Antimicrobial use and resistance in food animal production: food safety and associated concerns in Sub-Saharan Africa / Uso de antimicrobianos y resistencia en la producción animal para consumo humano: inocuidad de los alimentos y preocupaciones asociadas en el África subsahariana

The use of antimicrobials in food animal (FA) production is a common practice all over the world, with even greater usage and dependence in the developing world, including Sub-Saharan Africa (SSA). However, this practice which serves obvious economic benefits to producers has raised public health concerns over the last decades, thus driving the selection and dissemination of antimicrobial resistance and adversely impacting food safety and environmental health. This review presents the current and comprehensive antimicrobial usage practices in food animal production across SSA. We further highlighted the overall regional drivers as well as the public health, environmental, and economic impact of antimicrobial use in the production of food animals. Antimicrobial use is likely to increase with even exacerbated outcomes unless cost-effective, safe, and sustainable alternatives to antibiotics, especially probiotics, prebiotics, bacteriocins, antimicrobial peptides, bacteriophages, vaccines, etc. are urgently advocated for and used in food animal production in SSA. These, in addition to the implementation of strong legislation on antimicrobial use, and improved hygiene will help mitigate the public health concerns associated with antimicrobial use in food animals and improve the well-being and safety of food animals and their products.(AU)

Conexões entre dois mundos. Prática médica, artes de curar e os saberes locais angolanos nos textos europeus ao longo do século XVIII / Connections between two worlds. Medical practice, healing arts and the local angolan knowledge in european texts throughout the 18th century

As conexões entre a África e o Brasil são tema recorrente na historiografia, principalmente, aquela relacionada com as questões sociais, econômicas, logísticas e políticas que envolviam o tráfico de escravos entre ambos os continentes. Um dos aspectos de maior interesse para os pesquisadores da história das ciências é, nesse sentido, a questão da saúde dos povos escravizados. Neste aspecto, a história da Medicina e dos conhecimentos médicos e farmacêuticos retratam um cenário no qual os contributos dos conhecimentos de origem africana tem vindo a ser verificados. Neste artigo, pretendo reconhecer as práticas médicas aplicadas em território angolano através de uma série de tratados médicos escritos por europeus que praticaram medicina em Angola, mais precisamente em Luanda, pretendendo responder às seguintes questões: Qual é o peso do conhecimento das populações locais na formação dos tratados médicos angolanos? Havia circulação de conhecimentos médicos entre Angola e Brasil?.(AU)

The connections between Africa and Brazil are a recurring theme in historiography, especially that related to social, economic, logistical and political issues involving the slave trade between the two continents. One of the most interesting aspects for researchers in the history of science is, in this sense, the question of the health of enslaved peoples. In this respect, the history of medicine and medical and pharmaceutical knowledge portray a scenario in which the contributions of knowledge of African origin have been verified. In this article, I intend to recognise the medical practices applied in Angolan territory through a series of medical treaties written by Europeans who practised medicine in Angola, more precisely in Luanda, in order to answer the following questions: What is the weight of the local population’s knowledge in the formation of Angolan medical treaties? Was there a circulation of medical knowledge between Angola and Brazil?.(AU)

COVID-19: Some unresolved issues / COVID-19: Algunos asuntos no resueltos

Two years after the COVID-19 pandemic, many uncertainties persist about the causal agent, the disease and its future. This document contains the reflection of the COVID-19 working group of the Official College of Physicians of Madrid (ICOMEM) in relation to some questions that remain unresolved. The document includes considerations on the origin of the virus, the current indication for diagnostic tests, the value of severity scores in the onset of the disease and the added risk posed by hypertension or dementia. We also discuss the possibility of deducing viral behavior from the examination of the structure of the complete viral genome, the future of some drug associations and the current role of therapeutic resources such as corticosteroids or extracorporeal oxygenation (ECMO). We review the scarce existing information on the reality of COVID 19 in Africa, the uncertainties about the future of the pandemic and the status of vaccines, and the data and uncertainties about the long-term pulmonary sequelae of those who suffered severe pneumonia. (AU)

Cuando han transcurrido ya dos años de la pandemia de COVID-19 persisten muchas incertidumbres sobre el agente causal, la enfermedad y su futuro. El presente documento contiene la reflexión del grupo de trabajo sobre COVID-19 del Ilustre Colegio Oficial de Médicos de Madrid (ICOMEM) en relación a algunas preguntas que nos parecen sin resolver. El documento incluye reflexiones sobre el origen del virus, la indicación actual de pruebas diagnósticas, el valor de los “scores” de gravedad en el comienzo de la enfermedad y el riesgo añadido que supone la hipertensión o la demencia. Se discute también, la posibilidad de deducir del examen de la estructura del genoma viral completo el comportamiento viral, el futuro de algunas asociaciones de fármacos y el papel actual de recursos terapéuticos como los corticoides o la oxigenación extracorpórea (ECMO). Revisamos la escasa información existente sobre la realidad de la COVID-19 en África, las incertidumbres sobre el futuro de la pandemia y la situación de las vacunas y los datos e incertidumbres sobre las secuelas pulmonares a largo plazo de los que padecieron neumonía grave. (AU)

PrintThe Impact of Stigmatizing Experiences and Self-Stigma on Mental Health and Suicidal Behavior: Results from the Community of Portuguese Language Countries

Stigma is an attribute that discredits an individual from society, diminishing the person. People who have self-stigma endorse negative stereotypes about themselves, which leads to negative reactions and feelings of shame. Self-stigma affects overall health, particularly mental health, and quality of life, and can lead to suicidal behavior and poor self-esteem and self-efficacy. It has also been found to be a major barrier when it comes to seeking help from mental health professionals. This study aims (1) to assess stigmatizing experiences, self-stigma, mental health, and suicidal behavior, comparing differences between countries of residence; (2) to explore the associations between self-stigma, stigmatizing experiences, mental health variables, and suicidal behavior; and (3) to determine the predictive effect of self-stigma, number of stigmatizing experiences, and sociodemographic variables on mental health and suicidal behavior. Measurement instruments included a Sociodemographic Questionnaire, the Portuguese version of the Brief Symptom Inventory-18, the Suicidal Behaviours Questionnaire-Revised (SBQ-R), and the Paradox of Self‑Stigma scale (PaSS‑24). The results showed participants with higher levels of self-stigma and stigmatizing experiences presented significantly higher mental health issues and suicidal behavior. Correlational analyses showed significant correlations among mental health and suicidal variables and self-stigma variables. Regression analyses showed that sociodemographic variables, number of stigmatizing experiences, and self-stigma explained 25.3% of the variability in mental health issues while sociodemographic variables, number of stigmatizing experiences, and self-stigma explained 13.5% of the variability in suicidal behavior. This study was an important contribution to the knowledge regarding the relationship between stigma and mental health (AU)

Anestesia y cirugía en condiciones muy precarias. Casos clínicos / Anesthesia and surgery in very precarious conditions. Clinical cases

A 21 niños (4 de ellos lactantes) y 3 adultos les fueron realizadas herniorrafias inguinales, en condiciones muy precarias, en un hospital de un área económicamente deprimida de la República Democrática del Congo. Se empleó anestesia subaracnoidea en los adultos y ketamina por vía intravenosa e intramuscular en los niños.La ketamina es un anestésico insustituible en muchos lugares del mundo sin recursos, en los que no se dispone de los mínimos medios de seguridad. Conocer las técnicas anestésicas simples, pero de menor riesgo, puede resultar también útil en sitios con recursos ante situaciones inesperadas. De manera general, hace falta una mayor solidaridad, tanto de las sociedades de anestesia como de los anestesiólogos, para paliar las grandes carencias en medios y profesionales bien formados en lugares sin recursos.(AU)

We performed herniorrhaphy on 21 children (4 of them infants) and 3 adults, in very precarious conditions, in a hospital in a economically depressed area of the Democratic Republic of Congo. Anesthesia technique used in adults was subarachnoid and intravenous and intramuscular ketamine in children.Ketamine is an irreplaceable anesthetic in many parts of the world without resources, where the minimum safety means are not available. Knowing the simple anesthetic techniques, but with less risk, can also be useful in resourceful places, in unexpected situations. Greater solidarity is needed, both from anesthesia societies and from anesthesiologists, to alleviate the great deficiencies in well-trained professionals and means in places without resources.(AU)

Juvenile ossifying fibroma of the maxillofacial region: analysis of clinico-pathological features and management / Fibroma osificante juvenil de la región maxilofacial: Análisis de características y manejo clínico-patológico

Background: The diagnosis and management of juvenile ossifying fibroma (JOF) remains a highly debated topicwith paucity of studies with long-term follow-up, hence the aim of this study was to report on the clinico-patho-logical features and management of these neoplasms.Material and Methods: A retrospective analysis was performed on all histopathologically confirmed JOF pre-senting at two tertiary hospitals in Cape Town, South Africa over a period of 39 years. Clinical, demographic,histopathological and radiological features were analyzed. Surgical methods were documented and a minimumpost-operative follow-up of 12 months was a prerequisite.Results: Seventeen patients met the inclusion criteria and were included in this study. Overall, the ages of patientsranged from 3–31 years (mean= 13 years) with male to female ratio of 1.8:1. The ages of patients diagnosed withTrabecular JOF were significantly younger than patients with Psammomatoid JOF (P = 0.01). The majority ofpatients presented with marked swelling (88.2%). Interestingly, most neoplasms occurred in the mandible (76.5%)with all Psammomatoid JOF uncharacteristically occurring in the mandible. There was only one case of Trabecu-lar JOF occurring in the sinonasal area. Most neoplasms appeared as unilocular (76.5%) and well-defined (82.4%)with mixed radio-density (70.6%) on radiographs and computed tomography. Curettage with peripheral ostectomywas shown to be the least invasive method with an acceptable recurrence rate (10%). Six lesions underwent resec-tion without any recurrences however caused high morbidity to these young patients.Conclusions: The high number of lesions occurring in the mandible for both variants of JOF demonstrates that siteshould not be a major determining factor in the diagnosis of JOF. Moreover, curettage with peripheral ostectomy...(AU)

Health status and infectious diseases in male unaccompanied immigrant minors from Africa in Spain / Estado de salud y enfermedades infecciosas de menores inmigrantes no acompañados varones procedentes de África en España

Introduction: The aim was to examine the health status and infectious diseases in a cohort of unaccompanied immigrant minors (UIMs) from Africa in Spain, and to detect if there are differences according to the geographical area of origin. Methods: Cross-sectional study in 622 African male UIMs at the time of admission to residential care in Aragon (Spain) during 2005-2019. A physical, nutritional and laboratory examination was performed following sanitary guidelines. Results: The mean age of the African UIMs was 16.1 years (SD 1.7; range 13-17). 88.9% were from Maghreb (mean age 15.9 years; SD 1.5) and 14.1% from Western Sub-Saharan (mean age 16.8 years; SD 1). We found that the prevalence of caries, iron deficiency and dermatological problems was significantly higher (p<.05) among Maghrebian, and the prevalence of past and present hepatitis B virus (HBV) infection, intestinal parasitosis, eosinophilia (p<.00001) and latent tuberculosis (p=.0034) was significantly higher in those of Sub-Saharan origin. Conclusion: The most relevant finding was the high prevalence of present HBV infection (14.8%) among Sub-Saharan adolescents. This finding highlights the importance of recommending targeted screening, preventive vaccination programs, and integration into local health care systems that allow for long-term treatment and follow-up as a way to prevent the transmission of HBV infection.(AU)

Introducción: El objetivo fue estudiar el estado de salud y las enfermedades infecciosas de una cohorte de menores inmigrantes no acompañados (MENA) procedentes de África en España, y detectar si existen diferencias según la zona geográfica de origen. Métodos: Estudio transversal en 622 MENA varones africanos en el momento de su admisión en la atención residencial en Aragón (España) entre 2005 y 2019. Se realizó un examen físico, nutricional y analítico de laboratorio siguiendo las directrices sanitarias. Resultados: La edad media de los MENA africanos era de 16,1 años (DE 1,7, intervalo 13-17). El 88,9 % procedía del Magreb (edad media 15,9 años; DE 1,5) y el 14,1 % de la zona subsahariana occidental (edad media 16,8 años; DE 1). Se constató que la prevalencia de caries, ferropenia y problemas dermatológicos era significativamente mayor (p < 0,05) entre los magrebíes, y que la prevalencia de infección pasada y presente por el virus de la hepatitis B (VHB), parasitosis intestinal, eosinofilia (p < 0,00001) y tuberculosis latente (p = 0,0034) era significativamente mayor entre los sujetos de origen subsahariano. Conclusión: El dato más relevante fue la alta prevalencia de infección actual por el VHB (14,8 %) entre los adolescentes subsaharianos. Este hallazgo pone de relieve la importancia de recomendar cribados selectivos, programas de vacunación preventiva e integración en los sistemas locales de atención sanitaria que permitan un tratamiento y seguimiento a largo plazo como manera de prevenir la transmisión de la infección por el VHB.(AU)

Proyecto de cooperación sanitaria en Kamuzu Central Hospital (Malawi) / A healthcare cooperation project in Kamuzu Central Hospital (Malawi)

Malawi es un país africano que cuenta con un 44% de población pediátrica (menores de 15 años). Es el país con menos personal médico y enfermero titulado por habitante del mundo, uno de los más pobres y con una de las tasas de mortalidad infantil más altas del planeta. En este contexto surge un proyecto de cooperación que persigue desde 2008 reducir la mortalidad infantil, con el trabajo formativo-asistencial de equipos de Enfermería y Pediatría que se desplazan hasta el hospital terciario de referencia Kamuzu Central Hospital (KCH) durante varios meses al año. Para optimizar la asistencia pediátrica de los hasta 3.000 ingresos mensuales, en el KCH se han implantado diversas medidas como establecer un sistema de triaje, ubicación de los pacientes según criterios de gravedad, optimización de la antibioterapia e implantación de mejoras en el manejo de la patología respiratoria. Se han observado en los últimos años drásticos descensos de mortalidad en menores de 5 años, fundamentalmente en las primeras horas de ingreso, así como un marcado incremento de la esperanza de vida poblacional. La asistencia pediátrica en Malawi (KCH) progresa con gratificantes y esperanzadores resultados, aportando a los profesionales de Enfermería y Pediatría que se implican una formación humana y profesional incomparable. La constancia y continuidad del proyecto de cooperación es una gran oportunidad de mejora para la Pediatría, la supervivencia infantil en Malawi y para el aprendizaje y desarrollo de todos los profesionales que lo llevan a cabo.(AU)

Malawi is an African country with 44% of paediatric population (<15-year-old). It is the country with the lowest medical and nursing qualified staff per inhabitant in the world, one of the poorest and with one of the highest paediatric mortality rates in the planet. In this setting, a cooperation project was set up in 2008, with the goal to reduce child mortality, through the training-care work by Nursing and Paediatric teams who travelled to Kamuzu Central Hospital (KCH), a Third-Level Hospital of Reference, during some months per year. In order to optimize the paediatric care of the almost 3,000 patients admitted per month, different measures have been implemented at the KCH, such as establishing a triage system, classifying patients according to severity criteria, optimization of antibiotic therapy, and implementation of improvements in the management of respiratory conditions. In recent years, a dramatic reduction in mortality for <5-year-olds has been observed, particularly during the first hours after admission, as well as a pronounced increase in the life expectancy of the population. Paediatric care in Malawi (KCH) keeps progressing with rewarding and hopeful outcomes, providing an unmatched human and professional training to those Nursing and Paediatric professionals involved. The consistency and continuity of the cooperation project represents a major opportunity for the improvement of Paediatrics, child survival in Malawi, and training and development for all professionals involved.(AU)

COVID-19 y África: sobreviviendo entre la espada y la pared / COVID-19 and Africa: Surviving between a rock and a hard place

Con más de 575.000 muertes y cerca de 13,3 millones de casos a nivel global, la pandemia por COVID-19ha causado un terrible impacto en apenas medio año de evolución desde que por primera vez fuesen detectados casos en China. Conscientes de las dificultades planteadas en entornos con sistemas de salud robustos, donde la mortalidad ha sido significativa, y la transmisión difícilmente controlable, había una lógica preocupación por ver cómo el virus podría afectar a los países africanos, donde sus frágiles sistemas de salud auguraban un impacto aún mayor. Este «tsunami» anunciado, de potenciales consecuencias devastadoras, parece, sin embargo, no haber llegado todavía, y los países africanos, donde ya se ha evidenciado una creciente transmisión, no están viendo el impacto en la salud de sus habitantes que muchos habían predicho. En este artículo repasamos la situación actual de la pandemia en el continente africano, intentando entender los determinantes de su lenta progresión

With over 575,000 deaths and about 13.3 million cases globally, the COVID-19 pandemic has had a terrible impact globally during the 6 months since cases were first detected in China. Conscious of the many challenges presented in settings with abundance of resources and with robust health systems, where mortality has been significant and transmission difficult to control, there was a logical concern to see how the virus could impact African countries, and their fragile and weak health systems. Such an anticipated "tsunami", with potentially devastating consequences, seems however to not have yet arrived, and African countries, albeit witnessing an increasing degree of autochthonous transmission, seem to this day relatively unaffected by the pandemic. In this article we review the current situation of the pandemic in the African continent, trying to understand the determinants of its slow progress

¿Por qué es menos «intensa» la epidemia de Covid-19 en África? / Why is Covid-19 epidemics no so intense in Africa?

La mayoría de la bibliografía mundial sobre la pandemia Covid-19 se ha focalizado en los países del continente asiático, europeo o americano. En África parece que la incidencia es menor. En este artículo se hipotetiza sobre alguna de las posibles causas que han dado lugar a estas diferencias. La pirámide poblacional, la temperatura ambiente, la vulnerabilidad/resistencia de los habitantes del continente o factores sociopolíticos son subrayados. En caso de que la pandemia se extendiera en el continente africano, posiblemente la falta de recursos sanitarios haría que las consecuencias fueran desastrosas y de una magnitud dantesca

Most of the international bibliography published on Covid-19 pandemics is focused in the Asian, European or American continents. It seems that incidence is lower in Africa. In this article we hypothetize on several of the possible causes sustaining these differences. Population pyramid, climate, african population own vulnerability/resistance or sociopolitical factors are underlined. In the case the pandemics will spread in Africa, the lack of basic healthcare resources will perhaps make the consequences disastrous and of a dantesque magnitude

Hidrocefalia infantil en el África subsahariana: impacto de los cuidados perioperatorios en el archipiélago de Zanzíbar / Infant hydrocephalus in sub-Saharan Africa: Impact of perioperative care in the Zanzibar archipelago

INTRODUCCIÓN: La hidrocefalia infantil en países de bajo y mediano ingreso, representa uno de los problemas éticos y sanitarios más conflictivos con los que se enfrenta el desarrollo de la salud a nivel internacional. Las estimaciones más optimistas señalan que 200.000 nacidos anualmente desarrollarán una hidrocefalia o nacerán con un defecto del tubo neural en África oriental, central y sur de África (ECSA). Se calcula que menos del 10% de estos niños serán operados mediante derivaciones ventriculoperitoneales y, en general, en condiciones de mala calidad o con un índice de complicaciones muy elevado. OBJETIVO: Describir las características generales, la epidemiología y los datos demográficos de la hidrocefalia infantil de los pacientes atendidos en el Instituto NED en el archipiélago de Zanzíbar y valorar los detalles clínicos y los resultados a medio plazo del impacto de los cuidados de enfermería implantados. MATERIAL Y MÉTODOS: Se trata de un estudio observacional descriptivo y analítico de carácter retrospectivo, en pacientes diagnosticados y tratados de hidrocefalia infantil, en el período comprendido entre septiembre del 2016 y septiembre del 2018. Con la implantación de una serie de protocolos perioperatorios de enfermería en dichos pacientes, se describieron y analizaron los resultados obtenidos. RESULTADOS: Un total de 96 pacientes fueron atendidos de hidrocefalia infantil. Un 51% (n = 49) de estos pacientes eran varones, con una media de edad de 9,25 meses. Todas las madres de los pacientes fueron controladas durante el embarazo, pero solamente un 8% de ellas fueron tratadas con ácido fólico durante su gestación. El 81% de los niños nacieron mediante parto vaginal o parto espontáneo no complicado. Con respecto a la etiología, el 27,1% de la hidrocefalia tratada estaba asociada a una causa infecciosa y un 35,4% a una causa desconocida. Se realizaron 67 cirugías de derivación ventriculoperitoneal y 15 ventriculostomías endoscópicas. La tasa de complicaciones fue del 23,17%. CONCLUSIONES: Los resultados de esta investigación indican que la hidrocefalia infantil en Zanzíbar tiene una etiología, una evolución y unas complicaciones similares o menores que las descritas hasta la fecha en el África oriental. El hecho de implantar una serie de protocolos perioperatorios y cuidados estandarizados de enfermería influyen positivamente en los resultados obtenidos. En la actualidad, el Mnazi Mmoja Surgical NED Institute es uno de los escasos centros en África del Este con un registro exhaustivo de la actividad asistencial y el primer centro sanitario que oferta una formación continuada al personal de enfermería

INTRODUCTION: Child hydrocephalus in low- and middle-income countries represents one of the most sensitive ethical and health problems facing international health development. The most optimistic estimates indicate that 200,000 newborns annually will develop hydrocephalus or be born with a neural tube defect in East, Central and South Africa (ECSA). It is estimated that less than 10% of these children will be operated by ventriculoperitoneal shunts, and in general in poor quality conditions or with a very high complication rate. OBJECTIVE: To describe the general characteristics, epidemiology and demographic data of childhood hydrocephalus of patients treated at the NED Institute in the Zanzibar archipelago, and assess the clinical details and medium-term results of the impact of the set-up nursing care. MATERIAL AND METHODS: This is a descriptive and analytical observational study of a retrospective nature, in patients diagnosed and treated with childhood hydrocephalus, in the period from September 2016 to September 2018. With the implementation of a series of perioperative nursing protocols in these patients, the results obtained were described and analyzed. RESULTS: A total of 96 patients were treated for childhood hydrocephalus. 51% (n = 49) of these patients were male, with a mean age of 9.25 months. All the mothers of the patients were monitored during pregnancy, but only 8% were treated with folic acid during pregnancy. 81% of children were born through vaginal delivery or uncomplicated spontaneous delivery. Regarding the etiology, 27.1% of treated hydrocephalus was associated with an infectious cause and 35.4% with an unknown cause. 67 ventriculoperitoneal shunt surgery and 15 endoscopic ventriculostomies were performed. The complication rate was 23.17%. CONCLUSIONS: The results of this research indicate that childhood hydrocephalus in Zanzibar has etiology, evolution and complications that are similar to or less than those described to date in East Africa. Implementing a series of perioperative protocols and standardized nursing care positively influences the results obtained. Currently, the Mnazi Mmoja Surgical NED Institute is one of the few centers in East Africa with an exhaustive record of healthcare activity and is the first health center that offers further training to nurses

Requisitos, dinámica y ejecución de un proyecto de ayuda quirúrgica plástica en el continente africano: África Plástica / Requirements, dynamics and execution of a plastic surgical aid project on the African continent: Africa Plastica

Cada vez hay más cirujanos que quieren ayudar a los países con menos cirujanos. Entre la ayuda heroica unipersonal y el desplazamiento de equipos profesionales multidisciplinares y bien dotados tecnológicamente, se abren múltiples escenarios. Queremos mostrar nuestro modus operandi de visitas cortas pero repetidas y en el mismo lugar como muestra de proyecto de ayuda quirúrgica para países de bajos ingresos, desarrollado por un grupo no profesional de ayuda humanitaria. La implicación de los agentes sanitarios locales se considera indispensable. África Plástica surge con esa intención y bajo esa dinámica para ayudar a los países africanos que constituyen, para nosotros los canarios, nuestra zona de influencia natural

There is an increasing number of surgeons willing to help countries with fewer surgeons. Between heroic individual aid and the displacement of well-stocked multidisciplinary professional teams, numerous scenarios are possible. Our model of short and repeated visits to the same place conducted by a non-professional humanitarian aid group, is here shown as a way to provide surgical help to low-income countries. Local health workers implication in this effort is mandatory. Africa Plastica comes up with that intention and under this dynamics, in order to aid African countries, that represent for us, as Canarian, our natural hinterland

Human rights in the Horn of Africa: an index of child and maternal health / Los derechos humanos en el Cuerno de África: un índice de salud infantil y materna

OBJECTIVE: To construct a territorial measure and classification of child and maternal health in the countries of the Horn of Africa based on the 2030 Agenda for Sustainable Development adopted by all United Nations Member States in 2015. METHOD: The design of our index includes the variables child and maternal health defined in the Sustainable Development Goals (SDGs) to enable territorial ranking of the countries. For this purpose, we used Pena's distance method for 2017. RESULTS: The results indicate a relatively high territorial disparity in maternal health between the countries of the Horn of Africa according to the differing values of the SDGs variables of child and maternal health. CONCLUSIONS: We propose a territorial classification in the countries of the Horn of Africa. We believe that the most striking differences between countries relate to basic variables of maternal health such as being attended by skilled health personnel

OBJETIVO: Elaborar una medida y clasificación territorial de la salud infantil y materna en los países del Cuerno de África, basada en la Agenda 2030 para el Desarrollo Sostenible, que fue adoptada por todos los Estados miembros de las Naciones Unidas en 2015. MÉTODO: El diseño del índice incluye variables de salud infantil y materna definidas en los Objetivos de Desarrollo Sostenible (ODS), para permitir la clasificación territorial de los países. Para este propósito, utilizamos el método de distancia de Pena para 2017. RESULTADOS: Los resultados revelan una disparidad territorial relativamente alta en salud materna entre los países del Cuerno de África, de acuerdo con los diferentes valores de las variables ODS. CONCLUSIONES: Proponemos una clasificación territorial en el Cuerno de África. Consideramos que las mayores diferencias entre los países se relacionan con variables básicas de salud materna, como la asistencia de personal de salud cualificado

Labor humanitaria en África. Nuestra experiencia / Humanitarian work in Africa. Our experience

La tercera campaña de ayuda humanitaria llevada a cabo por la Sociedad Española de Cirugía Plástica, Reparadora y Estética (SECPRE) en Monrovia (Liberia) se desarrolló durante el mes de noviembre de 2018 y supone la continuación de este tipo de ayudas en el continente africano promovidas por la ONG Juan Ciudad. Como en otras misiones humanitarias protagonizadas por cirujanos plásticos, el objetivo es mejorar la calidad de vida de la población más vulnerable y colaborar en su reincorporación a la sociedad. Las campañas humanitarias quirúrgicas tienen una fecha de ida y otra de vuelta, con un proyecto de actividad quirúrgica que desarrollar en pocos días y en unas condiciones de recursos limitados. Una buena planificación, apoyándonos en los datos obtenidos de las experiencias anteriores, facilitó la consecución de nuestros objetivos. Con la presentación de este artículo queremos transmitir nuestra experiencia personal en este proyecto

The third humanitarian aid campaign by the Spanish Society of Plastic, Reconstructive and Aesthetic Surgery (SECPRE) in Monrovia (Liberia) was carried out in November 2018 and reflects the continuation of such aid programmes in the African continent promoted by the NGO Juan Ciudad. As in other humanitarian missions involving plastic surgeons, the objective is to improve the quality of life of the most vulnerable population and to collaborate in their reintegration into society. The surgical humanitarian campaigns have a round trip date, with a surgical activity project to be developed in a few days and under limited resource conditions. Good planning, based on the data obtained from previous experiences contributed to the achievement of our objectives. Our aim presenting this article is sharing our personal experience in this project

Epidemiologic studies about food allergy and food sensitization in tropical countries. Results and limitations

The variety of foods and methods of preparation are part of the cultural identity of each population, and thus the main foods that cause symptoms vary among different regions. Due to their increasing frequency, Adverse Reactions to Food (AFR) have been the subject of extensive study, especially in North America and Europe but few studies have been conducted in other areas, especially in populations located in the tropics and subtropics. In this article, we review available information on the epidemiology of food sensitization and food allergies in tropical regions and explore the different epidemiological data considering the major food involved, the underlying immune mechanism and clinical symptoms partners. In addition, we identify the possible limitations and questions that arise from studies conducted in tropical countries, which helps to generate objectives for future research

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Formación de las enfermeras de práctica avanzada: perspectiva internacional / Academic training for advanced practice nurses: International perspective

En este artículo se realiza un análisis general sobre la formación de las enfermeras de práctica avanzada a nivel internacional. En primer lugar, se presentan algunas características esenciales y globales de la formación en práctica avanzada, las competencias centrales y las dificultades encontradas en la implantación de programas formativos para estas figuras. Posteriormente, se expone la realidad de la formación de práctica avanzada en nuestro país, haciendo especial hincapié en algunos programas universitarios a nivel de máster y la expansión de las especialidades oficiales de enfermería. A continuación, se aborda la realidad europea, con una gran variabilidad entre países con relación a la implantación de estos roles, así como una gran heterogeneidad en la formación vinculada a su desempeño. Por último, la perspectiva internacional nos lleva al análisis de la formación de enfermeras de práctica avanzada en EE. UU., Latinoamérica, África, Asia y Oceanía

This article presents a general analysis about academic training of Advanced Practice Nurses at international level. Firstly, some essential and global characteristics of advanced practice training, the core competencies and the difficulties found in the implementation of the academic training programs for these figures are presented. Secondly, the reality of advanced practice training in our country is explained, with emphasis on some university programmes at Masters, level and the expansion of the official nursing specialties. Then the European situation is addressed, showing a great variability among countries in the implementation of these roles, as well as an important heterogeneity in the academic training associated with their performance. Lastly, continuing with the international perspective, the academic training for advanced practice nurses in the USA, Latin America, Africa, Asia and Oceania is described

Variations in the branching pattern of the aortic arch: an African perspective

Variation in the branches of the aortic arch is higher in individuals of African descent. However, published studies are few. The aims were to document variations in the branching pattern of the aortic arch in a South African sample, determine whether these variants are more common than other populations, and determine whether there are any significant differences in the prevalence of variation between males and females. The aortic arch and main branches were dissected in 733 cadavers. All branching patterns were documented and classified as types. Chi-Square tests were used to determine whether there were any significant differences in prevalence of variation between males and females. The diameters of the main branches were measured and compared between sexes.The standard branching pattern was present in 65% of individuals, similar to that reported for other African studies, but lower than other studies from around the world. Variations were more prevalent in males than in females (p = 0.025), while only the diameter of the left vertebral artery, when arising from the arch was significantly larger in females, with no differences between sexes for the other vessel diameters. The results of this study support the hypothesis that variations in the branching pattern of the aortic arch are more common in African individuals. These individuals may be at increased risk of associated although rare, clinical symptoms or iatrogenic injury

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