Distribution and dynamics of Anopheles gambiae s.l. larval habitats in three Senegalese cities with high urban malaria incidence.

Urban malaria has become a challenge for most African countries due to urbanization, with increasing population sizes, overcrowding, and movement into cities from rural localities. The rapid expansion of cities with inappropriate water drainage systems, abundance of water storage habitats, coupled with recurrent flooding represents a concern for water-associated vector borne diseases, including malaria. This situation could threaten progress made towards malaria elimination in sub-Saharan countries, including Senegal, where urban malaria has presented as a threat to national elimination gains. To assess drivers of urban malaria in Senegal, a 5-month study was carried out from August to December 2019 in three major urban areas and hotspots for malaria incidence (Diourbel, Touba, and Kaolack) including the rainy season (August-October) and partly dry season (November-December). The aim was to characterize malaria vector larval habitats, vector dynamics across both seasons, and to identify the primary eco- environmental entomological factors contributing to observed urban malaria transmission. A total of 145 Anopheles larval habitats were found, mapped, and monitored monthly. This included 32 in Diourbel, 83 in Touba, and 30 in Kaolack. The number of larval habitats fluctuated seasonally, with a decrease during the dry season. In Diourbel, 22 of the 32 monitored larval habitats (68.75%) were dried out by December and considered temporary, while the remaining 10 (31.25%) were classified as permanent. In the city of Touba 28 (33.73%) were temporary habitats, and of those 57%, 71% and 100% dried up respectively by October, November, and December. However, 55 (66.27%) habitats were permanent water storage basins which persisted throughout the study. In Kaolack, 12 (40%) permanent and 18 (60%) temporary Anopheles larval habitats were found and monitored during the study. Three malaria vectors (An. arabiensis, An. pharoensis and An. funestus s.l.) were found across the surveyed larval habitats, and An. arabiensis was found in all three cities and was the only species found in the city of Diourbel, while An. arabiensis, An. pharoensis, and An. funestus s.l. were detected in the cities of Touba and Kaolack. The spatiotemporal observations of immature malaria vectors in Senegal provide evidence of permanent productive malaria vector larval habitats year-round in three major urban centers in Senegal, which may be driving high urban malaria incidence. This study aimed to assess the presence and type of anopheline larvae habitats in urban areas. The preliminary data will better inform subsequent detailed additional studies and seasonally appropriate, cost-effective, and sustainable larval source management (LSM) strategies by the National Malaria Control Programme (NMCP).

Urban malaria vector bionomics and human sleeping behavior in three cities in Senegal.

BACKGROUND: Malaria is endemic in Senegal, with seasonal transmission, and the entire population is at risk. In recent years, high malaria incidence has been reported in urban and peri-urban areas of Senegal. An urban landscape analysis was conducted in three cities to identify the malaria transmission indicators and human behavior that may be driving the increasing malaria incidence occurring in urban environments. Specifically, mosquito vector bionomics and human sleeping behaviors including outdoor sleeping habits were assessed to guide the optimal deployment of targeted vector control interventions. METHODS: Longitudinal entomological monitoring using human landing catches and pyrethrum spray catches was conducted from May to December 2019 in Diourbel, Kaolack, and Touba, the most populous cities in Senegal after the capital Dakar. Additionally, a household survey was conducted in randomly selected houses and residential Koranic schools in the same cities to assess house structures, sleeping spaces, sleeping behavior, and population knowledge about malaria and vector control measures. RESULTS: Of the 8240 Anopheles mosquitoes collected from all the surveyed sites, 99.4% (8,191) were An. gambiae s.l., and predominantly An. arabiensis (99%). A higher number of An. gambiae s.l. were collected in Kaolack (77.7%, n = 6496) than in Diourbel and Touba. The overall mean human biting rate was 14.2 bites per person per night (b/p/n) and was higher outdoors (15.9 b/p/n) than indoors (12.5 b/p/n). The overall mean entomological inoculation rates ranged from 3.7 infectious bites per person per year (ib/p/y) in Diourbel to 40.2 ib/p/y in Kaolack. Low anthropophilic rates were recorded at all sites (average 35.7%). Of the 1202 households surveyed, about 24.3% of household members slept outdoors, except during the short rainy season between July and October, despite understanding how malaria is transmitted and the vector control measures used to prevent it. CONCLUSION: Anopheles arabiensis was the primary malaria vector in the three surveyed cities. The species showed an outdoor biting tendency, which represents a risk for the large proportion of the population sleeping outdoors. As all current vector control measures implemented in the country target endophilic vectors, these data highlight potential gaps in population protection and call for complementary tools and approaches targeting outdoor biting malaria vectors.

Performance of cervical cytology and HPV testing for primary cervical cancer screening in Latin America: an analysis within the ESTAMPA study.

Background: Cervical cytology remains widely used as the initial tool in cervical cancer screening worldwide. WHO guidelines recommend replacing cytology with primary HPV testing to reach cervical cancer elimination goals. We assessed the performance of cytology and high-risk HPV testing to detect cervical precancer, cervical intraepithelial neoplasia (CIN) grade 3 or worse (CIN3+) among women aged 30-64 years participating in the ESTAMPA study. Methods: Women were screened with cytology and HPV across ESTAMPA study centres in Latin America. Screen-positives were referred to colposcopy with biopsy collection and treatment as needed. Those with no evident precancer were recalled at 18-months for a second HPV test to complete disease ascertainment. Performance indicators for cytology and HPV to detect CIN3+ were estimated. Findings: 30,606 participants with available cytology and HPV results were included in the analysis. A total of 440 histologically confirmed CIN3s and 30 cancers were diagnosed. Cytology sensitivity for CIN3+ was 48.5% (95% CI: 44.0-53.0), whereas HPV testing had a sensitivity of 98.1% (95% CI: 96.3-96.7). Specificity was 96.5% (95% CI: 96.3-96.7) using cytology and 88.7% (95% CI: 88.3-89.0) with HPV. Performance estimates varied substantially by study centre for cytology (ranging from 32.1% to 87.5% for sensitivity and from 89.2% to 99.5% for specificity) while for HPV results were more consistent across sites (96.7%-100% and 83.6-90.8%, respectively). Interpretation: The limited and highly variable sensitivity of cytology strongly supports transition to the more robust and reproducible HPV-based cervical screening to ensure progress towards global cervical cancer elimination targets in Latin America. Funding: IARC/WHO, UNDP, HRP/WHO, NCI and local funders.

Infección oral y cervicofacial por agranulocitosis secundario debido al tratamiento con medicación antitiroidea: Reporte de Caso / Oral and Cervicofacial Infection Secondary to Agranulocytosis Caused by Antithyroid Medication: A Case Report

RESUMEN La agranulocitosis es el recuento bajo de glóbulos blancos (neutrófilos), que puede ser inducida por tratamientos con algunos medicamentos como los antitiroideos, que ocasionan manifestaciones orales como úlceras o necrosis gingival difusa. Se presenta el caso de una paciente mujer de 26 años, con antecedente de hipertiroidismo, quien acude a emergencia del Hospital Nacional Alberto Sabogal Sologuren por presentar tumefacción en la hemicara izquierda, asociada a disfagia, múltiples lesiones ulceradas en mucosa oral, con compromiso de tejido óseo, fiebre y malestar general. Luego de los exámenes auxiliares, se categoriza como una infección oral y cervicofacial por agranulocitosis debido al tratamiento con el metimazol. La literatura mundial reporta casos de agranulocitosis como efecto adverso del consumo de drogas antitiroideas, con reporte de manifestaciones orales; sin embargo, pocos casos evidencian compromiso cervical. Por lo cual se presenta este caso poco usual desde su diagnóstico hasta el tratamiento.

ABSTRACT Agranulocytosis refers to a low white blood cell count, specifically neutrophils, which can be caused by certain medications such as antithyroid drugs (ATD). This condition can result in oral manifestations, including diffuse gingival ulceration or necrosis. We present the case of a 26-year-old female patient with a history of hyperthyroidism who came to the emergency department of Alberto Sabogal Sologuren National Hospital with swelling on the left side of her face, accompanied by dysphagia, multiple ulcerated lesions in the oral mucosa involving bone tissue, as well as fever and general malaise. After conducting additional tests, the patient was diagnosed with oral and cervicofacial infection secondary to agranulocytosis caused by methimazole treatment. While the global literature reports cases of agranulocytosis as an adverse effect of antithyroid medication, with documented oral manifestations, only a few cases demonstrate cervical involvement. Therefore, we present this uncommon case from diagnosis to treatment.

Association between periodontitis and postoperative complications in hospital medical surgical procedures: a systematic review.

Background: Periodontitis is potentially harmful in the perioperative period due to biofilm generating a environment for bacteria to spread and colonize other anatomical areas, which can generate a potential risk of infection, delayed healing, increased morbidity, and even induce avulsion in intubated patients, and subsequent aspiration or ingestion of teeth with increased mobility. Objective: Associate the presence of periodontitis and postoperative complications in patients who underwent an in-hospital medical surgical procedure. Methods: A systematic review based on studies extracted from PubMed and Scopus was carried out on June 10, 2020, based on the Population, Intervention, Comparison and Result search strategy. As inclusion criteria, the studies had to include all the disaggregated terms of the research question, have a publication date of less than 15 years, and the target population had to have undergone elective hospital medical-surgical interventions. The exclusion criteria corresponded to not presenting an analytical or experimental observational study design, not having made a periodontal clinical diagnosis of the study subjects, and not expressing in the results the presence of postoperative medical-hospital complications. Articles were assessed for quality by supplementing the STROBE guideline and Newcastle Ottawa, for risk of bias by supplementing the STROBE guideline and the Cochrane Collaboration handbook tool. Results: A total of 131 articles were obtained, which were subjected to a selection process, resulting in 5 final analytical observational studies. A meta-analysis was performed and determined that periodontitis was a risk factor to postoperative complications after surgical procedures with an OR = 4,76; 95%CI [1,11-20,41]. Conclusions: Optimize the guidelines for assessing quality and risk of bias can make their comparison with other studies complex, however it was determined in a statistically significant way that patients with periodontitis have a higher risk of generating postoperative complications after a medical hospital surgery.

Introducción: La periodontitis es potencialmente dañina en el perioperatorio debido a que el biofilm genera un ambiente para que las bacterias se propaguen y colonicen otras áreas anatómicas, lo que puede generar un riesgo potencial de infección, retraso en la cicatrización, aumento de la morbilidad e incluso inducir avulsión en pacientes intubados, y aspiración o ingestión posterior de dientes con mayor movilidad. Objetivo: Asociar la presencia de periodontitis y complicaciones postoperatorias en pacientes sometidos a un procedimiento médico quirúrgico intrahospitalario. Métodos: Se realizó una revisión sistemática a partir de estudios extraídos de PubMed y Scopus el 10 de junio de 2020, basándose en la estrategia de búsqueda de Población, Intervención, Comparación y Resultados. Como criterios de inclusión, los estudios debían incluir todos los términos desagregados de la pregunta de investigación, tener una fecha de publicación menor a 15 años y la población objetivo debía haber sido sometida a intervenciones médico-quirúrgicas hospitalarias electivas. Los criterios de exclusión correspondieron a no presentar un diseño de estudio observacional analítico o experimental, no haber realizado un diagnóstico clínico periodontal de los sujetos de estudio y no expresar en los resultados la presencia de complicaciones médico-hospitalarias posoperatorias. Se evaluó la calidad de los artículos complementando la guía STROBE y Newcastle Ottawa, y el riesgo de sesgo complementando la guía STROBE y la herramienta del manual de Colaboración Cochrane. Resultados: Se obtuvo un total de 131 artículos, los cuales fueron sometidos a un proceso de selección, dando como resultado 5 estudios observacionales analíticos finales. Se realizó un metaanálisis y se determinó que la periodontitis fue un factor de riesgo de complicaciones posoperatorias después de procedimientos quirúrgicos con un OR = 4,76; IC95% [1,11-20,41]. Conclusiones: Optimizar las guías para evaluar la calidad y el riesgo de sesgo puede hacer compleja su comparación con otros estudios, sin embargo, se determinó de manera estadísticamente significativa que los pacientes con periodontitis tienen mayor riesgo de generar complicaciones posoperatorias luego de una cirugía médico hospitalaria.

Utilization Efficiency of Human Milk Oligosaccharides by Human-Associated Akkermansia Is Strain Dependent.

Akkermansia muciniphila is a mucin-degrading bacterium found in the human gut and is often associated with positive human health. However, despite being detected by as early as 1 month of age, little is known about the role of Akkermansia in the infant gut. Human milk oligosaccharides (HMOs) are abundant components of human milk and are structurally similar to the oligosaccharides that comprise mucin, the preferred growth substrate of human-associated Akkermansia. A limited subset of intestinal bacteria has been shown to grow well on HMOs and mucin. We therefore examined the ability of genomically diverse strains of Akkermansia to grow on HMOs. First, we screened 85 genomes representing the four known Akkermansia phylogroups to examine their metabolic potential to degrade HMOs. Furthermore, we examined the ability of representative isolates to grow on individual HMOs in a mucin background and analyzed the resulting metabolites. All Akkermansia genomes were equipped with an array of glycoside hydrolases associated with HMO deconstruction. Representative strains were all able to grow on HMOs with various efficiencies and growth yields. Strain CSUN-19, belonging to the AmIV phylogroup, grew to the highest level in the presence of fucosylated and sialylated HMOs. This activity may be partially related to the increased copy numbers and/or the enzyme activities of the α-fucosidases, α-sialidases, and ß-galactosidases. This study examines the utilization of individual purified HMOs by Akkermansia strains representing all known phylogroups. Further studies are required to examine how HMO ingestion influences gut microbial ecology in infants harboring different Akkermansia phylogroups. IMPORTANCE Human milk oligosaccharides (HMOs) are the third most abundant component of breast milk and provide several benefits to developing infants, including the recruitment of beneficial bacteria to the human gut. Akkermansia strains are largely considered beneficial bacteria and have been detected in colostrum, breast milk, and young infants. A. muciniphila MucT, belonging to the AmI phylogroup, contributes to the HMO deconstruction capacity of the infant. Here, using phylogenomics, we examined the genomic capacities of four Akkermansia phylogroups to deconstruct HMOs. Indeed, each phylogroup contained differences in their genomic capacities to deconstruct HMOs, and representative strains of each phylogroup were able to grow using HMOs. These Akkermansia-HMO interactions potentially influence gut microbial ecology in early life, a critical time for the development of the gut microbiome and infant health.

Vasculitis ANCA positiva inducida por Propiltiouracilo. Reporte de caso

La vasculitis asociada a propiltiouracilo (PTU) y ANCA es una enfermedad rara con una incidencia de 0,47-0,71 casos por cada 10 000 pacientes. Afecta principalmente a los vasos de menor calibre. Piel, riñones y pulmones son los más afectados. El diagnóstico requiere alta sospecha clínica y se apoya en estudios histopatológicos de las lesiones en piel y serología positiva para ANCA. La suspensión del medicamento suele bastar como manejo de la enfermedad. Mujer de 45 años de edad, con historia de consumo de PTU durante 2 años, desde su diagnóstico de hipertiroidismo; presentando placas purpúricas dolorosas en ambos miembros inferiores.

SUMMARY ANCA vasculitis associated to propylthiouracil (PTU) is a rare condition with an incidence of 0.47-0.71 cases per 100,000 patients. It affects mainly minor caliber blood vessels. The skin, kidneys and lungs are the organs most affected. To make the diagnosis it is necessary to have a high index of suspicion and rely on histopathologic findings of skin lesions plus a positive ANCA test. Stopping the inducing drug is usually necessary to manage this condition. We report the case of a 45-year-old woman who consumed PTU for two years for the treatment of hyperthyroidism presenting with painful purpuric plaques in the lower limbs.

The epidemiology and estimated etiology of pathogens detected from the upper respiratory tract of adults with severe acute respiratory infections in multiple countries, 2014-2015.

INTRODUCTION: Etiology studies of severe acute respiratory infections (SARI) in adults are limited. We studied potential etiologies of SARI among adults in six countries using multi-pathogen diagnostics. METHODS: We enrolled both adults with SARI (acute respiratory illness onset with fever and cough requiring hospitalization) and asymptomatic adults (adults hospitalized with non-infectious illnesses, non-household members accompanying SARI patients, adults enrolled from outpatient departments, and community members) in each country. Demographics, clinical data, and nasopharyngeal and oropharyngeal specimens were collected from both SARI patients and asymptomatic adults. Specimens were tested for presence of 29 pathogens utilizing the Taqman® Array Card platform. We applied a non-parametric Bayesian regression extension of a partially latent class model approach to estimate proportions of SARI caused by specific pathogens. RESULTS: We enrolled 2,388 SARI patients and 1,135 asymptomatic adults from October 2013 through October 2015. We detected ≥1 pathogen in 76% of SARI patients and 67% of asymptomatic adults. Haemophilus influenzae and Streptococcus pneumoniae were most commonly detected (≥23% of SARI patients and asymptomatic adults). Through modeling, etiology was attributed to a pathogen in most SARI patients (range among countries: 57.3-93.2%); pathogens commonly attributed to SARI etiology included influenza A (14.4-54.4%), influenza B (1.9-19.1%), rhino/enterovirus (1.8-42.6%), and RSV (3.6-14.6%). CONCLUSIONS: Use of multi-pathogen diagnostics and modeling enabled attribution of etiology in most adult SARI patients, despite frequent detection of multiple pathogens in the upper respiratory tract. Seasonal flu vaccination and development of RSV vaccine would likely reduce the burden of SARI in these populations.

Field Trials to Evaluate the Effectiveness of the Biogents®-Sweetscent Lure in Combination with Several Commercial Mosquito Traps and to Assess the Effectiveness of the Biogents-Mosquitaire Trap with and Without Carbon Dioxide.

A series of field experiments was conducted in Florida, California, and Louisiana in order to investigate whether adding the Biogents® (BG)-Sweetscent lure to several commercially available mosquito traps increases their Aedes albopictus catch rates and to evaluate the BG-Mosquitaire trap with and without CO2. Adding the BG-Sweetscent to the SkeeterVac Bite-Guard SVE6211, MosClean UV LED (ultraviolet light-emitting diode), Flowtron® Galaxie PV 75, Dynatrap® DT2000XL, Bite Shield Protector, and Black Flag® BZ-40 increased their Ae. albopictus catch rates up to 4.2-fold. The catch rates of the BG-Mosquitaire and the BG-Sentinel did not differ significantly for Ae. aegypti and Culex quinquefasciatus. The BG-Mosquitaire without CO2 and only with BG-Sweetscent caught 1.2 times more Ae. albopictus than the CO2- and Lurex3-baited Mosquito Magnet® Patriot and 2.6 times more than the CO2- and Sweetscent-baited SkeeterVac, respectively. The BG-Mosquitaire baited with Sweetscent and CO2 collected 6.8 times more Ae. albopictus than the Mosquito Magnet Patriot and 11.9 times more than the SkeeterVac. We conclude that BG-Sweetscent increases the tiger mosquito catch rates of many commercially available mosquito traps. We proved that the BG-Mosquitaire is as efficient as the well-known BG-Sentinel and that it can outperform mosquito traps that are baited with propane-generated CO2.

Tuberculosis pulmonar y métodos diagnósticos laboratoriales actuales / Pulmonar tuberculosis and latest diagnosis laboratory methods

La tuberculosis es una enfermedad altamente contagiosa, causada por Mycobacterium tuberculosis o bacilo de Koch. Puede tener repercusiones mortales en caso de no ser tratada oportunamente, siendo responsable de 1.3 millones de muertes a nivel mundial en el año 2016. Afecta al ser humano sobre todo a nivel pulmonar, manifestándose con tos crónica, producción de esputo, anorexia, pérdida de peso, fiebre, sudoración nocturna y hemoptisis; también puede producir enfermedad extrapulmonar. En los últimos 20 años se han desarrollado nuevos métodos para diagnosticar tuberculosis latente y activa, como ser los ensayos de liberación de interferón-gamma y GeneXpert® Objetivo: recopilar información actualizada sobre tuberculosis pulmonar, epidemiología y métodos diagnósticos.Material yMétodos: se utilizaron buscadores como Google académico, PubMed. Se seleccionaron 42documentos, entre estos: artículos originales, normas nacionales, guías de manejo, informes anuales de organizaciones reconocidas. Criterios de inclusión: publicaciones menores a 5 años, tanto en español, como en inglés. Conclusión: el diagnóstico oportuno de la tuberculosis disminuye la estadística de morbilidad y mortalidad debida a la enfermedad, por tanto, es de suma importancia conocer los métodos diagnósticos actuales existentes en el país, así como las ventajas, desventajas, sensibilidad yespecificidad...(AU)

An epidemiological study of avian influenza A (H5) virus in nomadic ducks and their raising practices in northeastern Bangladesh, 2011-2012.

BACKGROUND: In Bangladesh, nomadic duck flocks are groups of domestic ducks reared for egg production that are moved to access feeding sites beyond their owners' village boundaries and are housed overnight in portable enclosures in scavenging areas. The objectives of this study were to measure the prevalence of influenza A virus RNA and H5-specific antibodies in nomadic ducks and to characterize nomadic duck raising practices in northeastern Bangladesh. METHODS: We tested duck egg yolk specimens by competitive ELISA to detect antibodies against avian influenza A (H5) and environmental fecal samples by real-time reverse-transcription polymerase chain reaction (rRT-PCR) to detect influenza A virus RNA and H5 subtype. RESULTS: The median age of the ducks was 24 months (range: 8-36 months) and the median flock size was 300 ducks (range: 105-1100). Of 1860 egg yolk samples, 556 (30%, 95% confidence interval (CI): 28-32) were positive for antibodies against H5 and 58 flocks (94%) had at least one egg with H5-specific antibodies. Of 496 fecal samples, 121 (24%, 95% CI: 22-29) had detectable influenza A RNA. Thirty-three flocks (53%) had at least one fecal sample positive for influenza A RNA. CONCLUSIONS: Nomadic ducks in Bangladesh are commonly infected with avian influenza A (H5) virus and may serve as a bridging host for transmission of avian influenza A (H5) virus or other avian influenza A viruses subtypes between wild waterfowl, backyard poultry, and humans in Bangladesh.

Impact of acute whole-body cold exposure with concurrent isometric handgrip exercise on aortic pressure waveform characteristics.

PURPOSE: Adverse cardiovascular events are more prevalent during winter and in people that exercise/work in cold temperatures. Since pulse wave analysis indices, aortic systolic blood pressure (ASBP), augmentation index (AIx), and wasted left ventricular pressure energy (ΔE w), are stronger predictors of cardiovascular events and myocardial performance than brachial blood pressure (BP), we sought to evaluate the aortic hemodynamic responses during cold exposure with concurrent isometric handgrip exercise (IHG). METHODS: In a crossover randomized fashion, 20 healthy normotensive men (22.1 ± 2 years) were evaluated, by means of radial applanation tonometry, inside an environmental chamber in the supine position at cold (4 °C) and temperate (24 °C) conditions. Following a 30-min equilibration period, measurements were performed during pre-exercise baseline (REST), in the last 90 s of a 3-min IHG at 30% maximal voluntary contraction, and 3 min immediately after the finalization of IHG bout (recovery, REC). RESULTS: At REST, brachial systolic BP (BSBP) (12 ± 2 mmHg; P < 0.01), ASBP (14 ± 3 mmHg; P < 0.01), AIx (11 ± 3%; P < 0.05), and ΔE w (737 ± 128 dynes s/cm(2); P < 0.01) were higher in 4 °C compared to 24 °C trial. Compared to REST, IHG significantly increased (P < 0.01) BSBP, ASBP, AIx, and ΔEw, while BSBP and ASBP remained elevated during REC (P < 0.01). Compared to REST and temperate, AIx (11 ± 3%) and ΔE w (793 ± 145 dynes s/cm(2); P < 0.01) were higher during IHG and cold, while BSBP and ASBP were elevated during REC and cold. AIx and ΔE w returned to REST values in both trials, but AIx (11 ± 4%; P < 0.05) and ΔE w (656 ± 132 dynes s/cm(2); P < 0.05) were higher in the cold. CONCLUSIONS: Cold exposure with concurrent IHG induces a significant increase in aortic hemodynamic markers, which may evoke adverse cardiovascular events.

The effects of short term L-citrulline supplementation on wave reflection responses to cold exposure with concurrent isometric exercise.

BACKGROUND: Supplementation with L-citrulline (L-cit) has shown attenuating effects on blood pressure (BP) and pulse-wave-reflection responses (augmentation index (AIx)) to local exposure to cold, but the potential cardioprotective effects of L-cit during whole-body cold exposure with concurrent exercise are poorly understood. We hypothesized that L-cit would attenuate the BP and AIx responses to cold exposure and isometric handgrip (IHG) exercise. METHODS: Sixteen healthy males with a mean age of 23±3 years volunteered for a study of the effect of L-cit on the BP and AIx responses to cold exposure and IHG exercise. Experiments were conducted inside an environmental chamber in cold conditions (4 ºC). Radial waveforms were obtained in duplicates and averaged through applanation tonometry. After 5 minutes of measurements made at rest in the supine position (RES), after the finalization of the exercise about the subjects were evaluated in non exercise condition that were basically the same as the RES. After initial measurements in cold conditions, subjects were randomized to receive either a placebo (Maltodextrin, PL) or L-cit (100mg/kg) for 14 days, followed by a 14-day washout period and then a 14-day regimen of the other agent. Subjects were re-evaluated after each treatment period. RESULTS: At RES, there was a significant treatment-by-time interaction for brachial systolic BP (BSBP; P < 0.01), aortic systolic BP (ASBP; P < 0.01), and AIx (P < 0.05), such that L-cit decreased BSBP (-11±2mm Hg; P < 0.01), ASBP (-10±2mm Hg; P < 0.05), and AIx (-2±2%; P < 0.05) as compared with their respective values before the intervention. During IHG, BSBP, ASBP, and AIx were increased (P < 0.05) as compared with their values at RES, but these responses were unaffected by either of the study treatments. CONCLUSIONS: L-citrulline may be a feasible adjuvant treatment for decrease the BP and AIx responses induced by cold. Further research is warranted to evaluate the impact of cold exposure and exercise on cardiovascular risk in clinical populations.

Implementación del registro de paro cardiorrespiratorio en un hospital de segundo nivel / Implementation of a cardiopulmonary arrest registry in a secondary-level hospital

Antecedentes. En Colombia no existen publicaciones sobre la aplicación del registro de paro intrahospitalario, a pesar de que desde 1991 el Comité Internacional de Enlace en Reanimación (ILCOR) en la abadía de Utstein, Noruega, elaboró un formato con el fin de comparar y mejorar las maniobras de reanimación cardiopulmonar. El propósito de este trabajo fue aplicar un registro de paro al estilo Utstein en el Hospital San Juan de Dios de Cali, para conocer datos sobre la realidad del paro cardiorrespiratorio durante el periodo comprendido entre los meses de julio y octubre de 2010. Metodología. Se trata de un estudio prospectivo, observacional; se diseñó un registro de paro cardiorrespiratorio, se difundió y se pidió que lo llenaran los médicos del hospital que participaron en maniobras de reanimación cardiopulmonar en el período descrito. Resultados. Se presentaron 22 casos de paro cardiorrespiratorio; el 80 % ocurrieron en el servicio de urgencias, y el 95 % fueron atendidos por un médico general. Sólo el 14 % de los registros de paro fueron elaborados correctamente, y en un 23 % de los casos, la descripción no había sido realizada por el médico, sino por personal de enfermería. Conclusión. Este estudio encontró que la gran mayoría de los médicos no llenan un registro de paro aunque lo conozcan. Hace falta compromiso, tanto por parte del Gobierno como de la comunidad médica, para la correcta aplicación de esta recomendación, cuya utilidad es definitiva para la investigación en reanimación.

Background. There are no publications in Colombia regarding the implementation of a hospital cardiopulmonary arrest registry despite the fact that the International Liaison Committee on Resuscitation (ILCOR) already in 1991 developed, in a meeting at Utsein Abbey in Norway, a form designed to compare and improve cardiopulmonary resuscitation maneuvers. The purpose of this work was to apply a cardiopulmonary arrest registry in the Utstein style at San Juan de Dios Hospital in Cali, in order to gather data concerning the reality of cardiopulmonary arrest, during the period between July and October, 2010.Methodology. Prospective observational study. A cardiopulmonary arrest form was developed and communicated, and all physicians who had participated in cardiopulmonary resuscitation maneuvers during the study period were asked to complete the form. Results. There were 22 cases of cardiopulmonary arrest. Of these, 80 % happened in the emergency service, and 95 % were attended to by a general practitioner. Only 14 % of the records were filled correctly and, in 23 % of cases, the description had been written by the nursing staff instead of the physician.Conclusion. This study found that the vast majority of physicians do not fill a cardiopulmonary arrest form, even when they are aware of it. Commitment is lacking on the part of the government as well as the medical community regarding the correct implementation of this recommendation of critical importance for resuscitation research.