Health conditions of Hitnü indigenous people potentially exposed to crude oil in Arauca, Colombia / Condiciones de salud de los indígenas hitnü potencialmente expuestos a petróleo crudo (Arauca, Colombia)

Introduction: The Hitnü indigenous people live in precarious sanitary conditions, with food insecurity and being victims of sociopolitical violence in Arauca, Colombia. In addition, it is possible that they may be affected by exposure to hydrocarbons found in oil. Objective: To identify the health outcomes of morbidity and mortality profiles of the Hitnü people that could be associated with the exposure to crude oil. Materials and methods: A cross-sectional study was carried out with Hitnü indigenous people, during February and March, 2021, time of drought. A household questionnaire was applied, and one individual to collect data from the environment around the house, occupations and other activities, as well as data from sociodemographic, signs, symptoms, and findings of a medical examination. The potential association with hydrocarbons was explored considering three groups: inhabitants in Arauca city, Aspejaná reserve (not exposed), and San José del Lipa and La Vorágine reserves (exposed by the Ele river and tributaries). With free listings, causes of death were explored. The study incorporated a rigorous intercultural management in all its components. Results: A total of 576 indigenous people from 16 settlements participated. The water consumed could serve as means of exposure to hydrocarbons. Health problems were very varied, including infectious and chronic diseases, malnutrition, and trauma. The masses on the neck were associated with residing in the ancestral reserves (PR = 3.86; CI95% 1.77-8.39), territories with potential exposure to crude-oil. The most relevant causes of death were homicide, tumors, and tuberculosis. Conclusion: For its possible association with exposure to hydrocarbons, it is a priority to start the intercultural study of lymphadenopathies in indigenous communities potentially exposed to crude oil.

Introducción. El pueblo hitnü vive en condiciones sanitarias precarias, con inseguridad alimentaria y víctima de la violencia sociopolítica en Arauca (Colombia). Además, se sospecha que pueden estar afectados por la exposición a los hidrocarburos del petróleo. Objetivo. Identificar los eventos de salud del perfil de morbilidad y mortalidad de los indígenas hitnü que podrían asociarse con la exposición a petróleo crudo. Materiales y métodos. Se realizó un estudio transversal con indígenas hitnü, durante febrero y marzo de 2021, época de sequía. Se aplicó un cuestionario de hogares y uno individual para recolectar datos del ambiente peridomiciliario, ocupaciones y otras actividades, así como datos sociodemográficos, signos, síntomas y hallazgos de un examen médico. La potencial asociación con los hidrocarburos se exploró considerando tres grupos, según su localización: cabecera de Arauca, resguardo Aspejená (no expuestos) y resguardos de San José del Lipa y La Vorágine (expuestos por su cercanía al río Ele y afluentes). Con listados libres, se exploraron las causas de muerte. El estudio incorporó un riguroso manejo intercultural en todos sus componentes. Resultados. Participaron 576 indígenas de 16 asentamientos. El agua consumida pudo servir como medio de exposición a los hidrocarburos. Los problemas de salud fueron muy variados e incluían enfermedades infecciosas y crónicas, malnutrición y trauma. Las masas en el cuello se asociaron con residir en los resguardos ancestrales (RP=3,86; IC95% 1,77-8,39), territorios potencialmente expuestos al petróleo. Las causas de muerte más relevantes fueron el homicidio, los tumores y la tuberculosis. Conclusión: Por su posible asociación con los hidrocarburos, es prioritario el estudio intercultural de linfoadenopatías entre indígenas potencialmente expuestos al petróleo.

Salivary Streptococcus mutans colony-forming unit count in patients with and without orthodontic appliances / Recuento de unidades formadoras de colonias de Streptococcus mutans salivares en pacientes con y sin aparatología ortodóntica

ABSTRACT Orthodontic appliances promote the accumulation of biofilm in the oral cavity and increase counts of Streptococcus mutans (S. mutans). However, there are few comparative studies of the effects generated by the interaction of saliva and microorganisms in absence and presence of orthodontic appliances. Aim: The aim of this study was to determine the S. mutans colony-forming unit count (CFU/mL) in participants with and without fixed orthodontic appliances. Materials and Method: It was an observational cross-sectional study on 21 participants, all over 18 years of age, non-smokers, without removable oral appliances, who had not been under antibiotic treatment within the previous three months. Sociodemographic variables, oral hygiene habits, S. mutans CFU/mL count, and salivary pH were assessed. Saliva samples were collected, and the data was analyzed using Fisher's exact and Kruskal Wallis tests. A p-value<0.05 was considered statistically significant. Results: Fourteen (66.7%) of the participants were female; average age was 20.4 ± 2.2 years. The group without fixed orthodontic appliances had the highest salivary S. mutans CFU/mL count (Me: 56.0×103, IQR: 9.2×103 - 75.5×103), but there was no statistically significant difference between groups (p=0.7459). There was a statistically significant difference in salivary pH, with the metal orthodontic appliance group having the lowest pH (p=0.0478). No statistically significant difference in salivary S. mutans CFU/mL count was found between groups. Salivary pH was lower in the group with metal appliances than in the groups with non-metal appliances and without appliances.

RESUMEN Se ha reportado que la aparatología ortodóntica promueve la acumulación de biofilm en la cavidad bucal y aumenta los recuentos bacterianos de Streptococcus mutans (S. mutans). Sin embargo, los estudios comparativos sobre los efectos generados por la interacción de la saliva y los microorganismos en ausencia y presencia de aparatología ortodóntica son limitados. Determinar el recuento de Unidades Formadoras de Colonias (UFC/mL) de S. mutans en participantes con y sin aparatología ortodóntica fija. Materiales y Método: se realizó un estudio observacional de corte transversal con 21 participantes, todos mayores de 18 años, no fumadores, sin ningún tipo de aparatología oral removible y sin antecedentes de tratamiento antibiótico en los tres meses previos. Se evaluaron variables sociodemográficas, hábitos de higiene oral, recuento de UFC/mL de S. mutans y pH salival. Se recolectaron muestras salivales y los datos se analizaron mediante las pruebas Exacto de Fisher y Kruskal Wallis. Un valor de p ≤0,05 se consideró estadísticamente significativo. Resultados: participaron catorce (66,7%) mujeres; la edad promedio fue de 20.4 ± 2.2 años. El grupo sin ortodoncia fija presentó el mayor recuento de UFC/mL de S. mutans salival (Me: 56,0×103, RIC: 9,2×103 - 75,5×103), pero no hubo una diferencia estadísticamente significativa entre los grupos (p=0,7459). Con relación al pH salival, se observó una diferencia estadísticamente significativa, siendo el grupo de ortodoncia metálica el que presentó el pH más bajo (p=0,0478). Aunque no se encontró una diferencia estadísticamente significativa en el recuento de UFC/mL de S. mutans salival entre los grupos, el pH salival del grupo de aparatología metálica fue más bajo en comparación con los grupos no metálicos y sin aparatología.

Condiciones de salud de los indígenas hitnü potencialmente expuestos a petróleo crudo (Arauca, Colombia) / Health conditions of Hitnü indigenous people potentially exposed to crude oil in Arauca, Colombia

Introducción. El pueblo hitnü vive en condiciones sanitarias precarias, con inseguridad alimentaria y víctima de la violencia sociopolítica en Arauca (Colombia). Además, se sospecha que pueden estar afectados por la exposición a los hidrocarburos del petróleo. Objetivo. Identificar los eventos de salud del perfil de morbilidad y mortalidad de los indígenas hitnü que podrían asociarse con la exposición a petróleo crudo. Materiales y métodos. Se realizó un estudio transversal con indígenas hitnü, durante febrero y marzo de 2021, época de sequía. Se aplicó un cuestionario de hogares y uno individual para recolectar datos del ambiente peridomiciliario, ocupaciones y otras actividades, así como datos sociodemográficos, signos, síntomas y hallazgos de un examen médico. La potencial asociación con los hidrocarburos se exploró considerando tres grupos, según su localización: cabecera de Arauca, resguardo Aspejená (no expuestos) y resguardos de San José del Lipa y La Vorágine (expuestos por su cercanía al río Ele y afluentes). Con listados libres, se exploraron las causas de muerte. El estudio incorporó un riguroso manejo intercultural en todos sus componentes. Resultados. Participaron 576 indígenas de 16 asentamientos. El agua consumida pudo servir como medio de exposición a los hidrocarburos. Los problemas de salud fueron muy variados e incluían enfermedades infecciosas y crónicas, malnutrición y trauma. Las masas en el cuello se asociaron con residir en los resguardos ancestrales (RP=3,86; IC95% 1,77-8,39), territorios potencialmente expuestos al petróleo. Las causas de muerte más relevantes fueron el homicidio, los tumores y la tuberculosis. Conclusión. Por su posible asociación con los hidrocarburos, es prioritario el estudio intercultural de linfoadenopatías entre indígenas potencialmente expuestos al petróleo.

Introduction. The Hitnü indigenous people live in precarious sanitary conditions, with food insecurity and being victims of sociopolitical violence in Arauca, Colombia. In addition, it is possible that they may be affected by exposure to hydrocarbons found in oil. Objective. To identify the health outcomes of morbidity and mortality profiles of the Hitnü people that could be associated with the exposure to crude oil. Materials and methods. A cross-sectional study was carried out with Hitnü indigenous people, during February and March, 2021, time of drought. A household questionnaire was applied, and one individual to collect data from the environment around the house, occupations and other activities, as well as data from sociodemographic, signs, symptoms, and findings of a medical examination. The potential association with hydrocarbons was explored considering three groups: inhabitants in Arauca city, Aspejaná reserve (not exposed), and San José del Lipa and La Vorágine reserves (exposed by the Ele river and tributaries). With free listings, causes of death were explored. The study incorporated a rigorous intercultural management in all its components. Results. A total of 576 indigenous people from 16 settlements participated. The water consumed could serve as means of exposure to hydrocarbons. Health problems were very varied, including infectious and chronic diseases, malnutrition, and trauma. The masses on the neck were associated with residing in the ancestral reserves (PR = 3.86; CI95% 1.77-8.39), territories with potential exposure to crude-oil. The most relevant causes of death were homicide, tumors, and tuberculosis. Conclusion. For its possible association with exposure to hydrocarbons, it is a priority to start the intercultural study of lymphadenopathies in indigenous communities potentially exposed to crude oil.

Keratin Granulomas in the Peritoneum on Frozen Section: A Case Report with Multiple Suspects and the Search for the Culprit.

Keratin granulomas in the peritoneum are a rare finding with multiple etiologies and can be especially challenging for both the pathologist and the surgeon when these lesions are grossly visible. We report a case of a unique frozen section diagnostic scenario of evaluation of keratin granulomas in the peritoneum of a 47-year-old woman in the setting of multiple potential culprits: endometrial endometrioid adenocarcinoma following fertility sparing treatment, and a concurrent dermoid cyst. We discuss the various etiologies of keratin granulomas in the peritoneum, mechanism of their formation, diagnostic significance, as well as implications of fertility sparing treatments. To the best of our knowledge, this is the only case of keratin granulomas in the peritoneum with multiple distinct potential pathologic culprits as well the only case following fertility sparing treatment.

Lemmel's syndrome: Presentation of an uncommon cholangitis cause and a risk factor for failed endoscopic retrograde cholangiopancreatography. Case report.

INTRODUCTION: Lemmel's syndrome is a rare pathology that presents jaundice or dilation of common biliary tract, secondary to duodenal diverticula. Due to infrequency, a high suspicion has to be considered to avoid omitting this diagnosis, mainly in patients who present direct hyperbilirubinemia without choledocholithiasis. PRESENTATION OF CASE: A 76-year-old female admitted to the emergency department with cholangitis, secondary to an ampullary diverticulum (papilla was located inside the diverticulum). As a consequence, the endoscopic retrograde cholangiopancreatography failed and a biliodigestive derivation (choledochal duodenum anastomosis) was performed. DISCUSSION AND CONCLUSIONS: This case is an example of an unusual clinical and anatomical presentation of duodenal diverticulum. This unusual presentation is an example of the importance of not overlooking a diagnosis, which can lead to more severe complications such as cholangitis. It is also important to consider that cases like this are risk factors for failed endoscopic management and surgical possibilities procedures should also be considered in the management.

Salivary Streptococcus mutans colony-forming unit count in patients with and without orthodontic appliances.

Orthodontic appliances promote the accumulation of biofilm in the oral cavity and increase counts of Streptococcus mutans (S. mutans). However, there are few comparative studies of the effects generated by the interaction of saliva and microorganisms in absence and presence of orthodontic appliances. AIM: The aim of this study was to determine the S. mutans colony-forming unit count (CFU/mL) in participants with and without fixed orthodontic appliances. MATERIALS AND METHOD: It was an observational cross-sectional study on 21 participants, all over 18 years of age, non-smokers, without removable oral appliances, who had not been under antibiotic treatment within the previous three months. Sociodemographic variables, oral hygiene habits, S. mutans CFU/mL count, and salivary pH were assessed. Saliva samples were collected, and the data was analyzed using Fisher's exact and Kruskal Wallis tests. A p-value <0.05 was considered statistically significant. RESULTS: Fourteen (66.7%) of the participants were female; average age was 20.4 ± 2.2 years. The group without fixed orthodontic appliances had the highest salivary S. mutans CFU/mL count (Me: 56.0×103, IQR: 9.2×103 - 75.5×103), but there was no statistically significant difference between groups (p=0.7459). There was a statistically significant difference in salivary pH, with the metal orthodontic appliance group having the lowest pH (p=0.0478). No statistically significant difference in salivary S. mutans CFU/mL count was found between groups. Salivary pH was lower in the group with metal appliances than in the groups with non-metal appliances and without appliances.

Se ha reportado que la aparatología ortodóntica promueve la acumulación de biofilm en la cavidad bucal y aumenta los recuentos bacterianos de Streptococcus mutans (S. mutans). Sin embargo, los estudios comparativos sobre los efectos generados por la interacción de la saliva y los microorganismos en ausencia y presencia de aparatología ortodóntica son limitados. Determinar el recuento de Unidades Formadoras de Colonias (UFC/mL) de S. mutans en participantes con y sin aparatología ortodóntica fija. Materiales y Método: se realizó un estudio observacional de corte transversal con 21 participantes, todos mayores de 18 años, no fumadores, sin ningún tipo de aparatología oral removible y sin antecedentes de tratamiento antibiótico en los tres meses previos. Se evaluaron variables sociodemográficas, hábitos de higiene oral, recuento de UFC/mL de S. mutans y pH salival. Se recolectaron muestras salivales y los datos se analizaron mediante las pruebas Exacto de Fisher y Kruskal Wallis. Un valor de p ≤0,05 se consideró estadísticamente significativo. Resultados: participaron catorce (66,7%) mujeres; la edad promedio fue de 20.4 ± 2.2 años. El grupo sin ortodoncia fija presentó el mayor recuento de UFC/mL de S. mutans salival (Me: 56,0×103, RIC: 9,2×103 - 75,5×103), pero no hubo una diferencia estadísticamente significativa entre los grupos (p=0,7459). Con relación al pH salival, se observó una diferencia estadísticamente significativa, siendo el grupo de ortodoncia metálica el que presentó el pH más bajo (p=0,0478). Aunque no se encontró una diferencia estadísticamente significativa en el recuento de UFC/mL de S. mutans salival entre los grupos, el pH salival del grupo de aparatología metálica fue más bajo en comparación con los grupos no metálicos y sin aparatología.

Bochdalek hernia in a young adult successfully treated with a laparoscopic approach, a case report.

BACKGROUND: Bochdalek hernias are a rare form of diaphragmatic hernias; they are frequently found in children; however, they have been discovered in completely asymptomatic adults in exceptional situations. Being such a unique pathology, they can be easily confused and misdiagnose, exposing patients to unnecessary treatments. CASE REPORT: Patient is an otherwise healthy 30-year-old patient without past medical history; after vigorous physical activity, a Bochdalek hernia was discovered and successfully treated; on follow-ups, he is doing well without signs of recurrence. CONCLUSIONS: In adults, Bochdalek hernia is an uncommon form of diaphragmatic hernia. As most cases are asymptomatic, a high index of suspicion is needed since diagnosis is challenging. Modern surgical techniques can improve patient recovery and short hospital stay with minimal morbidity or mortality.

Urethral involvement is associated with higher mortality and local recurrence in vulvar melanoma: a single institutional experience.

Vulvar malignant melanoma (VMM), although uncommon, comprises 5-10% of all vulvar malignancies. Local control is notoriously poor in VMM with recurrence rates of 30-50% compared with approximately 3% in cutaneous melanomas. We studied clinicopathologic features of 37 women with VMM, after reviewing three decades of clinical follow-up data in our institutional databases. Most patients were Caucasian (n = 35) with an average age at diagnosis of 60.6 years (range 23-83). The most common subtype was mucosal lentiginous melanoma (n = 25). We compared Kaplan-Meier survival curves of 31 patients defined by clinical and microscopic attributes using exact log-rank tests. Younger patients at diagnosis (23-64 years), those with thin melanomas (≤1 mm), and those with Clark's level II or III tumors had better 5-year survival rates than older patients (65-83 years) and those with thick melanomas (>1 mm) and those with Clark's level IV or V (P ≤ 0.05), respectively, by exact log-rank test. Local recurrence of melanoma occurred in 15 patients. Nine patients (24%) had eventual urethral involvement by malignant melanoma, and this feature was associated with significantly shorter survival (P = 0.036). Patients with urethral involvement had shorter median time to death and worse 5-year survival rates. Given that spread to the urethra is common in VMM and urethral recurrence is also associated with mortality, pathology excision specimens should be carefully reviewed with attention to urethral involvement as a potentially important prognostic factor.

Influence of climate variability on acute myocardial infarction mortality in Havana, 2001-2012.

INTRODUCTION: Death from acute myocardial infarction is due to many factors; influences on risk to the individual include habits, lifestyle and behavior, as well as weather, climate and other environmental components. Changing climate patterns make it especially important to understand how climatic variability may influence acute myocardial infarction mortality. OBJECTIVES: Describe the relationship between climate variability and acute myocardial infarction mortality during the period 2001-2012 in Havana. METHODS: An ecological time-series study was conducted. The universe comprised 23,744 deaths from acute myocardial infarction (ICD-10: I21-I22) in Havana residents from 2001 to 2012. Climate variability and seasonal anomalies were described using the Bultó-1 bioclimatic index (comprising variables of temperature, humidity, precipitation, and atmospheric pressure), along with series analysis to determine different seasonal-to-interannual climate variation signals. The role played by climate variables in acute myocardial infarction mortality was determined using factor analysis. The Mann-Kendall and Pettitt statistical tests were used for trend analysis with a significance level of 5%. RESULTS: The strong association between climate variability conditions described using the Bultó-1 bioclimatic index and acute myocardial infarctions accounts for the marked seasonal pattern in AMI mortality. The highest mortality rate occurred during the dry season, i.e., the winter months in Cuba (November-April), with peak numbers in January, December and March. The lowest mortality coincided with the rainy season, i.e., the summer months (May-October). A downward trend in total number of deaths can be seen starting with the change point in April 2009. CONCLUSIONS: Climate variability is inversely associated with an increase in acute myocardial infarction mortality as is shown by the Bultó-1 index. This inverse relationship accounts for acute myocardial infarction mortality's seasonal pattern.

Cost-utility of a walking programme for moderately depressed, obese, or overweight elderly women in primary care: a randomised controlled trial.

BACKGROUND: There is a considerable public health burden due to physical inactivity, because it is a major independent risk factor for several diseases (e.g., type 2 diabetes, cardiovascular disease, moderate mood disorders neurotic diseases such as depression, etc.). This study assesses the cost utility of the adding a supervised walking programme to the standard "best primary care" for overweight, moderately obese, or moderately depressed elderly women. METHODS: One-hundred six participants were randomly assigned to an interventional group (n = 55) or a control group (n = 51). The intervention consisted of an invitation, from a general practitioner, to participate in a 6-month walking-based, supervised exercise program with three 50-minute sessions per week. The main outcome measures were the healthcare costs from the Health System perspective and quality adjusted life years (QALYs) using EuroQol (EQ-5D.) RESULTS: Of the patients invited to participate in the program, 79% were successfully recruited, and 86% of the participants in the exercise group completed the programme. Over 6 months, the mean treatment cost per patient in the exercise group was 41 euros more than "best care". The mean incremental QALY of intervention was 0.132 (95% CI: 0.104-0.286). Each extra QALY gained by the exercise programme relative to best care cost 311 euros (95% CI, 143 euros-394 euros). The cost effectiveness acceptability curves showed a 90% probability that the addition of the walking programme is the best strategy if the ceiling of inversion is 350 euros/QALY. CONCLUSION: The invitation strategy and exercise programme resulted in a high rate of participation and is a feasible and cost-effective addition to best care. The programme is a cost-effective resource for helping patients to increase their physical activity, according to the recommendations of general practitioners. Moreover, the present study could help decision makers enhance the preventive role of primary care and optimize health care resources. TRIAL REGISTRATION: [ISRCTN98931797].