Combined atrial fibrillation ablation and balloon mitral commissurotomy in patients with rheumatic mitral stenosis.

INTRODUCTION: Ablation of atrial fibrillation (AF) is usually not considered in patients with rheumatic mitral stenosis (RMS). We analyzed the results of a combined procedure of AF ablation and percutaneous balloon mitral commissurotomy (PBMC). METHODS: We prospectively included 22 patients with severe RMS to undergo a combined PBMC + AF ablation procedure. Noninvasive mapping of the atria was also performed. A historical sample of propensity-scored matched patients who underwent PBMC alone was used as controls. The primary endpoint was freedom from AF/AT at 1-year. Multivariate analysis evaluated sinus rhythm (SR) predictors. RESULTS: Successful pulmonary vein isolation and electrocardiographic imaging-based drivers ablation was performed in 20 patients following PBMC. At 1-year, 75% of the patients in the combined group were in SR compared to 40% in the propensity-score matched group (p = 0.004). The composite of AF recurrence, need for mitral surgery and all-cause mortality was also more frequent in the control group (65% vs. 30%; p = 0.005). Catheter ablation (odds ratio [OR] 1.58; 95% confidence interval [CI] [1.17-17.37]; p = 0.04) and AF type (OR 1.46; 95% CI [1.05-82.64]; p < 0.001) were the only independent predictors of SR at 1-year. Noninvasive mapping in the combined group showed that the number of simultaneous rotors (OR 2.10; 95% CI [1.41-10.2]; p = 0.04) was the only independent predictor of AF. CONCLUSION: A combined procedure of AF ablation and PBMC significantly increased the proportion of patients in sinus rhythm at 1-year. Noninvasive mapping may help to improve AF characterization and guide personalized AF treatment.

Using Linguistic Properties of Place Specification for Network Naming to Improve Mobility Performance.

By considering the definitions and properties from the field of linguistics regarding place specification, a questionnaire that can be used to improve naming in networks is obtained. The questionnaire helps introduce the idea of place specification from linguistics and the concept of metric spaces into network naming schemes. The questionnaire results are used to improve the basic Information-Centric Networking (ICN) architecture's notoriously lax network naming structure. The improvements are realized by leveraging components from the Named-Node Network Architecture, a minor ICN design, to supply the resulting network architecture with the properties the questionnaire highlights. Evaluation results from experiments demonstrate that modifying the network architecture so that the proposed questionnaire is satisfied results in achieving high mobility performance. Specifically, the proposed system can obtain mean application goodput at above 88 % of the ideal result, with a delay below 0.104 s and with the network time-out Interest ratio below 0.082 for the proposed single mobile push producer, single mobile consumer scenario, even when the nodes reach the maximum tested speed of 14 m/s.

Synthesis, Anti-Proliferative Activity Evaluation and 3D-QSAR Study of Naphthoquinone Derivatives as Potential Anti-Colorectal Cancer Agents.

Colorectal cancer (CRC) is a disease with high incidence and mortality, constituting the fourth most common cause of death from cancer worldwide. Naphthoquinones are attractive compounds due to their biological and structural properties. In this work, 36 naphthoquinone derivatives were synthesized and their activity evaluated against HT-29 cells. Overall, high to moderate anti-proliferative activity was observed in most members of the series, with 15 compounds classified as active (1.73 < IC50 < 18.11 µM). The naphtho[2,3-b]thiophene-4,9-dione analogs showed potent cytotoxicity, 8-hydroxy-2-(thiophen-2-ylcarbonyl)naphtho[2,3-b]thiophene-4,9-dione being the compound with the highest potency and selectivity. Our results suggest that the toxicity is improved in molecules with tricyclic naphtho[2,3-b]furan-4,9-dione and naphtho[2,3-b]thiophene-4,9-dione systems 2-substituted with an electron-withdrawing group. A 3D-QSAR study of comparative molecular field analysis (CoMFA) was carried out, resulting in the generation of a reliable model (r² = 0.99 and q² = 0.625). This model allowed proposing five new compounds with two-fold higher theoretical anti-proliferative activity, which would be worthwhile to synthesize and evaluate. Further investigations will be needed to determine the mechanism involved in the effect of most active compounds which are potential candidates for new anticancer agents.

Novel Strategies to Improve the Cardioprotective Effects of Cardioplegia.

The use of cardioprotective strategies as adjuvants of cardioplegic solutions has become an ideal alternative for the improvement of post-surgery heart recovery. The choice of the optimal cardioplegia, as well as its distribution mechanism, remains controversial in the field of cardiovascular surgery. There is still a need to search for new and better cardioprotective methods during cardioplegic procedures. New techniques for the management of cardiovascular complications during cardioplegia have evolved with new alternatives and additives, and each new strategy provides a tool to neutralize the damage after ischemia/reperfusion events. Researchers and clinicians have committed themselves to studying the effect of new strategies and adjuvant components with the potential to improve the cardioprotective effect of cardioplegic solutions in preventing myocardial ischemia/reperfusion-induced injury during cardiac surgery. The aim of this review is to explore the different types of cardioplegia, their protection mechanisms, and which strategies have been proposed to enhance the function of these solutions in hearts exposed to cardiovascular pathologies that require surgical alternatives for their corrective progression.

Novel Insights into the Cardioprotective Effects of the Peptides of the Counter-Regulatory Renin-Angiotensin System.

Currently, cardiovascular diseases are a major contributor to morbidity and mortality worldwide, having a significant negative impact on both the economy and public health. The renin-angiotensin system contributes to a high spectrum of cardiovascular disorders and is essential for maintaining normal cardiovascular homeostasis. Overactivation of the classical renin-angiotensin system is one of the most important pathophysiological mechanisms in the progression of cardiovascular diseases. The counter-regulatory renin-angiotensin system is an alternate pathway which favors the synthesis of different peptides, including Angiotensin-(1-7), Angiotensin-(1-9), and Alamandine. These peptides, via the angiotensin type 2 receptor (AT2R), MasR, and MrgD, initiate multiple downstream signaling pathways that culminate in the activation of various cardioprotective mechanisms, such as decreased cardiac fibrosis, decreased myocardial hypertrophy, vasodilation, decreased blood pressure, natriuresis, and nitric oxide synthesis. These cardioprotective effects position them as therapeutic alternatives for reducing the progression of cardiovascular diseases. This review aims to show the latest findings on the cardioprotective effects of the main peptides of the counter-regulatory renin-angiotensin system.

Cytokine and T cell responses in post-chikungunya viral arthritis: A cross-sectional study.

OBJECTIVE: To define the relationship between chronic chikungunya post-viral arthritis disease severity, cytokine response and T cell subsets in order to identify potential targets for therapy. METHODS: Participants with chikungunya arthritis were recruited from Colombia from 2019-2021. Arthritis disease severity was quantified using the Disease Activity Score-28 and an Arthritis-Flare Questionnaire adapted for chikungunya arthritis. Plasma cytokine concentrations (interleukin (IL)-1ß, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, IL-13, interferon-γ and tumor necrosis factor (TNF)) were measured using a Meso Scale Diagnostics assay. Peripheral blood T cell subsets were measured using flow cytometry. RESULTS: Among participants with chikungunya arthritis (N = 158), IL-2 levels and frequency of regulatory T cells (Tregs) were low. Increased arthritis disease activity was associated with higher levels of inflammatory cytokines (IL-6, TNF and CRP) and immunoregulatory cytokine IL-10 (p<0.05). Increased arthritis flare activity was associated with higher Treg frequencies (p<0.05) without affecting T effector (Teff) frequencies, Treg/Teff ratios and Treg subsets. Finally, elevated levels of IL-2 were correlated with increased Treg frequency, percent Tregs out of CD4+ T cells, and Treg subsets expressing immunosuppressive markers, while also correlating with an increased percent Teff out of live lymphocytes (p<0.05). CONCLUSION: Chikungunya arthritis is characterized by increased inflammatory cytokines and deficient IL-2 and Treg responses. Greater levels of IL-2 were associated with improved Treg numbers and immunosuppressive markers. Future research may consider targeting these pathways for therapy.

Accreditation of Quality in Primary Health Care in Chile: Perception of the Teams from Accredited Family Healthcare Centers.

This study aimed to investigate the perception of the health teams belonging to the Family Healthcare Centers (CESFAMs) that are accredited, regarding the process of implementation and the achievement of accreditation. A qualitative approach was applied, with contributions from grounded theory, through the technique of individual in-depth interviews and focus groups. The interviews were carried out in nine accredited CESFAMs. For the presentation, organization and analysis of the data, Atlas.ti V9 software was used. From the results, derived from the open phase of the analysis, obtained from the opinions of the participants, a total of 26 categories emerged relating to the facilitating and hindering factors of the process. From the axial phase, it was possible to establish central categories that were related to quality management policies, the structure of Primary Health Care (PHC), participation and co-construction, and leadership and change management. In conclusion, the discourse of the teams reveals the need to have necessary conditions for the accreditation process, which are mainly related to training, characteristics of the types of leadership and teamwork in harmony with the process. Finally, the study reveals a gap in the community participation in this process, which suggests continuing this line of research.

The Role of METTL3 in the Progression of Cardiac Fibrosis.

Cardiac fibrosis is known as the expansion of the cardiac interstitium through excessive deposition of extracellular matrix proteins; this process is performed by a multifunctional cell known as the cardiac fibroblast. After the myocardial injury, these cells are activated as a repair program, increase, and switch to a contractile phenotype, which is evidenced by an increase in alpha- smooth muscle actin. Likewise, there is an increase in type I and III collagen, which are considered profibrotic biomarkers. It is believed that one of the proteins involved in cardiac remodeling is METTL3, which is the enzyme responsible for N6-methyladenosine (m6A) methylation, the most common and abundant epigenetic modification of eukaryotic mRNA. This review focuses on recent studies in which the possible role of METTL3 in the progression of fibrosis has been demonstrated, mainly in cardiac fibrogenesis.

Potential of Angiotensin-(1-7) in COVID-19 Treatment.

The new coronavirus currently named SARS-CoV-2 was announced by the World Health Organization as the virus causing the COVID-19 pandemic. The pathogenesis of SARS-CoV-2 initiates upon contact of a structural spike protein with the angiotensin II-converting enzyme receptor, leading to the induction of inflammatory mechanisms and progression to severe disease in some cases. Currently, studies have emerged linking COVID-19 with angiotensin-(1-7), demonstrating the potential of angiotensin-(1-7)/Mas Receptor axis induction to control disease severity due to its antiinflammatory, vasodilator, antioxidant, antiproliferative, anticoagulant, antiangiogenic and fibrosis inhibitory effects. The renin angiotensin-system peptide Angiotensin-(1-7) shows a high therapeutic potential for COVID-19 mainly because of its ability to counteract the adverse effects caused in various organs due to angiotensin II-converting enzyme blockade. In light of these factors, the use of convalescent plasma conjugated therapy and Ang (1-7) agonists for the treatment of COVID-19 patients could be recommended. The differential expression of ACE2 and the varied response to SARSCoV- 2 are thought to be connected. According to several investigations, ACE2 antibodies and pharmacological inhibitors might be used to prevent viral entry. Given its capacity to eliminate the virus while ensuring lung and cardiovascular protection by regulating the inflammatory response, angiotensin-( 1-7) is expected to be a safe choice. However, more clinical evidence is required to clarify the therapeutic usage of this peptide. The aim of this review article is to present an update of scientific data and clinical trials on the therapeutic potential of angiotensin-(1-7) in patients with COVID-19.

Mechanisms of the Quorum Sensing Systems of Pseudomonas Aeruginosa: Host and Bacteria.

Quorum-sensing is a communication mechanism between bacteria with the ability to activate signaling pathways in the bacterium and in the host cells. Pseudomonas aeruginosa is a pathogen with high clinical relevance due to its vast virulence factors repertory and wide antibiotic resistance mechanisms. Due to this, it has become a pathogen of interest for developing new antimicrobial agents in recent years. P. aeruginosa has three major QS systems that regulate a wide gene range linked with virulence factors, metabolic regulation, and environment adaption. Consequently, inhibiting this communication mechanism would be a strategy to prevent the pathologic progression of the infections caused by this bacterium. In this review, we aim to overview the current studies about the signaling mechanisms of the QS system of P. aeruginosa and its effects on this bacterium and the host.

Effects of Metformin on Ischemia/Reperfusion Injury: New Evidence and Mechanisms.

The search for new drugs with the potential to ensure therapeutic success in the treatment of cardiovascular diseases has become an essential pathway to follow for health organizations and committees around the world. In June 2021, the World Health Organization listed cardiovascular diseases as one of the main causes of death worldwide, representing 32% of them. The most common is coronary artery disease, which causes the death of cardiomyocytes, the cells responsible for cardiac contractility, through ischemia and subsequent reperfusion, which leads to heart failure in the medium and short term. Metformin is one of the most-used drugs for the control of diabetes, which has shown effects beyond the control of hyperglycemia. Some of these effects are mediated by the regulation of cellular energy metabolism, inhibiting apoptosis, reduction of cell death through regulation of autophagy and reduction of mitochondrial dysfunction with further reduction of oxidative stress. This suggests that metformin may attenuate left ventricular dysfunction induced by myocardial ischemia; preclinical and clinical trials have shown promising results, particularly in the setting of acute myocardial infarction. This is a review of the molecular and pharmacological mechanisms of the cardioprotective effects of metformin during myocardial ischemia-reperfusion injury.

Experiences and perceptions on sexuality, risk and STI/HIV prevention campaigns by university students. Designing a digital intervention. / Experiencias y percepciones sobre sexualidad, riesgo y campañas de prevención de ITS/VIH por estudiantes universitarios. Diseñando una intervención digital.

This study reports on the qualitative phase of a study that seeks to design a digital intervention for the prevention of STI / HIV and promotion of sexual health in university students. The experience and perception that university students have about sexuality, risk and prevention campaigns are addressed through focus groups. Semi-structured interviews are conducted with key informants. The results reveal that sexual education is limited and restricted to the biological aspect, as well as loaded with prejudices and gender biases, which narrows the information provided to the student population. Wavering prevention strategies that fail to motivate students or offer them opportunities for making informed and independent decisions about their sexual health are apparent. The STI / HIV campaigns assessed are distant, fear-based and not inclusive. Interventions in sexual health do not weigh experiential aspects of youth sexuality, as they are based on models of ideal and stereotyped behavior, discarding first-person narratives and their rich complexity. It is imperative to innovate in the prevention of STI/HIV, formulating interventions based on an integrative, multidisciplinary and contextualized design that values the theory and experience of the target populations.

Damos cuenta de la fase cualitativa de una investigación que busca diseñar una intervención digital de prevención de ITS/VIH y promoción de salud sexual en jóvenes universitarios. A partir de grupos focales se abordó la experiencia y percepción que universitarios tienen sobre sexualidad, riesgo y campañas de prevención. Se realizan entrevistas semiestructuradas a informantes claves. Los resultados muestran que la educación sexual es escasa, reducida a lo biológico, cargada de prejuicios y sesgos de género, limitando el manejo de información por la población estudiantil. Se evidencian estrategias vacilantes de prevención, no logrando motivar ni ofrecer oportunidades para la toma de decisiones conscientes y autónomas en salud sexual. Las campañas de ITS/VIH se evaluaron poco inclusivas, lejanas y basadas en el miedo. Las intervenciones en salud sexual han fallado en sopesar aspectos experienciales de la sexualidad juvenil, basándose en modelos de comportamiento ideal y estereotipado, desechando narrativas en primera persona y su rica complejidad. Es imperativo innovar en la prevención de ITS/VIH, formulando intervenciones basadas en un diseño integrador, multidisciplinar y situado, que valore la teoría y la experiencia de las poblaciones objetivo.

Characterization of Communes with Quality Accredited Primary Healthcare Centers in Chile.

The accreditation process of primary healthcare centers in Chile has not had the same progress as in hospitals, which show high levels of compliance. The purpose of this research is to characterize the communes that have accredited family healthcare centers (CESFAMs) through socio-economic, municipal management, clinical management, and population variables by performing a principal components analysis (PCA) with biplot analysis and a grouping of communes through a hierarchical analysis. The biplot analysis and hierarchical analysis yielded the formation of three large groups of communes with accredited CESFAMs, characterized mainly by population size, number of people registered in the municipal health system, socioeconomic indicators, and financial management and clinical management variables. It was found that the communes that have accredited CESFAMs are characterized by dissimilar behavior in relation to the variables analyzed. Through the model used, it was possible to establish at least three groups of communes according to their behavior against these variables. Of these, the variables of a municipal financial nature were not decisive in achieving the accreditation of the CESFAMs of these communes. Therefore, it is possible that there are other variables or factors that could be facilitating the achievement of accreditation processes.

Accessibility in People with Disabilities in Primary Healthcare Centers: A Dimension of the Quality of Care.

The purpose of this research is to evaluate universal accessibility in primary healthcare (PHC) centers in the Atacama region, Chile, through an analytical cross-sectional study with a quality approach, which uses the external audit model with the application of a dichotomous comparison guideline, evaluating levels of compliance with four dimensions of universal accessibility described in the literature: participation, information, accessibility chain and architectural aspects. This was carried out in 18 PHC, and set as Lower Control Limit (LCL) of 70% to compare levels of compliance, and a hierarchical model and k-mean analysis were applied. Results: Very low compliance averages were obtained, 37.7% participation, 4% information, 44.4% access chain, and 63.9% architectural aspects, indicating a critical situation. Moreover, the cluster comparison allowed to observe that a group of healthcare centers complies more than other groups, which requires more attention. Conclusions: The low level of accessibility for people with disabilities may be associated with various factors that require further monitoring and analysis. However, low levels of accessibility require changing the way of relating to this vulnerable group of the population, and considering including them in the design and reasonable adjustments made in PHC centers. The findings from this research open the possibility for future research that increases understanding of how to reduce barriers in a such wide variety of forms of disability.

Recent Insights into COVID-19 in Children and Clinical Recommendations.

Pediatric coronavirus disease 2019 (COVID-19) and multisystem inflammatory syndrome in children (MIS-C) have been recognized in multiple countries globally. In this review, we provide recent insights into SARS-CoV-2 infection in children from epidemiological, clinical, and laboratory perspectives, including reports on the disease course and therapy. We highlight key features of SARS-CoV-2 infection in children, the relationship between MIS-C and Kawasaki disease, and summarize treatment guidelines for COVID-19 in children from institutional protocols from Colombia, case reports, recommendations based on expert consensus, and official statements from organizations such as the World Health Organization (WHO), United States Center for Disease Control (CDC), Colombian Association of Infectious Diseases, and the Colombian Society of Pediatrics. Finally, we discuss gaps in research with suggestions for future research on the pathogenesis underlying pediatric COVID-19.

Evolution of infant mortality in Chile and how it has been reflected in scientific publications between 1980 and 2019. / Evolución de la mortalidad infantil en Chile y su reflejo en las publicaciones científicas entre 1980 y 2019.

INTRODUCTION: One of the Millennium Development Goals is to reduce the child mortality rate (CMR), an indicator still present in the Sustainable Development Goals (2015-2030). At the same time, scientific investigations and reports were necessary to assess the behavior of the infant mortality rate (IMR) and the effectiveness of interventions to approach it. OBJECTIVE: To describe IMR behavior in Chile and how it has been reflected in the scientific publications made in the 1980-2019 period. MATERIAL AND METHODS: Implementation of the multivariate adaptive regression spline (MARS) method in relation to IMR between 1980 and 2016, and search for related articles published between 1980 and 2019 in SciELO, Lilacs, PubMed, Cochrane Library, and Embase. The analysis included IMR behavior and its reflection in the publications made in that period. RESULTS: IMR decreased from 28 % to 7.2 % per 1000 live births between 1980 and 2016 (-74 %) and 82 publications were identified in this period. Two types of studies about IMR were reported as of the cutoff point of 1996. In the first period, studies focused on preventable diseases and interventions, while IMR showed a slowing down in its reduction. After the cutoff point, studies focused on non-preventable diseases and factors related to inequalities and inequities. CONCLUSIONS: IMR prevails as a synthetic indicator of health conditions. Changes in its evolution and causes have been reflected in publications, which have shifted their focus and areas of interest in accordance with the changes in this indicator.

Introducción. Los Objetivos de Desarrollo del Milenio incluyen la reducción de la tasa de mortalidad infantil (TMI), indicador que sigue vigente en las metas de los Objetivos de Desarrollo Sostenible (2015-2030). En paralelo, se requirieron investigaciones y reportes científicos para evaluar el comportamiento de la TMI y la efectividad de intervenciones para su abordaje. Objetivo. Describir el comportamiento de la TMI en Chile y su reflejo en las publicaciones científicas durante el período 1980-2019. Material y métodos. Aplicación del método de regresión lineal multivariable adaptiva (MARS, por su sigla en inglés) sobre las TMI entre 1980 y 2016, y búsqueda de artículos relacionados publicados entre 1980 y 2019 en SciELO, Lilacs, PubMed, Cochrane Library y Embase. Se analizó el comportamiento de la TMI y su reflejo en las publicaciones del período. Resultados. Hubo una reducción de la TMI de 28 ‰ a 7,2 ‰ nacidos vivos entre 1980 y 2016 (-74 %) y se identificaron 82 publicaciones en el período. Se registraron dos tipos de estudio sobre la TMI a partir de un punto de corte en 1996. En el primer período, los estudios abordaron patologías evitables e intervenciones, a la par de una reducción de la velocidad de descenso de la TMI. Posteriormente al punto de corte, los estudios se enfocaron en enfermedades no evitables y factores relacionados con inequidades y desigualdades. Conclusiones. La TMI prevalece como indicador sintético de las condiciones de salud. Las modificaciones en su evolución y sus causas se han reflejado en las publicaciones, que han variado sus énfasis y focos de atención según el cambio en este indicador.

[Community participation in health: the challenge in Chile]. / La participación social en salud: el desafío de Chile.

Health care reforms implemented in Latin America and the Caribbean over the last 20 years have viewed community participation as a system-wide component. Nonetheless, these reform efforts have yet to break through the conceptual and operational barriers holding back the development and expansion of community participation. In Chile, changes introduced to the health care system are far from achieving any real participation from the community. Therefore, the consumer's role needs to be redefined from merely controlling the parts, to reaching across the whole system in a way that consumer input might identify and quickly correct any possible shortcomings in the health system's design, as well as its operations. With this in mind, the main challenges are to strengthen coordination among the various promotion and participation commitments, as well as community control, and to generate data and other evidence to assess the impact of community participation in health strategies.

[Screening mammography coverage and Decennial Plan for Cancer Control, Colombia 2014]. / Cobertura de mamografía de tamizaje y Plan Decenal para el Control de Cáncer, Colombia 2014.

OBJECTIVE: Estimate the coverage of screening mammograms in Colombia during 2014, as well as the performance in hours of equipment by the team and the number of teams required, to reach the goal of 70% coverage of screening mammography before the year 2021. MATERIALS AND METHODS: A descriptive census study was carried out to characterize existing mammography equipment in the country. To this end, information was required from the Special Registry of Health Providers (REPS) and the operating licenses of mammography equipment processed before the territorial entities; the information was processed, validated and analyzed through frequency distribution tables in the Microsoft Office Excel® program. RESULTS: The estimation of screening mammography coverage for the country based on the census of mammographers is 27.6%; To reach the screening goal of screening mammography of 70% at the country level, a mammograph requires weekly 38.2 hours for screening, use 56.3% of total time for screening mammograms and acquire approximately 69 additional equipment to those screened in 2014. There are marked differences in these data at the department and regional level. CONCLUSION: At the country level, the estimation of screening mammography coverage is not good, it is necessary to improve the performance of mammography equipment, as well as acquire additional equipment for some regions; accompanied by effective programmatic strategies in early detection of breast cancer.

OBJETIVO: Estimar la cobertura de mamografías de tamización en Colombia durante el año 2014; así como el rendimiento en horas a emplear por equipo y el número de equipos requeridos, para alcanzar la meta de cobertura del 70% de mamografía de tamización antes del año 2021. MATERIALES Y MÉTODOS: Se realizó un estudio descriptivo para la caracterización de equipos de mamografía existentes en el país. Para ello, se requirió la información del Registro Especial de Prestadores de Salud (REPS) y la información de licencias de funcionamiento de equipos de mamografía tramitados ante los entes territoriales; la información fue procesada, validada y analizada a través de tablas de distribución de frecuencias, en el programa Microsoft Office Excel®. RESULTADOS: La estimación de cobertura de mamografía de tamización para el país, con base en el censo de mamógrafos, es de 27.6%; para alcanzar la meta de cobertura de mamografías de tamización del 70% a nivel país, un mamógrafo requiere emplear semanalmente 38.2 horas para tamización, el 56,3% de su tiempo total para mamografías de tamización y adquirir aproximadamente 69 equipos adicionales a los censados en el año 2014. Se muestran marcadas diferencias en estos datos a nivel departamental y regional. CONCLUSIÓN: A nivel país, la estimación de cobertura de mamografía de tamización no es óptima; y se requiere mejorar el rendimiento de los equipos de mamografía, así como adquirir equipos adicionales para algunas regiones, acompañado de estrategias programáticas eficaces en detección temprana de cáncer de mama.

[Occupational exposure to formaldehyde and new table of occupational diseases]. / La exposición ocupacional al formol y la nueva tabla de enfermedades laborales.

This paper presents an update on the carcinogenic effect of formaldehyde. First, generalities of its chemical composition are considered, followed by the description of some of its uses, both in the industry and in health institutions, as well as an account of the risk to which the general population is exposed, in particular health personnel, as a result of prolonged exposure to this chemical component. Emphasis is placed on the concentration of formaldehyde in everyday life and in the workplace, while the guidelines of decree 1477 of August 5, 2014, issued by the Ministry of Labor of Colombia, on occupational exposure to this chemical are analyzed to demonstrate that this decree does not consider the already known carcinogenic effects of formaldehyde, widely supported by scientific evidence, thus leaving a void for both occupational prevention and labor legislation.

En este documento se presenta una actualización referente al efecto carcinógeno del formol; inicialmente se consideran generalidades de su composición química, luego se evidencian algunos de sus usos, tanto en la industria como en las instituciones de salud, y posteriormente se muestra el riesgo al que está expuesta la población general y en particular el personal del área de la salud, como consecuencia de una exposición prolongada ante este componente químico. Se hace hincapié en la concentración del formaldehido tanto en la vida cotidiana como en el ámbito laboral y se consideran los lineamientos del decreto 1477 del 5 de agosto de 2014, emanado por el Ministerio del Trabajo de la República de Colombia, sobre la exposición ocupacional a esta sustancia química resaltando que este decreto no hace mención a los ya conocidos efectos car-cinogénicos del formol, ampliamente soportados por la evidencia científica, dejando un vacío tanto para la prevención ocupacional como para la legislación laboral.