Encephalomyelitis in a patient with monkeypox: an unusual complication.

A new outbreak of monkeypox has been reported worldwide with CNS complications like encephalitis or myelitis being extremely rare. We present a case of a 30-year-old man with PCR-confirmed diagnosis of monkeypox who developed rapid neurological deterioration with extensive inflammatory involvement of the brain and spinal cord on MRI. Because of the clinical and radiological resemblance to acute disseminated encephalomyelitis (ADEM), it was decided to indicate treatment with high-dose corticosteroids for 5 days (without concomitant antiviral management due to lack of availability in our country). Given the poor clinical and radiological response, 5 days of immunoglobulin G were administered. During follow-up the patient's clinical condition improved, physiotherapy was started and all associated medical complications were controlled. To our knowledge, this is the first reported monkeypox case with severe CNS complications treated with steroids and immunoglobulin in the absence of specific antiviral treatment.

Operationalizing Integrated Water Resource Management in Latin America: Insights from Application of the Freshwater Health Index.

Water crises in Latin America are more a consequence of poor management than resource scarcity. Addressing water management issues through better coordination, identification of problems and solutions, and agreement on common objectives to operationalize integrated water resources management (IWRM) could greatly improve water governance in the region. Composite indices have great potential to help overcome capacity and information challenges while supporting better IWRM. We applied one such index, the Freshwater Health Index (FHI) in three river basins in Latin America (Alto Mayo, Perú; Bogotá, Colombia; and Guandu, Brazil) to assess freshwater ecosystem vitality, ecosystem services, and the water governance system in place. The approach included convening management agencies, water utilities, planning authorities, local NGOs and industries, community groups and researchers to co-implement the FHI. The results provide detailed information on the ecological integrity of each basin and the sustainability of the ecosystem services being provided. All three basins show very low scores for governance and stakeholder engagement, thus improving both in the region should be a priority. The results also shed light on how the FHI framework can help inform decision-making to improve IWRM implementation by facilitating stakeholder engagement while contributing to coordination, identification of problems and solutions as well as agreement on common objectives. Because implementation of IWRM is part of the solution for the United Nations Sustainable Development Goal (SDG) 6.5 ("By 2030, implement IWRM at all levels, including through transboundary cooperation as appropriate"), our case studies can serve as examples to other Latin American countries to achieve SDG 6.5.

Estrés laboral: una revisión de las principales causas consecuencias y estrategias de prevención / Work Stress: A Review of the Main Causes, Consequences, and Prevention Strategies / O estresse no trabalho: uma revisão das principais causas, consequências e estratégias de prevenção

Introducción: El estrés laboral es una enfermedad peligrosa que altera el estado psicológico de la persona, porque genera reacciones y respuestas de tipo emocional, cognitivo, fisiológico y del comportamiento frente a situaciones con alta demanda laboral que sobrepasa los recursos personales y del trabajo. Se considera una problemática de tipo social y económica asociada con factores de riesgo psicosocial y con desencadenantes. Por ello, es fundamental su detección precoz, para evitar sus secuelas y para emplear estilos de afrontamiento. Objetivo: Analizar los referentes teóricos del estrés laboral, teniendo en cuenta sus principales causas, consecuencias y estrategias de prevención en el ámbito laboral. Metodología: Revisión documental disponible en las bases de datos Epistemonikos, ProQuest, Frontiers in Psychology, Academy, Biblioteca Digital, Elsevier, Redalyc, Dialnet, SciELO y Science Direct, de estudios publicados entre 2015 y 2020 que incluyeran conceptos de estrés laboral, causas, consecuencias y estrategias de prevención. Se revisaron 60 artículos, y para seleccionar la información se aplicó búsqueda, organización, categorización y análisis de 5554 documentos electrónicos. Se excluyeron 6 estudios relacionados con temas específicos del síndrome de burnout. Conclusiones: El estrés es una problemática prevalente en el contexto organizacional que se genera por múltiples factores asociados con las condiciones laborales y personales y origina en el individuo consecuencias fisiológicas y mentales que afectan su desempeño y productividad. De ahí que sea necesario incentivar una cultura preventiva que fomente la salud de los colaboradores.

Introduction: The labor stress is dangerous disease that alters the psychological state of the person, by generating emotional, cognitive, physiological and behavioral reactions and responses to situa-tions with high work demand that exceeds personal and work resources. It is considered as a social and economic problem associated with psychosocial risk factors and triggers, which, it is essential to attach importance to its early detection and thus avoid its consequences, as well as the use of coping styles. Objective: To analyze the theoretical references of work stress, considering the main causes, conse-quences and prevention strategies in the workplace. Methodology: Documentary review available in the databases Epistemonikos, ProQuest, Frontiers in Psychology, Academy, Bibliotheca Digital, Elsevier, Redalyc, Dialnet, SciELO and Science Direct. Inclusion criteria: works published between 2015 and 2020 that include concepts of work stress, causes, consequences and prevention strategies. 60 articles were reviewed to select the information, a search, organization, categorization and analysis of 5554 electronic documents were applied, 6 studies related to specific topics of Burnout syndrome were excluded. Conclusions: Stress is a prevalent problem in the organizational context that is generated by multiple factors associated with the work and personal conditions, originating in the individual consequences of physiological and mental type affecting the performance and the productivity, being necessary to stimulate a preventive culture that promotes the health of the collaborators.

Introdução: O estresse relacionado ao trabalho é uma doença perigosa que altera o estado psicoló-gico da pessoa, pois gera reações emocionais, cognitivas, fisiológicas, comportamentais e respostas a situações com altas exigências de trabalho que excedem os recursos pessoais e de trabalho. É conside-rado um problema social e econômico associados a fatores de risco psicossociais e desencadeadores. É, portanto, essencial detectá-lo cedo, para evitar suas consequências e usar estilos de enfrentamento. Objetivo: Analisar as referências teóricas do estresse relacionado ao trabalho, levando em conta suas principais causas, consequências e estratégias de prevenção no local de trabalho. Metodologia: revisão documental disponível nas bases de dados Epistemonikos, ProQuest, Frontiers in Psychology, Academy, Digital Library, Elsevier, Redalyc, Dialnet, SciELO e Science Direct, de estudos publicados entre 2015 e 2020 que incluíam conceitos de estresse relacionado ao trabalho, causas, consequências e estratégias de prevenção. Sessenta artigos foram revisados, e para selecionar as informações, foi aplicada uma pesquisa onde foram organizados, categorizados e analisados 5554 documentos eletrônicos. Foram excluídos seis estudos relacionados a questões específicas da Síndro-me de Burnout. Conclusões: O estresse é um problema predominante no contexto organizacional que é gerado por múltiplos fatores associados às condições de trabalho e pessoais, e causa consequências fisiológicas e mentais no indivíduo que afetam seu desempenho e produtividade. Portanto, é necessário incentivar uma cultura preventiva que promova a saúde dos funcionários.Palavras-chave: estresse ocupacional; psicossocial; saúde ocupacional; trabalhadores.

Clinical practice guidelines for the surgical endodontic management of post-treatment periapical disease / Guía de práctica clínica para el manejo quirúrgico en endodoncia de la enfermedad periapical postratamiento

ABSTRACT Introduction: in Colombia, persisting post-endodontic disease has been reported by up to 45%, validating the use of secondary alternative therapies, like endodontic microsurgery (EM). The aim of this study was to systematically-and with reliable scientific evidence-develop de Novo Clinical Practice Guidelines for the surgical endodontic management of post-treatment periapical disease (PPD), with more accurate recommendations for therapeutic decisions and preferences consulted with both practitioners and patients. Method: the guidelines developers team identified EM as a topic in the literature and established the scope, objective, questions, and outcomes, which were analyzed using the scientific evidence reported in secondary or primary clinical studies. A first screening identified titles and abstracts for each question asked. The validity of the selected studies was quantified with tools like AMSTAR or SIGN. Finally, the strength of recommendations and the quality of evidence were confirmed with GRADE. Results: concepts like PPD, EM indication, use of local anesthetics, antibiotics and presurgical anti-inflammatory drugs, effect of magnification, implementation of cone beam computed tomography, hemostasis, retrograde filling, and control time were integrated, supporting each topic with relevant evidence, experts' recommendations, and even good practice points. Conclusions: this document is considered a tool with sufficient evidence for clinical decision-making in EM.

RESUMEN Introducción: en Colombia, la persistencia de enfermedad posendodoncia ha sido reportada hasta en un 45%, lo cual justifica propuestas terapéuticas secundarias, como la microcirugía endodóntica (ME). El objetivo del presente estudio consistió en desarrollar sistemáticamente, y con evidencia científica confiable, una Guía de Práctica Clínica de Novo para el manejo quirúrgico en endodoncia de la enfermedad periapical postratamiento (EPP), con las recomendaciones más acertadas frente a decisiones y preferencias terapéuticas consultadas a profesionales y pacientes. Método: el grupo desarrollador de la guía identificó el tópico ME y estableció el alcance, el objetivo, las preguntas y los desenlaces, analizados mediante la evidencia científica registrada a partir de estudios clínicos secundarios o primarios. Un primer tamizaje identificó títulos y resúmenes para cada pregunta formulada. La validez de los estudios seleccionados se cuantificó con las herramientas AMSTAR o SIGN. Finalmente, la fuerza de las recomendaciones y la calidad de la evidencia se constataron con la herramienta GRADE. Resultados: se integraron los conceptos de EPP, indicación de la ME, uso de anestésicos locales, antibióticos y antinflamatorios prequirúrgicos, efecto de la magnificación, implementación de la tomografía computarizada de haz cónico, hemostasia, materiales de retroobturación y el tiempo de control, sustentando cada tópico con la evidencia, la recomendación de los expertos y en ocasiones con las premisas de las buenas prácticas. Conclusiones: el presente documento se considera una herramienta con suficiente evidencia para la toma de decisiones clínicas en ME.

Enfoque práctico de la neurosífilis meningovascular: a propósito de un caso presuntivo / Meningovascular neurosyphilis practical approach. Report of a presumptive case

Se presenta el caso clínico de un paciente masculino de 62 años de edad, con ataque cerebrovascular (ACV) isquémico de circulación posterior, secundaria a neurosífilis meningovascular presuntiva, sin coinfección por VIH. La neurosífilis puede tener una presentación clínica heterogénea, siendo el ACV isquémico una de sus principales manifestaciones. El diagnóstico se realiza básicamente con confirmación serológica de la sífilis y posteriormente el estudio del líquido cefalorraquídeo (LCR). Un diagnóstico y tratamiento oportuno puede prevenir complicaciones neurológicas a futuro. La recomendación de manejo actual sigue siendo la penicilina cristalina endovenosa.

We present a 62 year-old male who had a posterior circulation ischemic stroke probably due to meningovascular neurosyphilis, without HIV coinfection. Neurosyphilis can present in a heterogeneous manner. The diagnosis is made with the serologic confirmation, as well as a CSF study. A prompt diagnosis and treatment can prevent neurologic complications.

Enfermedad de Pompe como diagnóstico diferencial de enfermedad de motoneurona: reporte de casos y revisión de la literatura / Pompe disease as a differential diagnosis of motor neuron disease: report of a case and review of the literature

A través del presente estudio se pretende demostrar la importancia de la evaluación de la enfermedad de Pompe como diagnóstico diferencial de la enfermedad de motoneurona. En el siguiente trabajo presentamos dos casos clínicos en los que inicialmente se consideró enfermedad de motoneurona, y en donde finalmente se documentó un déficit de alfa glucosidasa como causal de la sintomatología.

Through this study we aim to demonstrate the importance of the evaluation of pompe disease as a differential diagnosis of motor neuron disease. Here we present two cases in which the initial approach was of a motor neuron disease, but with a more comprehensive assessment it was documented an alpha glucosidase deficiency.

Caracterización de pacientes con enfermedad de Parkinson en un centro de referencia de la ciudad de Bogotá, Colombia / Characterization of patients with Parkinson's disease in a reference center of Bogotá, Colombia

Introducción: la enfermedad de Parkinson es una de las enfermedades neurodegenerativas más prevalentes a nivel mundial. Se han documentado las características clínicas de presentación de la enfermedad, además de los síntomas motores y no motores. En nuestra población no hay datos al respecto. Objetivo: describir las características demográficas y clínicas de una cohorte de pacientes con enfermedad de Parkinson, evaluados en un centro de referencia de movimientos anormales de la ciudad de Bogotá, Colombia. Materiales y métodos: estudio descriptivo retrospectivo de los pacientes con enfermedad de Parkinson que asisten a la consulta de movimientos anormales. Se observaron todos los pacientes registrados en la base de datos de enero de 2013 hasta junio de 2015 y se revisaron las variables sociodemográficas, los síntomas motores y no motores y se analizaron de acuerdo al tiempo de evolución de la enfermedad. Todos los datos fueron analizados en el programa SPSS, en donde se establecieron frecuencias, promedios y proporciones. Resultados: se analizaron en total 446 pacientes, de los cuales el 50.7 % son mujeres. La edad promedio encontrada fue de 68 años. Encontramos en ellos, síntomas pre-motores como hiposmia en un 33.6 % y alteraciones del sueño REM en un 32 %. Los síntomas motores experimentados como de presentación inicial fueron: temblor (62.3 %), bradicinesia (15.9 %), rigidez (12.6 %), dificultad para caminar (8.1 %), alteración del equilibrio (1.6 %) y caídas (1.6 %). Conclusión: en la población estudiada se encontraron frecuencias de patrones motores similares con los registros internacionales, sin embargo, las características demográficas y las manifestaciones no motoras tuvieron algunas diferencias.

Introduction: Parkinson's disease is one of the most prevalent neurodegenerative diseases worldwide. It's clinical presentation, motor and non-motor signs have been described previously. In our population, we don't know the frequency of those signs and symptoms. Objective: Describe the clinical presentation, motor and non-motor signs of a cohort of patients with Parkinson's disease, that were evaluated in a movement disorders center of reference, at Bogotá, Colombia. Materials and methods: Descriptive retrospective study of patients with Parkinson's disease, who went to the movement disorders clinic between January 2013 and June 2015. Patients were organized depending on the time from the onset of the disease. Socio-demographic variables, motor and non-motor signs and symptoms where studied. Frequencies, mean and proportions were analyzed using SPSS 22 version. Results: 446 patients were analyzed, from which 50.7% were women. The mean age found was 68 years old. We found hiposmia in 33.6% of patients and abnormalities in REM sleep in 32% of them. The first motor symptoms noticed by the patient were tremor (62.3%), bradykinesia (15.9%), stiffness (12.6%), difficulty walking (8.1%), balance problems (1.6%) and falls (1.6%). Conclusion: Parkinson's disease is the second most frequent neurodegenerative disease worldwide. Its clinical presentation is diverse, and in our population we have never study the patterns of presentation. We found similar frequencies compared with the international registries of this disease, with some difference in demographic and non-motor symptoms.

Primary gliosarcoma of the brain: radiologic and histopathologic features.

Gliosarcoma is a rare central nervous system (CNS) neoplasm with biphasic glial and non-glial malignant components. Here we describe the radiologic and histopathologic features observed in five cases of primary gliosarcoma. The mean age at diagnosis in the studied patients was 54.2 years; these patients were predominantly males (male:female ratio = 4:1). At diagnosis all patients had several clinical deterioration. The most common symptoms of presentation were: headache (5/5 cases), seizures (4/5 cases) and hemiparesis (1/5 cases). All the tumors were large (mean major diameter= 4.12±1.64 cm) at diagnosis as evidenced in computer tomography (CT) scans and magnetic resonance images (MRIs), with preferential involvement of the temporal lobe and frequent associated deviation of the midline structures. Other common characteristics identified on CT scans and MRIs were partial contrast medium uptake with annular pattern (5/5 cases), peripheral edema (5/5 cases), and central calcification (3/5 cases). In additional a peak of dye uptake was observed (4/5 cases) on MRI spectrometry. In the histopathology, the glial component showed malignant astrocytes, with high Ki67 (>60%) and p53 positivity; the sarcomatous components displayed pleomorphic spindle cells similarly with p53 positivity and high Ki67 (75-90%) in all cases. Dedifferentiation to pleomorphic sarcoma (two cases), fibrosarcoma (one case), leiomyosarcoma (one case) and MPNST (one case) were documented. All patients received radiotherapy/chemotherapy and had a median overall survival of ten months. The study of radiologic and histopathologic features in primary gliosarcomas of the brain is a priority to achieve early diagnosis that can be translated to better outcomes. Here we describe the radiologic and histopathologic features observed in a group of gliosarcoma patients with variable histopathologic dedifferentiation.

Servicios amigables para jóvenes: construcción conjunta entre jóvenes y funcionarios / Health care services for young people: a joint construction among youth and health personnel

Antecedentes: La atención integrada y amigable a los adolescentes en salud es un aspecto de vital importancia para el logro de indicadores en salud y para la prevención de comportamientos de riesgo que dejan consecuencias severas.Objetivos: Identificar la percepción, experiencias y expectativas de jóvenes y funcionarios de salud sobre los servicios a jóvenes de la zona de ladera de Cali, Colombia. Desarrollar una estrategia conjunta entre jóvenes y funcionarios para el mejoramiento de los mismos servicios de salud a partir de los lineamientos de los Servicios Amigables para Jóvenes (SAJ).Métodos: Estudio de investigación-acción-participación con jóvenes y funcionarios de una ESE de Cali. La población de jóvenes se encontraba entre los 10 a 19 años. Inicialmente se aplicó un instrumento de evaluación al personal de salud y luego una encuesta sobre los SAJ. Se e realizaron entrevistas grupales y grupos de discusión para analizar los resultados. Se hizo abogacía y se formularon propuestas ante las autoridades locales y tomadores de decisiones sobre el manejo de los recursos.Resultados: La encuesta al personal de salud mostró que en la mayoría de las instituciones prestadoras de salud, no se cuenta con espacios y horarios definidos para la atención a los jóvenes, falta capacitación y número adecuado de funcionarios para la atención, ausencia de material de apoyo para educación en salud. La encuesta de jóvenes fue respondida por 100 jóvenes, el 76% fueron mujeres. El promedio de edad fue de 15.7 años con un rango entre los 12 y 26 años; con relación a la satisfacción en la atención brindada por el personal de salud, el porcentaje más alto lo obtuvo el personal médico y el más bajo el personal auxiliar de enfermería. El servicio más consultado es la consulta con médico general y los servicios más frecuentados en el último mes fueron vacunación (19.7%), odontología y urgencias (11.8% para cada uno).

Background: To accomplish health indicators among youth and prevent risks that leave severe consequences, it is important to offer integral health care.Objectives: To identify perceptions, experiences and expectations about health services for youth and health care agents from the Zona de Ladera in the city of Cali. To develop a concerted strategy with youth and health care agents to improve health services under the ®Friendly Youth Services¼ (SAJ abbreviation in Spanish) guide. Methods: Action - Research with participation of health-care personnel, youth, and adolescents from 10 to 19 years of age, was conducted in a public health-care institution in the city of Cali. The methodology included interviews, focal and discussion groups to analyze results and define steps to change services for adolescents. Advocacy and proposals about resource management were made to the local authorities and decision makers.Results: The main findings were lack of time schedules for services to adolescents and the absence of educational materials for them. The study noted a lack of resources like equipment, well-trained personnel – especially with positive attitude toward adolescents, appropriate location for delivery of services, and community participation in health matters. The interview was answered by 100 young individuals, 76% were female, ranging from 12 to 26 years of age; the higher score about satisfaction was for physicians and the lowest was for nursing assistants. Respondents mainly seek physician attention. The service most frequently sought in the last three months was dentistry, vaccinations, and emergency attention (19.7%, and 11.8%, respectively).Conclusions: It is necessary and useful to reorient health-care services for young individuals according to SAJ principles to emphasize health promotion, access to services, and skills and knowledge of health personnel to most appropriately care for the youth.

Efectos secundarios de los tratamientos del cáncer de próstata localizado en la calidad de vida y el ajuste marital / Secondary effects of the localizaed prostate cancer treatments on the quelity of life and marital adjustment

El objetivo general de este estudio descriptivo correlacional fue analizar la relación entre los efectos secundarios del tratamiento antineoplásico, la calidad de vida y el ajuste marital en hombres que han sufrido cáncer de próstata localizado. Los instrumentos utilizados fueron una entrevista estructurada para la recolección de datos sociodemográficos