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BACKGROUND: The burden of disease of diabetes in Colombia have increased in the last decades. Secondary prevention is crucial for diabetes control. Many patients already treated remain with poor glycemic control and without timely and appropriate treatment intensification. This has been called in the literature as Clinical Inertia. Updated information regarding clinical inertia based on the Colombian diabetes treatment guidelines is needed. OBJECTIVE: To measure the prevalence of clinical inertia in newly diagnosed Type 2 Diabetes Mellitus (T2DM) patients in healthcare institutions in Colombia, based on the recommendations of the current official guidelines. METHODS: An observational and retrospective cohort study based on databases of two Health Medical Organizations (HMOs) in Colombia (one from subsidized regimen and one from contributory regimen) was conducted. Descriptive analysis was performed to summarize demographic and clinical information. Chi-square tests were used to assess associations between variables of interest. RESULTS: A total of 616 patients with T2DM (308 for each regimen) were included. Median age was 61 years. Overall clinical inertia was 93.5% (87.0% in contributory regimen and 100% in subsidized regimen). Patients with Hb1Ac ≥ 8% in the subsidized regimen were more likely to receive monotherapy than patients in the contributory regimen (OR 2.33; 95% CI 1.41-3.86). CONCLUSIONS: In this study, the prevalence of overall clinical inertia was higher in the subsidized regime than in the contributory regime (100% vs 87%). Great efforts have been made to equalize the coverage between the two systems, but this finding is worrisome with respect to the difference in quality of the health care provided to these two populations. This information may help payers and clinicians to streamline strategies for reducing clinical inertia and improve patient outcomes.

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BACKGROUND: Arthropod-borne flaviviruses like dengue virus (DENV) and yellow fever virus (YFV) are major human pathogens. In Latin America, YFV is maintained in sylvatic cycles involving non-human primates (NHP) and forest-dwelling mosquitos. YFV supposedly does not circulate north of Panama. METHODS: We conducted a serologic study for flaviviruses and other emerging viruses in NHP from southeastern Mexico. A total of thirty sera of black-handed spider monkeys (Ateles geoffroyi, n = 25), black howler monkeys (Alouatta pigra, n = 3), and mantled howler monkeys (Al. palliata, n = 2) sampled in 2012 and 2018 were screened by an indirect immunofluorescence assay (IFA) to detected IgG antibodies against DENV, YFV, Zika virus (ZIKV), West Nile virus (WNV), Rift Valley fever virus, Crimean-Congo hemorrhagic fever virus, Middle East respiratory syndrome coronavirus, and Zaire Ebola virus, and confirmed by plaque reduction neutralization tests (PRNT90) representing all mosquito-borne flavivirus serocomplexes circulating in the Americas. RESULTS: A total of 16 sera (53.3%; 95% CI, 34.3-71.7) showed IFA reactivity to at least one tested flavivirus with end-point titers ranging from 1:100 to 1:1000. No serum reacted with other viruses. Monotypic and high mean PRNT90 endpoint YFV titers of 1:246 were found in 3 black-handed spider monkey sera (10.0%; 95% CI, 2.1-26.5) sampled in 2018 in Tabasco, compared to all other flaviviruses tested. Monotypic endpoint PRNT90 titers of 1:28 for Ilheus virus and 1:22 for WNV in serum of black howler monkeys sampled in 2018 in Tabasco suggested additional flavivirus exposure. CONCLUSIONS: Our findings may suggest unnoticed YFV circulation. Intensification of YFV surveillance in NHP and vectors is warranted in Mexico and potentially other areas considered free of yellow fever.

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Bats are important natural reservoir hosts of a diverse range of viruses that can be transmitted to humans and have been suggested to play an important role in the Zika virus (ZIKV) transmission cycle. However, the exact role of these animals as reservoirs for flaviviruses is still controversial. To further expand our understanding of the role of bats in the ZIKV transmission cycle in Latin America, we carried out an experimental infection in wild-caught Artibeus lituratus bats and sampled several free-living neotropical bats across three countries of the region. Experimental ZIKV infection was performed in wild-caught adult bats (4 females and 5 males). The most relevant findings were hemorrhages in the bladder, stomach and patagium. Significant histological findings included inflammatory infiltrate consisting of a predominance of neutrophils and lymphocytes, in addition to degeneration in the reproductive tract of males and females. This suggests that bat reproduction might be at some level affected by ZIKV. Leukopenia was also observed in some inoculated animals. Hemorrhages, genital alterations, and leukopenia are suggested to be caused by ZIKV; however, since these were wild-caught bats, we cannot exclude other agents. Detection of ZIKV by qPCR was observed at low concentrations in only two urine samples in two inoculated animals. All other animals and tissues tested were negative. Finally, no virus-neutralizing antibodies were found in any animal. To determine ZIKV infection in nature, the blood of a total of 2056 bats was sampled for ZIKV detection by qPCR. Most of the sampled individuals belonged to the genus Pteronotus sp. (23%), followed by the species Carollia sp. (17%), Anoura sp. (14%), and Molossus sp. (13.7%). No sample of any tested species was positive for ZIKV by qPCR. These results together suggest that bats are not efficient amplifiers or reservoirs of ZIKV and may not have an important role in ZIKV transmission dynamics.

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BACKGROUND AND OBJECTIVE: Vestibular disorders are linked to a group of pathologies that can affect the vestibular part, the auditory part, or both parts of the inner ear. The problem in this study is the little information that exists about the audiological profile of people suffering from vestibular disorders in Costa Rica. There are international research studies on this topic, but there are no records of studies conducted in the Costa Rican population. This is why there is interest in developing this research which aims to characterize the audiological profile and the levels of handicap in people with vestibular disorders under Centro Equilibra, Vertigo and Equilibrio consultation during the months of September to November 2019. PATIENTS AND METHODS: A descriptive, cross-sectional, quantitative, and observational analytical study with patients over 18 years old who attended Centro Equilibra. The main variables analysed were sex, age, personal pathological history, medical diagnosis, main vestibular symptoms, auditory manifestations, and levels of handicap. RESULTS: The data was obtained from 177 people; vestibular disorders occurred more in the female sex (ratio 2.6:1). The mean age was 56 years. Fifty-three point seven percent presented slight sensorineural hearing loss, gradually decreasing. Of the population, 33.9% presented tinnitus, mostly at high frequencies. In the adult population, 52% presented some level of hearing handicap, unlike older adults, where the majority (77%) did not present any level of handicap. People with vestibular disorders perceive greater physical handicap (83%). CONCLUSIONS: Hearing loss was the most common hearing manifestation and although statistical analysis shows that it is not directly related to vestibular disorders, it is related to concomitant metabolic diseases. For this reason, it is necessary to promote the prevention of metabolic diseases as one of the measures to improve hearing health, even from an early age.

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Background: There is scarce information on the burden of invasive pneumococcal disease (IPD) among adults in low- and middle-income countries. This study aimed to describe the clinical outcomes and microbiological characteristics associated with IPD in adults and subgroups aged 18-59 years and ≥60 years in Colombia. Methods: A retrospective chart review study was conducted in five institutions of Bogotá from January 2011 to December 2017. Analyses were carried out for overall population and stratified by age group (18-59; ≥ 60 years). Results: There were 169 IPD cases; median age was 58 years, 51.5% were male, and 80.5% had at least one comorbidity. Bacteremic pneumonia was the most common presentation (63.9%). The median length of hospital stay was 12 days with high healthcare resource utilization (HCRU): 58.6% required ICU and 53.3% inotropic support. Overall case-fatality rate (CFR) was 41.4%. Clinical outcomes were worse in patients ≥60 years old with significantly higher CFR and HCRU (ICU admission, mechanical ventilation, and inotropic support) compared to those aged 18-59 years. The most frequent serotypes were 3, 6 A/C, 14, and 19A. The sensitivity to penicillin in meningitis and non-meningitis isolates were 75% and 89.1% respectively. Conclusions: IPD was associated with a substantial burden in adults and worse clinical outcomes and HCRU in older adults in Colombia. Surveillance data combined with clinical outcomes have the potential to inform age-based pneumococcal vaccination policies.

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INTRODUCTION: HIV is an independent risk factor for cardiovascular diseases (CVD). There is insufficient information regarding comorbidities and cardiovascular risk factors in the Colombian HIV population. The aim of this study is to describe the prevalence of cardiovascular risk factors and comorbidities in patients from the HIV Colombian Group VIHCOL. METHODS: This is a multicenter, cross-sectional study conducted in the VIHCOL network in Colombia. Patients 18 years or older who had at least 6 months of follow-up were included. A stratified random sampling was performed to estimate the adjusted prevalence of cardiovascular risk factors and comorbidities. RESULTS: A total of 1616 patients were included. 83.2% were men, and the median age was 34 years. The adjusted prevalence for dyslipidemia, active tobacco use, hypothyroidism, and arterial hypertension was 51.2% (99% CI: 48.0%-54.4%), 7.6% (99% CI: 5.9%-9.3%), 7.4% (99% CI: 5.7%-9.1%), and 6.3% (99% CI: 4.8%-7.9%), respectively. CONCLUSIONS: In this Colombian HIV cohort, there is a high prevalence of modifiable CVD risk factors such as dyslipidemia and active smoking. Non-pharmacological and pharmacological measures for the prevention and management of these risk factors should be reinforced.

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BACKGROUND AND OBJECTIVE: Vestibular disorders are linked to a group of pathologies that can affect the vestibular part, the auditory part, or both parts of the inner ear. The problem in this study is the little information that exists about the audiological profile of people suffering from vestibular disorders in Costa Rica. There are international research studies on this topic, but there are no records of studies conducted in the Costa Rican population. This is why there is interest in developing this research which aims to characterize the audiological profile and the levels of handicap in people with vestibular disorders under Centro Equilibra, Vertigo and Equilibrio consultation during the months of September to November 2019. PATIENTS AND METHODS: A descriptive, cross-sectional, quantitative, and observational analytical study with patients over 18years old who attended Centro Equilibra. The main variables analysed were sex, age, personal pathological history, medical diagnosis, main vestibular symptoms, auditory manifestations, and levels of handicap. RESULTS: The data was obtained from 177 people; vestibular disorders occurred more in the female sex (ratio 2.6:1). The mean age was 56years. Fifty-three point seven percent presented slight sensorineural hearing loss, gradually decreasing. Of the population, 33.9% presented tinnitus, mostly at high frequencies. In the adult population, 52% presented some level of hearing handicap, unlike older adults, where the majority (77%) did not present any level of handicap. People with vestibular disorders perceive greater physical handicap (83%). CONCLUSIONS: Hearing loss was the most common hearing manifestation and although statistical analysis shows that it is not directly related to vestibular disorders, it is related to concomitant metabolic diseases. For this reason, it is necessary to promote the prevention of metabolic diseases as one of the measures to improve hearing health, even from an early age.

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Resumen Las familias, en la actualidad, enfrentan nuevos retos y cambios que comprometen su capacidad de adaptación y su bienestar. Este estudio tuvo como objetivo describir y comparar indicadores de resiliencia familiar y bienestar familiar de 442 familias colombianas ubicadas geográficamente en Bogotá (n = 196), Santa Marta (n = 81) y Cali-Palmira (n = 145). El diseño fue analítico transversal. Las familias diligenciaron el Índice Familiar de Regeneración y Adaptación (FIRA-G) para valorar la resiliencia y el Índice de Bienestar de los miembros de la Familia (FMWB). Los resultados demostraron relaciones significativas y positivas entre bienestar familiar y resiliencia familiar al igual que una relación inversa y significativa entre indicadores de resiliencia negativos como tensión, distrés y tensión familiar con indicadores positivos de resiliencia familiar tales como coherencia, fortaleza y apoyo social. La comparación entre ciudades evidenció divergencias entre las familias de Bogotá y Cali-Palmira, en los niveles de bienestar familiar, estresores familiares y apoyo de parientes y amigos. En el caso de la ciudad de Santa Marta se encuentran diferencias en los estresores familiares con Cali-Palmira y en apoyo social comunitario con Bogotá. La discusión se orienta a mostrar que la resiliencia familiar es resultado de la participación de varios elementos: los recursos familiares adaptativos positivos que le permiten a las familias reducir el estrés y enfrentar las demandas del ambiente, la presencia de los dos padres en familias sin indicadores clínicos que hace que la carga de estrés sea compartida -lo cual abona el terreno para la resiliencia familiar-, y el apoyo social manifestado en ayudas externas al núcleo familiar por parte de la comunidad, los parientes y los amigos.

Abstract Currently, modern families are coping with different stressful situations. The family studies are focused on the conceptual perspective, political perspective and methodological topic and they leave aside the familiar dynamics and functioning. This paper was interested in describing and comparing indicators of family resilience and family welfare of 442 Colombian families. This study had three hypotheses: The first one is focused on differences in well-being family dimension per location; the second hypothesis was focused on significant differences in family resilience per location, and the third one was interested in significant relations in family resilience and family well-being. The theoretical support to this research is the McCubbin and Patterson's resilience model called Double ABCX and Family Adaptation and Adjust Response Model by Patterson. The family well-being is considered a result of internal family functioning and is measured by the family member perception about the concern about health problems, fears, anger and sadness. Family resilience is understood as the capacity to recover from adversity. This capacity strengthens families and improves their resources. In this theoretic resilience approach the resilience is a dynamic result to the adaptation phase and the family well-being is the final adjustment. The design was cross-sectional analytical with a convenience sample. The families were interviewed in their homes, from each family both parents and a child between 9 and 17 years old participated. They are located geographically in Bogotá (n = 196), Santa Marta (n = 81) and Cali-Palmira (n = 145). Families completed the Family Member Well-being Index (FMWB) and the Family Regeneration and Adaptation Index (FIRA-G) to assess resilience. Families residing in Bogotá showed significant differences with those of Cali-Palmira in the dimension of family well-being, family stress and support from friends and family. While families located in Santa Marta showed differences with respect to the families located in Cali-Palmira in family stress and in community and social support. The father correlations between the family resilience index and the well-being family index is strong and inverse with the family stress and the family well-being summarized. The mother well-being family perception is significant associated with family resilience, and these correlations was strongest with family well-being summarized. The family stress index, strains and distress exposed moderate and inverse relations with the positive resilience family summarized. The discussion deals with family resilience as a product of the dynamic interaction in the hole family system and is oriented to the fact that the presence of support from family and friends reduces the burden of family stress, promotes support in the face of crisis and, in general, improves the well-being and family adaptation. In general, the differences reflect varied resilience trajectories that depend on the challenges posed by the close context of the city where they live. An approach to this result leads us to think as a hypothesis not yet widely explored, in the mobility factor of cities, which limits contact with close family networks. In big cities like Bogotá, its internal mobility compromises the times and spaces of daily life, and thus allows or prevents families from organizing their relationships in the different areas of their social life. Resilience occurs through positive adaptive family resources that included social support and family coherence and allow families to reduce stress and meet the demands of the environment. On the other hand, the presence of the two parents in families without clinical indicators shows that the burden of shared stress helps family resilience, which is also fed by the presence of external aids to the family nucleus, such as the support of the community, family and friends.

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RESUMEN Introducción: La psiquiatría cultural evalúa las manifestaciones, los síntomas de sufrimiento emocional o los trastornos mentales en los distintos contextos culturales; asimismo, aborda problemas sociales como la pobreza, la violencia y las desigualdades entre grupos o clases sociales. Objetivo: Presentar una revisión narrativa de los aspectos culturales más relevantes en el contexto de la práctica clínica en psiquiatría y proponer algunas alternativas para mejorar la competencia cultural de los profesionales de la salud. Métodos: Se llevó a cabo una revisión narrativa de los artículos más relevantes en el área. Resultados: Habitualmente se utiliza la perspectiva cultural para explicar diferencias en las prevalencias que se observan en algunos trastornos mentales según el sexo y la localización geográfica. Las diferencias culturales modifican la expresión de distress o sufrimiento emocional, y esto puede reducir la precisión y afectar a la confiabilidad de las clasificaciones y la validez de los diagnósticos actuales usados en psiquiatría. La Asociación Psiquiátrica Americana, en la clasificación más reciente, revisó los trastornos asociados con la cultura pero solo incluyó un reducido número de situaciones. La formación médica y la psiquiatría deben responder a las necesidades de comunidades diversas y proporcionar un cuidado de calidad mediante el desarrollo de competencias transculturales en los currículos. Conclusiones: Se debe considerar que las diferencias culturales modifican la expresión de distress y con ello se menoscaba la validez y la confiabilidad de los diagnósticos hegemónicos en distintos contextos culturales. En un mundo cada vez más globalizado, es posible que futuras clasificaciones diagnósticas omitan los «síndromes culturales¼.

ABSTRACT Background: Cultural psychiatry evaluates manifestations, symptoms of emotional distress and mental disorders in diverse cultural contexts; it also addresses social problems such as poverty, violence, inequalities between groups or social classes. Objective: To present a narrative review of the most relevant cultural aspects in the context of clinical practice in psychiatry and to suggest some alternatives to improve the cultural competence of health care professionals. Method: A narrative review was carried out of the most relevant articles in the area. Results: Usually, the cultural argument is used to explain differences in observed prevalences in some mental disorders according to gender and geographical location. Cultural differences modify the expression of emotional distress and this can reduce the accuracy and affect the reliability and validity of the current diagnostic classification used in psychiatry. The American Psychiatric Association, in the most recent classification, revised cultural syndromes but only included a limited number of situations. Consequently, medical education and psychiatry must respond to diverse populations and provide quality care through the development of trans-cultural competence in the curriculum. Conclusions: It should be considered that cultural differences modify the expression of distress and thereby undermine the validity and reliability for diagnoses in distinct cultural contexts. In an increasingly globalised world, future classifications may completely omit 'cultural syndromes'.

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Introducción: A partir de la aparición de la epidemia COVID-19 se conforma un equipo multidisciplinario en Santiago de Cuba con participación de varias instituciones y activado por el Consejo de defensa provincial. El análisis integrado epidemiológico, la gestión gubernamental y la respuesta social resultarían determinantes en el control de la enfermedad. Objetivos: Identificar posibles grupos de casos con COVID-19 en la provincia Santiago de Cuba y caracterizar su transmisión según variables epidemiológicas. Métodos: Se desarrolló un estudio ecológico, comparándose los clústeres de transmisión de COVID-19. Se resumieron variables de interés y se realizó análisis de redes sociales desde el punto de vista de las relaciones entre casos y contactos, así como análisis espacial. Resultados: Se identificaron cinco grupos espaciales de transmisión en los municipios, uno en Palma Soriano, uno en Contramaestre y tres en Santiago de Cuba. Los antecedentes patológicos personales (hipertensión y procesos respiratorios), el sexo femenino, los casos sintomáticos y el promedio de 22 a 27 contactos por cada confirmado fueron las variables más relevantes. Se identificó fuente de infección introducida en 51 por ciento (25/49). Además, se identificaron redes sociales complejas en la transmisión de la enfermedad. Conclusiones: La transmisión de COVID-19 en la provincia Santiago de Cuba mostró grupos de casos y contactos con redes sociales epidemiológicas características para cada municipio, así como el modo de transmisión de acuerdo a la fuente de infección, relaciones de familiaridad o cercanía social y la relación de distancia espacial entre contactos, aspectos que influyeron en las bajas tasas de incidencia de la enfermedad, con predominio en su forma sintomática, edades jóvenes y en mujeres(AU)

Introduction: From the onset of COVID-19 epidemic, a multidisciplinary team is formed in Santiago de Cuba with the participation of several institutions and activated by the Provincial Defense Council. Integrated epidemiological analysis, government management and social response would be decisive in controlling the disease. Objectives: To identify possible groups of COVID-19 cases in the Santiago de Cuba province and to describe the transmission according to epidemiological variables. Methods: An ecological study was carried out, comparing COVID-19 transmission clusters. Variables of interest were summarized and analysis of social contact networks was carried out from the point of view of the relationships between cases and contacts, as well as spatial analysis. Results: Five spatial transmission groups were identified in the municipalities, one in Palma Soriano, one in Contramaestre and three in Santiago de Cuba. The personal pathological antecedents (hypertension and respiratory processes), female sex, symptomatic cases and the average of 22 to 27 contacts for each confirmed were the most relevant variables. A source of introduced infection was identified in 51 percent (25/49). In addition, complex social networks were identified in the transmission of the disease. Conclusions: The transmission of COVID-19 in Santiago de Cuba province showed groups of cases and contacts with characteristic epidemiological social networks for each municipality, as well as the mode of transmission according to the source of infection, relationships of familiarity or social closeness and the relationship of spatial distance between contacts, which influenced on the low incidence rates of the disease, with predominance of symptomatic form, young ages and in women(AU)

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Quinacrine (Qx), a molecule used as an antimalarial, has shown anticancer, antiprion, and antiviral activity. The most relevant antiviral activities of Qx are related to its ability to raise pH in acidic organelles, diminishing viral enzymatic activity for viral cell entry, and its ability to bind to viral DNA and RNA. Moreover, Qx has been used as an immunomodulator in cutaneous lupus erythematosus and various rheumatological diseases, by inhibiting phospholipase A2 modulating the Th1/Th2 response. The aim of this study was to evaluate the potential antiviral effect of Qx against denominated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Vero E6 cells. The cytotoxicity of Qx in Vero E6 cells was determined by the MTT assay. Afterwards, Vero E6 cells were infected with SARS-CoV-2 at different multiplicities of infections (MOIs) of 0.1 and 0.01 in the presence of Qx (0-30 µM) to determinate the half maximal effective concentration (EC50). After 48 h, the effect of Qx against SARS-CoV-2 was assessed by viral cytotoxicity and viral copy numbers, the last were determined by digital real-time RT-PCR (ddRT-PCR). Additionally, electron and confocal microscopy of Vero E6 cells infected and treated with Qx was studied. Our data show that Qx reduces SARS-CoV-2 virus replication and virus cytotoxicity, apparently by inhibition of viral ensemble, as observed by ultrastructural images, suggesting that Qx could be a potential drug for further clinical studies against coronavirus disease 2019 (COVID-19) infection.

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El objetivo de este estudio fue establecer la relación entre la percepción de las estrategias de afrontamiento familiar y la percepción de bienestar familiar e infantil en familias en condición de vulnerabilidad. La investigación es de corte cuantitativo con diseño analítico transversal. Se evaluaron 113 familias a través de cuestionarios sobre afrontamiento y bienestar familiar; adicionalmente, los hijos diligenciaron un inventario de bienestar infantil. Los resultados demostraron que los hijos reportan mayor puntuación media moderada en bienestar familiar, seguido de los padres y, finalmente, las madres. Para el afrontamiento familiar, las madres demostraron niveles de afrontamiento promedio más alto, seguidas de los padres y los hijos. Las correlaciones bivariadas indicaron relaciones significativas entre el bienestar infantil (IBI), el afrontamiento familiar (Family Coping Index - FAMCI) y el bienestar general percibido. La discusión se concentra en la madre como promotora del bienestar al interior de la familia, los estresores que la familia padece y la relación con experiencias de desplazamiento en el pasado que influyen en las estrategias de afrontamiento seleccionadas.

The objective of this study was to establish the relationship between the perception of family coping strategies and the perception of family and child well-being in families in vulnerable conditions. The research is quantitative with a cross-sectional analytical design. 113 families were evaluated through questionnaires on family coping and well-being; the children also completed a child welfare inventory. Results showed that children report the highest moderate average score in family well-being, followed by fathers and finally mothers. For family coping, mothers demonstrated higher average coping levels, followed by fathers and children. Bivariate correlations indicated significant relationships between child well-being (IBI), family coping coping (Family Coping Index -FAMCI), and perceived general well-being. The discussion focuses on the mother as a promoter of well-being within the family, the stressors that families suffer and the relationship with experiences of displacement in the past that influence the selected coping strategies.

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Embryonal tumors are the new nomenclature of the primitive neuroectodermal tumors or PNET. Their supratentorial location and their manifestation in adult population are not very frequent. Embryonal tumors are conformed from undifferentiated neuroepithelial cells that have the ability to show differentiation to several cell lines. Next is presented a case from an adult male patient with a clinical headache pictures and convulsions. With imaging study that shows a meningeal enhancement with frontal lobe infiltration with histopathological study of embryonic tumor with areas of glial differentiation.

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Abstract: Research on gingival health of 12-year-old schoolchildren in Costa Rica is scarce. Since nutrition is an integral component of oral health, this study aimed to determine gingival status of 12-year-olds at Carmen Lyra Public School, San José, Costa Rica, and correlate these variables with the frequency of intake of different types of food and body mass index (BMI (kg/m2)). Sixty-two 12-year-old schoolchildren were recruited. A periodontist assessed Plaque Index (Silness and Löe,1964), presence of calculus, and Gingival Index (Löe and Silness, 1967). Gingivitis was defined as the presence of bleeding on probing (BOP) on at least one site, and the extent was classified according to the percentage of teeth whose gingiva presented BOP limited: 25-49% of teeth tested; extensive >50% of teeth tested. A semi-quantified food consumption frequency questionnaire was administered. BMI was calculated for each participant. Overall Plaque Index was 1.18. Calculus was present on 40.40% of the sample, 19.4% had supragingival calculus and 21% had either supragingival/subgingival calculus or both. Presence of calculus was related with number of bleeding surfaces (p=0.030). Number of teeth with calculus was related to bleeding(p=0.029), and number of bleeding surfaces (p=0.009). Gingival Index was 0.97, mild gingivitis. Gingivitis was present on 96.8% of children examined. Limited gingivitis was present in 11.5% of children and extensive gingivitis in 88.5%. None of the variables measured differed by gender. No relationships were found between the consumption of starchy foods, animal and vegetable protein sources, fruit, vegetables, fast foods, sugar sweetened beverages and desserts with Plaque Index, calculus, Gingival Index, and BOP. Teeth calculus was related with being overweight (chi- square=0.038). BMI for males was 20.21 and females 20.11. BMI was not related to BOP or calculus. Within the limitations of this pilot study, we concluded the prevalence of gingivitis and calculus is high in the sample examined. A greater sample is needed to determine correlations between the frequency of foods evaluated and gingival health.

Resumen: La investigación sobre la salud gingival en escolares de 12 años en Costa Rica es escasa. Dado que la nutrición es un componente integral de la salud oral, este estudio tuvo como objetivo determinar el estado de salud gingival de los niños de 12 años de la escuela Carmen Lyra, San José, Costa Rica, y correlacionar estas variables con la frecuencia de ingesta de diferentes tipos de alimentos y el índice de masa corporal (IMC (kg/m2)). Sesenta y dos escolares de 12 años fueron reclutados. Una periodoncista calibrada, evaluó el índice de placa (Silness y Löe, 1964), la presencia de cálculo y el índice gingival (Löe y Silness, 1967). La gingivitis se definió como la presencia de sangrado al sondaje en al menos un sitio. La extensión se clasificó de acuerdo con el porcentaje de dientes que presentaba sangrado al sondaje. Entre un 25-49% de los dientes con sangrado al sondaje, gingivitis limitada y extensiva, si presentaba más del 50% de dientes con sangrado al sondaje. Se administró un cuestionario de frecuencia de consumo de alimentos. El IMC se calculó para cada participante. El índice de placa fue de 1,18. El cálculo estuvo presente en el 40.40% de la muestra, el 19.4% tenía cálculo supragingival y el 21% tenía cálculo supragingival / subgingival o ambos. La presencia de cálculo se relacionó con el número de superficies sangrantes (p=0.030). El número de dientes con cálculo, se relacionó con el sangrado (p=0.029) y el número de superficies sangrantes (p=0.009). El índice gingival fue de 0.97, gingivitis leve. La gingivitis estuvo presente en el 96,8% de los niños examinados. La gingivitis limitada estuvo presente en el 11.5% de los niños y la gingivitis extensa en el 88.5%. Ninguna de las variables evaluadas difirió por género. No se encontraron relaciones entre el consumo de harinas, fuentes de proteínas animales y vegetales, frutas, verduras, comidas rápidas, bebidas azucaradas y postres con el índice de placa, cálculo, índice gingival y sangrado al sondaje. El cálculo se relacionó con el sobrepeso (chi-cuadrado=0.038). El IMC para los hombres fue 20.21 y las mujeres 20.11. El IMC no estaba relacionado con el sangrado al sondaje o cálculo. Dentro de las limitaciones de este estudio piloto, concluimos que la prevalencia de gingivitis y cálculo es alta en la muestra examinada. Se necesita una muestra mayor para determinar las correlaciones entre la ingesta de los diferentes tipos de alimentos evaluados y la salud gingival.

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Propolis natural extracts have been used since ancient times due to their antioxidant, anti-inflammatory, antiviral, and antimicrobial activities. In this study, we produced scaffolds of type I collagen, extracted from Wistar Hanover rat tail tendons, and impregnated them with propolis nanoparticles (NPs) for applications in regenerative medicine. Our results show that the impregnation of propolis NPs to collagen scaffolds affected the collagen denaturation temperature and tensile strength. The changes in structural collagen self-assembly due to contact with organic nanoparticles were shown for the first time. The fibril collagen secondary structure was preserved, and the D-pattern gap increased to 135 ± 28 nm, without losing the microfiber structure. We also show that the properties of the collagen scaffolds depended on the concentration of propolis NPs. A concentration of 100 µg/mL of propolis NPs with 1 mg of collagen, with a hydrodynamic diameter of 173 nm, was found to be an optimal concentration to enhance 3T3 fibroblast cell metabolic activity and cell proliferation. The expected outcome from this research is both scientifically and socially relevant since the home scaffold using natural nanoparticles can be produced using a simple method and could be widely used for local medical care in developing communities.

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Objective: To evaluate the cost-effectiveness of ceftolozane/tazobactam + metronidazole (C/T+M) and ceftolozane/tazobactam (C/T) compared with 8 alternatives used in the treatment of complicated intraabdominal infection (cIAI) and complicated urinary tract infection (cUTI) respectively. Methods: A Monte Carlo simulation decision model was used for the estimation and comparison of treatment-related costs, and quality adjusted life years for patients with cIAI treated with C/T+M in comparison with cefepime + metronidazole, ciprofloxacin + metronidazole, doripenem, levofloxacin + metronidazole, meropenem, piperacillin/tazobactam, ceftazidime + metronidazole or imipenem/cilastatin and patients with cUTI treated with C/T in comparison with cefepime, ciprofloxacin, doripenem, levofloxacin, meropenem, piperacillin/tazobactam, ceftazidime or imipenem/cilastatin. Local costs were estimated using base cases identified by experts and consulting local databases. Sensitivity values of the PACTS (Program to Assess Ceftolozane/Tazobactam Susceptibility) study in Latin America were used in the model. Results: C/T+M and C/T obtained incremental cost-effectiveness ratios (ICER) that were below the Colombian cost-effectiveness threshold (3 GDP per capita) in most comparisons, and were dominated by meropenem, considering only gram-negative microorganisms. Sensitivity assessments were also carried out, in which only the population with P. aeruginosa infections was considered, showing positive results for C/T+M and C/T (cost-effective or dominant with regards to all comparators). Conclusions: C/T+M and C/T could be cost-effective alternatives in the treatment of CIAI and CUTI in Colombia, when there is an adequate and rational use of antibiotics. The results of the sensitivity analyses showed dominance and cost-effectiveness with regards to every comparator in patients infected with P. aeruginosa

Objetivo: Evaluar la costo-efectividad de ceftolozano/tazobactam + metronidazol (C/T + M) y ceftolozano/tazobactam (C/T) en comparación con 8 alternativas utilizadas en el tratamiento de las infecciones intraabdominales complicadas (IAAc) e infecciones del tracto urinario complicadas (ITUc) respectivamente. Métodos: Se usó un modelo de decisión de simulación de Monte Carlo para la estimación y comparación de los costos relacionados con el tratamiento y los años de vida ajustados por calidad para pacientes con IAAc tratados con C/T + M, en comparación con cefepima + metronidazol, ciprofloxacina + metronidazol, doripenem , levofloxacina + metronidazol, meropenem, piperacilina / tazobactam, ceftazidima + metronidazol o imipenem/cilastatina, y pacientes con ITUc tratados con C/T en comparación con cefepime, ciprofloxacina, doripenem, levofloxacina, meropenem, piperacilina / tazobactam, ceftazidima o imipenem/cilastatina . Los costos locales se estimaron por medio de casos base identificados por expertos y consultando bases de datos locales. Se utilizaron los valores de sensibilidad bacteriana del estudio PACTS (Programa para evaluar la susceptibilidad al ceftolozano/tazobactam) en América Latina para poblar el modelo. Resultados: C/T + M y C/T obtuvieron razones de costo-efectividad incrementales (RCEI) que estaban por debajo del umbral de costo-efectividad colombiano (3 PIB per cápita) en la mayoría de las comparaciones, y fueron dominados por meropenem, considerando solo microorganismos gran-negativos También se llevaron a cabo análisis de sensibilidad, en los que solo se consideró la población con infecciones por P. aeruginosa, mostrando resultados positivos para C/T + M y C/T (costo efectivo o dominante con respecto a todos los comparadores). Conclusiones: C/T + M y C/T podrían ser alternativas costo efectivas en el tratamiento de IAAc e ITUc en Colombia, cuando existe un uso adecuado y racional de antibióticos. Los resultados de los análisis de sensibilidad mostraron dominio y costo-efectividad en relación con todos los comparadores en pacientes infectados con P. aeruginosa.

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La burla emerge como una acción simbólica en la relación burlón-burlado. Usualmente se expresa en la modalidad hostil o en la modalidad amigable. El propósito de este artículo es reflexionar acerca de la noción de desarrollo que subyace a los estudios de la burla. Para cumplir con este objetivo se adoptaron los postulados de Jaan Valsiner acerca de los axiomas que conducen la investigación y las matrices de pensamiento psicológico que dan sentido a la re-organización de las teorías del desarrollo en tres modelos: Diferenciación, Equilibración y Enseñanza-aprendizaje. La revisión muestra una distribución de los estudios de la burla en el axioma no evolutivo y en el axioma evolutivo. Los estudios en el axioma evolutivo se caracterizan por la identificación de capacidades y habilidades cognitivas y sociales que se complejizan con la edad. En esta modalidad de trabajos se subordina la expresión de la burla respecto a otras expresiones humorísticas como el sarcasmo, la sátira y la ironía. Los referentes teórico-metodológicos de los estudios en el axioma evolutivo se aproximan al Modelo por Equilibración. Las conclusiones señalan la pertinencia de sostener la coherencia de las matrices de pensamiento psicológico en las investigaciones que indagan problemáticas del desarrollo.

The teasing emerges as a symbolic action in the interaction between a teaser and teased. It is Usually expressed in a hostile or in a friendly mode. The purpose of this article is to reflex about the development concept that underlies the teasing studies. To fulfill this objective, we were adopted Jaan Valsiner's postulates about the guided axioms in the developing research and also we adopted the psychological thought matrices that give meaning to the re-organization of theories of development in three models: Differentiation, Balance and Teaching and Learning. The review shows a distribution of studies of teasing in the evolutive axiom. The studies in the evolutive axiom are characterized by the identification of cognitive and social capabilities and abilities which complexitfy with the age. In this type of researches the teasing expression is subordinated respect to other humoristic expression as: the sarcasm, the satire and the irony. The theorical ­ methodological referents in the evolutive axiom are approach to the Balance Model. The conclusion focus on the pertinence to hold coherence in the psychological thought matrices for the researches that inquire in the development subject.

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Objective: To determine the prevalence of comorbidities among adults living with HIV from two healthcare centers in Colombia, and to identify factors associated with comorbidity-free years. Methods: Observational, retrospective medical chart review study. Summary statistics for demographic and clinical characteristics were developed and relationship between comorbidity-free years were analyzed through Kaplan-Meier analysis and Cox regression. Results: 669 clinical charts were included, 71.7% were male and 16.1% were 50 years or older, 69.96% had at least one comorbidity. The most frequent comorbidities were dislipidemia(15.06%), hypertension(5.67%), risk factors were tobacco use(15.33%), alcohol intake(24.36%) and drugs abuse (14.66%). Discussion: These findings are consistent with previous reports showing the underlying processes of patients, producing multiple comorbidities. Conclusions: Significant proportion of patients have comorbidities that may increase risk of other complications or reduced comorbidity-free years. Poly-pharmacy among HIV+ adults need to be addressed to ensure adherence and minimize drug-drug interactions.

Objetivo: Determinar la prevalencia de comorbilidades entre adultos viviendo con VIH en dos centros de atención en Colombia e identificar los factores asociados con años libres de comorbilidad . Metodos: Revisión observacional retrospectiva de historias clínicas. Resumen de estadísticas de características demográficas y clínicas y análisis de correlación entre características clínicas a través de pruebas de Kaplan-Meier y regresión de Cox. Resultados: Se analizaron 669 historias clínicas, 71.7% fueron hombres y 16.1% tuvieron 50 años o más, 69.96% tuvieron al menos una comorbilidad. Las comorbilidades más frecuentes fueron dislipidemia(15.06%), hipertensión (5.67%), los factores de riesgo fueron el uso de tabaco (15.33%), ingesta de alcohol (24.36%) y abuso de drogas (14.66%). Discusión: Estos hallazgos son consistentes con reportes previos que evidencian los procesos subyacentes que llevan a múltiples comorbilidades. Conclusiones: Una proporción significativa de pacientes tiene comorbilidades que pueden aumentar el riesgo de otras condiciones o los años libres de comorbilidad. La polifarmacia en pacientes HIV+ debe hacerse de manera que se asegure la adherencia y se minimicen las interacciones entre medicamentos.

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