medicamento com mais frequência de prescrição, e depois as sulfoniluréias. Um de quatro pacientes não rinha registro de prescrição de medicamentos. O uso de ácido acetilsalicílico como prevenção do risco cardiovascular foi menor do que se esperava.

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Resumen Introducción: La púrpura de Henoch-Schönlein es la vasculitis más frecuente en la infancia. La afectación renal continúa siendo la causa de morbimortalidad principal en niños. El espectro del compromiso renal va desde manifestaciones leves hasta el desarrollo de síndrome nefrótico o nefrítico, o insuficiencia renal. Objetivo: Determinar las características clínicas al comienzo y el compromiso renal de los pacientes con diagnóstico definitivo de púrpura de Henoch-Schönlein, durante el primer mes, a los 3 meses y al ario de seguimiento. Métodos: Estudio descriptivo, retrospectivo, de pacientes con diagnóstico definitivo de púrpura de Henoch-Schönlein, de la consulta de Reumatología Pediátrica, en una institución de Bogotá, Colombia, en el período comprendido de 2010 a 2016. Resultados: Ochenta y seis pacientes fueron incluidos en el estudio, 42 niñas y 44 niños, edad media de presentación 5,3 años, DE 2,4 años (1a14anos). Se presentó compromiso renal en 39 pacientes (45%). Se evidenció una tendencia mayor a compromiso renal entre los pacientes con artritis (p = 0,053). El hallazgo clínico más frecuente fue proteinuria aislada (49%), seguido de proteinuria/hematuria (28%) y hematuria aislada en el 15%. Había 8/39 pacientes con compromiso renal durante el año de seguimiento que fueron llevados a biopsia, 6 (75%) con compromiso renal al inicio y 25% al mes. El promedio de seguimiento fue de 26,8 meses con una desviación estándar de 17 meses (1 a 72 meses), no hubo disfunción renal a la última valoración en ninguno de los 39 pacientes con compromiso renal. Conclusión: El compromiso renal fue más frecuente en las primeras semanas de la enfermedad, así como en las formas severas.

Abstract Introduction: Henoch-Schönlein Purpura is the most common vasculitis in children, with Henoch-Schönlein Purpura kidney involvement remaining the main cause of morbidity and mortality. The spectrum of Kidney involvement of kidney involvement ranges from mild symptoms to the development of a nephrotic and/or nephritic syndrome or kidney failure. Objective: To determine the clinic features at onset, and kidney involvement of patients with a final diagnosis of Henoch-Schönlein Purpura during the first month, 3 months, and up to the first year of follow-up. Methods: A retrospective study conducted on patients with a final diagnosis of Henoch-Schönlein Purpura in a Paediatric Rheumatology Department in an institution of Bogota, Colombia, during the period between 2010 and 2016. Results: The study included 86 patients, 42 girls and 44 boys. The median age at disease onset was 5.3 years (SD 2.4 years: range1-14years). Kidney involvement was present in 39/86 (45%) patients. A trend to kidney involvement was observed in patients with abdominal symptoms (p=,053). The most frequent clinical finding was isolated proteinuria (49%), followed of proteinuria/haematuria (28%), and isolated hematuria (15%). Renal biopsy was performed on 8/39 patients with Henoch-Schönlein Purpura nephritis. The mean follow-up was 26.8 months (SD 17 months: range 1-72). There was no evidence of kidney damage in the last assessment in any of the 39 patients with kidney involvement. Conclusion: In this group of patients, kidney involvement was more severe and common in the first weeks of the disease onset.

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El sobrepeso y la obesidad son un problema de salud pública para México, razón por la cual el gobierno ha implementado varias acciones para controlarlo. En el caso del grupo de edad entre doce y quince años, estas acciones son promovidas principalmente en las escuelas. El objetivo de este trabajo fue analizar el grado de implementación y efectividad de las acciones efectuadas, desde la perspectiva de los agentes escolares responsables, a fin de establecer modificaciones sustentadas en la Teoría Social Cognitiva para mejorar su efectividad. La investigación fue de tipo cualitativo y basada en el método de casos. A partir del análisis temático de dos casos de escuelas secundarias públicas, se identificaron dos elementos críticos de mejora apoyados teóricamente en la literatura y la información generada: la participación de los padres de familia y la implementación de un modelo educativo que promueva el aprendizaje significativo y el desarrollo de competencias de autorreflexión, autoeficacia y prevención.

Overweight and obesity are a public health problem for Mexico, which is why the government has implemented several actions in order to bring it under control. In the case of the age group between ages twelve and fifteen, these actions are mainly promoted in schools. The purpose of this work was to analyze from the point of view of the school agents responsible, the implementation and effectiveness degree of the actions performed. The aim is to establish adjustments supported by the Social Cognitive Theory, in order to improve their effectiveness. This was a qualitative type research based on the case method. We identified two critical elements for improvement, with theoretical bases on the literature and the information generated, obtained from the theme analysis of two public high schools: Participation of the parents and the implementation of an educational model that promotes meaningful learning and the development of self-reflection, self-efficiency, and prevention skills.

O sobrepeso e a obesidade sao problema de saúde pública para o México, ração pela que o governo implementou várias ações para controlá-los. No caso da faixa etária entre doce e quinze anos, estas ações sao promovidas principalmente nas escolas. O objetivo deste trabalho foi analisar o grao de implementação e efetividade das ações efetuadas, desde a perspectiva dos agentes escolares responsáveis, a fim de estabelecer alterações sustentadas na Teoria Social Cognitiva para melhorar sua efetividade. A pesquisa foi de tipo qualitativo e baseada no método de casos. A partir da análise temática de dois casos de escolas secundarias públicas, identificaram-se dois elementos críticos de aperfeicoamento apoiados teoricamente na literatura e informação gerada: a participação dos pais e a implementação de um modelo educativo a promover a aprendizagem significativa e o desenvolvimiento de competencias de autorreflexao, autoeficácia e prevenção.

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Many snakes are able to use their chemosensory system to detect scent of conspecifics, which is important in many social contexts. Age discrimination based on chemical cues may be especially important to ensure access to sexually mature potential partners. In this study, we used 24 individual Boa constrictor snakes (12 adults mature and 12 non-mature individuals) that had been captured in different areas of Ecuador, and were maintained in captivity at the Vivarium of Quito. We used tongue-flick experiments to examine whether these snakes were able to discriminate between scents from mature and non-mature individuals. Results showed that B. constrictor snakes used chemical cues to recognize conspecifics and that the scent of individuals of different ages elicited chemosensory responses of different magnitudes. The scents from adult conspecifics elicited the quickest and highest chemosensory responses (i.e., short latency times and high tongue-flick rates), although we did not find differential responses to scent of males and females. The magnitude of the responses was lower to scent of sub adult individuals, and then even lower to scent of juvenile snakes, but in all cases the scent of snakes was discriminated from a blank control. We discuss the potential chemical mechanisms that may allow age recognition and its implications for social and sexual behavior of this snake species.

Muchas serpientes son capaces de usar su sistema quimiosensorial para detectar el olor de individuos coespecíficos, lo que es importante en muchos contextos sociales. La discriminación de la edad basada en señales químicas puede ser especialmente importante para asegurar el acceso a parejas potenciales que sean sexualmente maduras. En este estudio, usamos 24 individuos de una especie de boa (Boa constrictor) (12 individuos adultos y 12 inmaduros) que habían sido capturados en diferentes partes de Ecuador y eran mantenidos en cautividad el Vivarium de Quito. Usamos experimentos de protusiones linguales para examinar si esta serpiente es capaz de discriminar entre el olor de individuos maduros y no maduros. Los resultados mostraron que B. constrictor usa señales químicas para reconocer co-específicos y que el olor de individuos de distinta edad provoca respuestas quimiosensoriales de diferente magnitud. El olor de individuos adultos provocó las respuestas más rápidas y elevadas (esto es, tiempos de latencia más cortos y tasas más altas de protusiones linguales), aunque no encontramos diferencias en las respuestas a olores de machos y hembras. La magnitud de las respuestas fue más baja a olores de sub adultos, e incluso más baja a olor de juveniles, pero en todos los casos el olor de una serpiente era discriminado de un control no oloroso. Discutimos los posibles mecanismos químicos que pueden permitir esta discriminación de la edad y sus implicaciones para el comportamiento social y sexual de esta serpiente.

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Many snakes are able to use their chemosensory system to detect scent of conspecifics, which is important in many social contexts. Age discrimination based on chemical cues may be especially important to ensure access to sexually mature potential partners. In this study, we used 24 individual Boa constrictor snakes (12 adults mature and 12 non-mature individuals) that had been captured in different areas of Ecuador, and were maintained in captivity at the Vivarium of Quito. We used tongue-flick experiments to examine whether these snakes were able to discriminate between scents from mature and non-mature individuals. Results showed that B. constrictor snakes used chemical cues to recognize conspecifics and that the scent of individuals of different ages elicited chemosensory responses of different magnitudes. The scents from adult conspecifics elicited the quickest and highest chemosensory responses (i.e., short latency times and high tongue-flick rates), although we did not find differential responses to scent of males and females. The magnitude of the responses was lower to scent of sub adult individuals, and then even lower to scent of juvenile snakes, but in all cases the scent of snakes was discriminated from a blank control. We discuss the potential chemical mechanisms that may allow age recognition and its implications for social and sexual behavior of this snake species.

Assuntos

RESUMO

Lung cancer is the most frequent cause of cancer death worldwide and its global incidence has been steadily increasing during recent decades. A third of patients with newly diagnosed non-small-cell lung cancer (NSCLC) present with locally advanced disease. There is not a single widely accepted standard of care for these patients because of the wide spectrum of presentation of the disease. Although feasible and safe in experienced hands, evidence that surgical resection after induction treatment improves overall survival (OS) is lacking. For resectable or potentially resectable stage III, the findings of two phase III trials suggest that surgical resection should not be considered a standard of care but rather reserved for selected patients after critical multidisciplinary assessment, in whom surgery improves survival after downstaging if pneumonectomy can be avoided or in some T4N0-1 resectable tumours. For unresectable stage III NSCLC the standard of care is a combination of chemotherapy and radiotherapy. In those patients with good performance status and minimal weight loss, the concurrent approach has resulted in a statistically significant improvement in OS rates compared with a sequential approach in randomised clinical trials, although several questions remain unresolved.

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