Eosinophilia prevalence and related factors in travel and immigrants of the network +REDIVI. / Prevalencia de la eosinofilia y factores relacionados en los viajeros e inmigrantes de la red +REDIVI.

The population movements during the last decades have resulted in a progressively increasing interest in certain infectious diseases. Eosinophilia is a common finding in immigrants and travellers. One of the most common causes of eosinophilia is helminth infection, and some intestinal protozoa. The aim of this paper is to describe the epidemiological characteristics of cases with eosinophilia and its association with the presence of parasites in the REDIVI data network. This is a multicentre prospective observational study that includes patients diagnosed with eosinophilia registered in the cooperative network for the study of infectious diseases in travellers and immigrants (+REDIVI) from January 2009 to December 2012. A total of 5,255 episodes were recorded in the network during the study period, and eosinophilia was observed in 8.1-31.3% of cases (depending on the immigration group). There were 60.2% men, with a median age of 31years. There were 72.4% immigrants, and 81.2% were asymptomatic. The most commonly identified parasites were S.stercoralis (34.4%), Schistosoma sp. (11.0%), and hookworm (8.6%). The relationship between eosinophilia and parasite infection was significant for all helminths (except for cutaneous larva migrans). The symptoms and duration of the journey did not significantly determine the presence of eosinophilia. In the case of eosinophilia in a person who has lived in helminth endemic areas, it is advisable to carry out targeted studies to diagnose the infection, regardless of immigration type, length of stay, or the presence of symptoms.

Entry characteristics and performance in a Masters module in Tropical Medicine: a 5-year analysis.

OBJECTIVES: Postgraduate courses can contribute to better-qualified personnel in resource-limited settings. We aimed to identify how entry characteristics of applicants predict performance in order to provide support measures early. METHODS: We describe demographic data and end-of-module examination marks of medical doctors who enrolled in a first semester module of two one-year MSc programmes between 2010 and 2014. We used t-tests and one-way anova to compare, and post hoc tests to locate differences of mean marks between categories of entry characteristics in univariate analysis. After exclusion of collinear variables, multiple regression examined the effect of several characteristics in multivariable analysis. RESULTS: Eighty-nine students (47% male) with a mean age of 32 (SD 6.4) years who received their medical degree in the UK (19%), other European (22%), African (35%) or other countries (24%) attended the 3-months module. Their mean mark was 69.1% (SD 10.9). Medical graduates from UK universities achieved significantly higher mean marks than graduates from other countries. Students' age was significantly negatively correlated with the module mark. In multiple linear regression, place of medical degree (ß = -0.44, P < 0.001) and time since graduation (ß = -0.28, P = 0.007) were strongest predictors of performance, explaining 32% of the variation of mean marks. CONCLUSION: Students' performance substantially differs based on their entry criteria in this 1st semester module. Non-UK graduates and mature students might benefit from early support.

Etiology and outcome of febrile children coming from the tropics.

INTRODUCTION: International travelers have grown significantly over last years, as well as imported diseases from tropical areas. Information in pediatric population is scarce. We describe demographic and clinical characteristics of febrile children coming from the tropics. METHODS: Retrospective review of patients under 18 years old, presenting at a tertiary hospital and surrounding primary health care centers between July 2002 and July 2018 with a stay in a tropical region during the previous year. Patients were selected from microbiological charts of thick smears for malaria or dengue serologies. RESULTS: 188 patients were studied: 52.7% were born in Spain with a median age of 3.0 years old (IQR 1.5-8.0). Main regions of stay were Sub-Saharan Africa (54.8%) and Latin America (29.8%), mostly for visiting their friends and relatives (56.3%), followed by recent arrival migrants (32.4%). Only 34% of travelers attended pre-travel consultation. More than 80% of these febrile children attended directly the Emergency Room. The most frequent diagnoses were febrile syndrome without source (56.4%), respiratory condition (15.4%) and acute diarrhea (11.7%). Around a half (52.1%) were managed as outpatients, but 46.2% were hospitalized and 7.4% were admitted to Intensive Care Unit. No specific diagnosis was achieved in 24% of cases. However, 29.7% were diagnosed with malaria. CONCLUSION: Children with fever coming from tropical areas were at risk of severe infectious diseases. Malaria was diagnosed in one out of four and 7% required admission in PICU. This information emphasizes the need of reinforcing training about tropical diseases among first line physicians.

Etiology and outcome of febrile children coming from the tropics.

INTRODUCTION: International travelers have grown significantly over last years, as well as imported diseases from tropical areas. Information in pediatric population is scarce. We describe demographic and clinical characteristics of febrile children coming from the tropics. METHODS: Retrospective review of patients under 18 years old, presenting at a tertiary hospital and surrounding primary health care centers between July 2002 and July 2018 with a stay in a tropical region during the previous year. Patients were selected from microbiological charts of thick smears for malaria or dengue serologies. RESULTS: 188 patients were studied: 52.7% were born in Spain with a median age of 3.0 years old (IQR 1.5-8.0). Main regions of stay were Sub-Saharan Africa (54.8%) and Latin America (29.8%), mostly for visiting their friends and relatives (56.3%), followed by recent arrival migrants (32.4%). Only 34% of travelers attended pre-travel consultation. More than 80% of these febrile children attended directly the Emergency Room. The most frequent diagnoses were febrile syndrome without source (56.4%), respiratory condition (15.4%) and acute diarrhea (11.7%). Around a half (52.1%) were managed as outpatients, but 46.2% were hospitalized and 7.4% were admitted to Intensive Care Unit. No specific diagnosis was achieved in 24% of cases. However, 29.7% were diagnosed with malaria. CONCLUSION: Children with fever coming from tropical areas were at risk of severe infectious diseases. Malaria was diagnosed in one out of four and 7% required admission in PICU. This information emphasizes the need of reinforcing training about tropical diseases among first line physicians.

Conocimiento y uso de la medicina tradicional frente al SARS-Cov2 (COVID-19) en estudiantes de medicina: estudio cualitativo / Knowledge and use of traditional medicine against SARS-Cov2 (COVID-19) in medical students: qualitative study

Introducción. En la historia de la humanidad, el hombre ha tenido que enfrentar diversas epidemias, pandemias de agentes biológicos que han ocasionado muerte y sufrimiento. De ahí la medicina tradicional ha mantenido su popularidad en todo el mundo. Objetivo. Analizar el conocimiento y uso de la medicina tradicional frente al SARS-Cov2 (COVID-19) en estudiantes de medicina durante el año 2022. Material y métodos. Cualitativo, fenomenológico, descriptivo e interpretativo. Se realizaron entrevistas a estudiantes de medicina. Las categorías de análisis consideradas en este estudio fueron: a) Conocimientos sobre medicinas tradicionales utilizadas contra el Covid-19, b) Usos de medicina tradicional alternativa para Covid-19: Resultados. Se destaca la transmisión intergeneracional de conocimientos sobre medicina tradicional. Los padres y abuelos han sido los principales transmisores de esta práctica, lo que sugiere un arraigo cultural y una confianza en su eficacia a lo largo del tiempo. Existe una falta de comprensión sobre los mecanismos de acción y los beneficios de la medicina tradicional. Conclusión. Se encontró que son pocos los conocimientos por parte de los alumnos referentes a las medicinas tradicionales. Respecto a las experiencias vividas por parte de ellos refieren que muchos recibieron tratamiento tradicional a muchos les resulto beneficiosos en cuanto a mejoría de algunos síntomas.

Introduction. In the history of humanity, man has had to face various epidemics, pandemics of biological agents that have caused death and suffering. Hence traditional medicine has maintained its popularity throughout the world. Objective. Analyze the knowledge and use of traditional medicine against SARS-Cov2 (COVID-19) in medical students during the year 2022. Material and methods. Qualitative, phenomenological, descriptive and interpretive. Interviews were conducted with medical students. The analysis categories considered in this study were: a) Knowledge about traditional medicines used against Covid-19, b) Uses of alternative and complementary traditional medicine for Covid-19. Results. The intergenerational transmission of knowledge about traditional medicine stands out. Parents and grandparents have been the main transmitters of this practice, which suggests cultural roots and confidence in its effectiveness over time. There is a lack of understanding about the mechanisms of action and benefits of traditional medicine. Conclusion. It was found that there is little knowledge on the part of the students regarding traditional medicines. Regarding their experiences, they report that many received traditional treatment, many of which found it beneficial in terms of improvement in some symptoms.

Infección por dengue sin signos de alarma en un niño con cardiopatía chagásica crónica / Dengue infection in a child with chronic heart disease for Chagas

Se presenta el caso de un preescolar en que se diagnosticó una cardiomiopatía chagásica crónica posterior a una infección aguda por virus dengue. El niño, residente de un área endémica para enfermedad de Chagas, debutó con insuficiencia cardíaca que mejoró con el tratamiento de soporte y tras la resolución completa de la arbovirosis, persistieron los cambios de cardiomiopatía crónica. Esta evidencia de alteración estructural miocárdica se atribuyó a la cardiomiopatía chagásica de base previamente subclínica. La coexistencia de enfermedades infecciosas en el trópico representa un reto diagnóstico, situación a la que se agregan problemas socioeconómicos como la pobreza y falta de acceso a servicios sanitarios básicos.

A case is reported of a chronic chagasic cardiomyopathy in a two-years old child who was diagnosed after an acute dengue virus infection. The patient residing in an endemic area for Chagas disease, debuted with heart failure that improved with support treatment and after the complete resolution of the arbovirus, the changes of chronic cardiomyopathy persisted. The myocardial structural alteration was attributed to subclinical chagasic cardiomyopathy. The coexistence of infectious diseases in the tropics represents a diagnostic challenge, a situation to which are added problems such as poverty and lack of access to basic health services.

Esquistossomose e o Coração - Em Nome das Doenças Tropicais Negligenciadas e Outras Doenças Infecciosas que Afetam o Coração (Projeto NET-Heart) / Schistosomiasis & Heart - On Behalf of the Neglected Tropical Diseases and other Infectious Diseases affecting the Heart (the NET-Heart Project)

Resumo Fundamento A esquistossomose é uma doença tropical negligenciada que pode levar a complicações cardiovasculares. No entanto, o envolvimento cardiovascular na esquistossomose ainda precisa ser totalmente elucidado, devido ao número limitado de casos e ausência de evidência confiável, uma vez que a doença ocorre tipicamente em locais sem infraestrutura adequada para uma coleta de dados robusta. Objetivo Esta revisão sistemática teve como objetivo avaliar as implicações cardiovasculares da esquistossomose, incluindo no diagnóstico e tratamento, e propor um algoritmo para rastrear as manifestações cardiovasculares. Métodos Foi realizada uma revisão sistemática nos bancos de dados MEDLINE/PubMed e LILACS, com busca por artigos sobre o comprometimento cardiovascular na esquistossomose. Resultados Trinta e três artigos foram considerados para esta revisão: seis artigos de revisão, uma revisão sistemática, um ensaio clínico, 14 estudos observacionais, sete relatos de casos, e quatro séries de casos. O comprometimento cardiovascular inclui um amplo espectro de condições clínicas, tais como isquemia do miocárdio, disfunção ventricular, miocardite, hipertensão arterial pulmonar, e pericardite. Conclusões As complicações cardíacas da esquistossomose podem causar incapacidade em longo prazo e morte. O monitoramento clínico, exame físico, eletrocardiograma precoce, e ecocardiograma devem ser considerados como medidas chave para detectar o envolvimento cardiovascular. Dada a ausência de um tratamento eficaz das complicações, são necessários saneamento e educação nas áreas endêmicas para a eliminação desse problema de saúde mundial.

Abstract Background Schistosomiasis is a Neglected Tropical Disease which may lead to cardiovascular (CV) complications. However, the CV involvement in schistosomiasis has yet to be fully elucidated due to the limited number of cases and lack of reliable evidence, as schistosomiasis typically occurs in locations without adequate infrastructure for robust data collection. Objective This systematic review aims to assess cardiovascular implications of schistosomiasis, including in the diagnosis and treatment, and propose an algorithm for screening of CV manifestations. Methods A systematic review was performed in the MEDLINE/PubMed and LILACS databases of articles on the CV involvement in schistosomiasis. Results Thirty-three records were considered for this review: six review articles, one systematic review, one clinical trial, 14 observational studies, seven case reports, and four cases series. CV involvement includes a wide spectrum of clinical conditions, such as myocardial ischemia, ventricular dysfunction, myocarditis, pulmonary arterial hypertension, and pericarditis. Conclusions Cardiac complications of schistosomiasis may cause long-term disability and death. Clinical monitoring, physical examination, early electrocardiogram, and echocardiogram should be considered as key measures to detect CV involvement. Due to the lack of effective treatment of complications, sanitation and education in endemic areas are necessary for the elimination of this global health problem.

[Hotline for Zika virus: experience of a tropical and travel medicine unit]. / Línea de atención telefónica sobre virus Zika: experiencia de una unidad de medicina tropical y del viajero.

The current outbreak of Zika virus has caused great social alarm, generated in part by the lack of information in the general population. In order to provide accurate and verified information, the Tropical and Travel Medicine Unit of Hospital Carlos III-La Paz (Madrid, Spain) established a hotline for Zika virus infection. We present the data concerning the first 6 months of operation of the telephone hotline. The predominant call profile consisted of women seeking information about the risk of acquiring the disease before travelling. Brazil, Mexico and Colombia were the destinations for which the most information was requested. Most of the consultations were resolved by providing information only. The implementation of call devices that provide confirmed and reliable information on diseases associated with great alarm are of significant public health interest, as they reduce the number of unnecessary medical consultations and save on medical costs.

Critical care medicine in the French Territories in the Americas: Current situation and prospects / La medicina intensiva en los territorios franceses de la Región de las Américas: situación actual y perspectivas / Medicina intensiva nos territórios ultramarinos franceses nas Américas: situação atual e perspectivas

ABSTRACT Hospitals in the French Territories in the Americas (FTA) work according to international and French standards. This paper aims to describe different aspects of critical care in the FTA. For this, we reviewed official information about population size and intensive care unit (ICU) bed capacity in the FTA and literature on FTA ICU specificities. Persons living in or visiting the FTA are exposed to specific risks, mainly severe road traffic injuries, envenoming, stab or ballistic wounds, and emergent tropical infectious diseases. These diseases may require specific knowledge and critical care management. However, there are not enough ICU beds in the FTA. Indeed, there are 7.2 ICU beds/100 000 population in Guadeloupe, 7.2 in Martinique, and 4.5 in French Guiana. In addition, seriously ill patients in remote areas regularly have to be transferred, most often by helicopter, resulting in a delay in admission to intensive care. The COVID-19 crisis has shown that the health care system in the FTA is unready to face such an epidemic and that intensive care bed capacity must be increased. In conclusion, the critical care sector in the FTA requires upgrading of infrastructure, human resources, and equipment as well as enhancement of multidisciplinary care. Also needed are promotion of training, research, and regional and international medical and scientific cooperation.

RESUMEN Los hospitales en los territorios franceses de la Región de las Américas funcionan según las normas francesas e internacionales. El objetivo de este artículo es describir distintos aspectos de los cuidados intensivos en los territorios franceses. Para ello, hemos revisado los datos oficiales sobre el tamaño de la población y el número de camas de las unidades de cuidados intensivos (UCI), así como la bibliografía sobre algunos aspectos específicos de las UCI, en los territorios franceses. Las personas que viven en los territorios franceses, o que están de visita en ellos, están expuestas a riesgos específicos: principalmente traumatismos graves causados por el tránsito, envenenamiento por mordeduras, heridas de bala o por apuñalamiento, y enfermedades infecciosas tropicales emergentes. La atención de estos traumatismos y enfermedades puede requerir conocimientos específicos y cuidados intensivos. Sin embargo, no hay suficientes camas de UCI en los territorios franceses. De hecho, hay 7,2 camas de UCI por 100 000 habitantes en Guadalupe, 7,2 en Martinica y 4,5 en Guayana Francesa. Además, los pacientes gravemente enfermos que viven en zonas remotas a menudo tienen que ser trasladados, normalmente por helicóptero, lo que retrasa su ingreso en la unidad de cuidados intensivos. La crisis de la COVID-19 ha puesto de manifiesto que el sistema de atención de salud en los territorios franceses no está preparado para enfrentarse a una epidemia de estas dimensiones y que debe aumentarse la capacidad hospitalaria de las unidades de cuidados intensivos. En conclusión, el sector de los cuidados intensivos en los territorios franceses tiene que mejorar su infraestructura, recursos humanos y equipamiento, así como perfeccionar la atención multidisciplinaria. También es necesario promover la capacitación, la investigación y la cooperación médica y científica, tanto regional como internacional.

RESUMO Os hospitais nos territórios ultramarinos franceses nas Américas funcionam segundo os padrões franceses e internacionais. O objetivo deste artigo é descrever os diversos aspectos da atenção intensiva nesta região. Analisamos os dados oficiais relativos ao tamanho da população e ao número de leitos de unidade de terapia intensiva (UTI) nestes territórios junto com uma revisão da literatura científica sobre as características particulares destes centros de terapia intensiva. Os residentes locais ou visitantes dos territórios ultramarinos franceses nas Américas são expostos a riscos específicos, sobretudo acidentes de trânsito graves, envenenamentos por animais peçonhentos, ferimentos por armas brancas ou armas de fogo e doenças infecciosas tropicais emergentes que requerem conhecimento especializado e atenção intensiva. Porém, não há leitos suficientes de UTI nos territórios ultramarinos franceses nas Américas: são 7,2 leitos de UTI por 100.000 habitantes em Guadalupe, 7,2 na Martinica e 4,5 na Guiana Francesa. Ademais, em áreas remotas, os pacientes em estado crítico frequentemente precisam ser transferidos por helicóptero, o que causa demora na internação em UTI. A crise da COVID-19 demonstra o despreparo do sistema de saúde para enfrentar a pandemia e a necessidade de aumentar o número de leitos de UTI nestes territórios. Em conclusão, é imprescindível modernizar a infraestrutura e os equipamentos, capacitar melhor os recursos humanos e melhorar a atenção multidisciplinar. Incentivar a formação profissional, pesquisa e cooperação médico-científica regional e mundial é também fundamental.

Estudo da conservação de material biológico com a tecnologia Fta-card® / Study on the conservation of biological material with Fta-card® technology / Estudio de conservación de material biológico con la tecnología Fta-card®

O Whatman FTA-Card® é um papel-filtro quimicamente tratado, destinado à coleta, transporte, armazenamento de amostras para posterior extração de ácidos nucléicos. A tecnologia FTA-Card® é utilizada para manter estável DNA e RNA em temperatura ambiente, podendo ser utilizados para fixação de uma ampla variedade de material orgânico ou tecidos. Foram realizados testes para certificar sua eficiência na conservação do material a ser analisado com o intuito de eliminar a cadeia fria de conservação, agilizando o processo e diminuindo os custos da execução de exames moleculares associados ao diagnóstico de patologias. Foram testadas oito amostras de felinos na forma de sangue total e soro, para a extração utilizou-se o kit Magazorb RNA Total mini-prep kit (Promega®, EUA), para o diagnóstico foi utilizada a técnica de PCR em tempo real para amplificar o gene CI2 de mamíferos, a fim de visualizar a eficácia na conservação de ácidos nucleicos. A utilização desse método torna possível que o material biológico seja enviado por serviços de transporte postais, reduzindo os custos e viabilizando diagnósticos provenientes de áreas mais remotas.(AU)

Whatman FTA-Card® is a chemically treated filter paper intended for the collection, transport, and storage of samples for later extraction of nucleic acids. FTA-Card® technology is used to keep DNA and RNA stable at room temperature and can be used to fix a wide variety of organic material or tissues. Tests were carried out to certify its efficiency in the conservation of the material to be analyzed in order to eliminate the cold conservation chain, speeding up the process and decreasing the costs of performing molecular tests associated with the diagnosis of pathologies. By using this method, biological material can be sent by postal transport services, reducing costs and making diagnoses from more remote areas feasible. Samples of feline specimens were tested in the form of whole blood and serum, using the Magazorb RNA Total mini-prep kit (Promega®, USA) for the extraction. Diagnosis was performed using real-time PCR technique to amplify the mammalian CI2 gene in order to visualize the effectiveness in conserving nucleic acids.(AU)

Whatman FTA-Card® es un papel de filtro tratado químicamente, destinado a la recogida, transporte, almacenamiento de muestras para su posterior extracción de ácidos nucleicos. La tecnología FTA-Card® se usa para mantener el ADN y el ARN estables a la temperatura ambiente y se puede usar para la fijación de una amplia variedad de materiales o tejidos orgánicos. Se realizaron pruebas para certificar su eficiencia en la conservación del material a analizar con el fin de eliminar la cadena de frío de conservación, agilizando el proceso y reduciendo los costos de realización de pruebas moleculares asociadas al diagnóstico de patologías. Se analizaron ocho muestras felinas en forma de sangre total y suero, para la extracción se utilizó el mini-prep kit Magazorb RNA Total (Promega®, USA), para el diagnóstico se utilizó la técnica de PCR en tiempo real para amplificar el CI2 de mamífero gen, con el fin de visualizar la efectividad en la conservación de ácidos nucleicos. El uso de ese método permite el envío de material biológico por los servicios de transporte postal, lo que reduce los costes y permite realizar diagnósticos desde zonas más remotas.(AU)

Virus Mayaro, un alphavirus olvidado en Colombia: posible efecto sobre la salud pública / Mayaro virus, an alphavirus forgotten in Colombia: possible effect on public health

Sobre el Mayaro virus poco se conoce sobre su transmisión y patogénesis. Se sabe que habita en diferentes zonas del hemisferio occidental y que es transmitido por los Aedes aegypti y albopictus (Diptera: Culicidae). Ya se han investigado escenarios donde su circulación puede superponerse y generar infecciones mixtas, y por ello ha ganado importancia en la salud pública, puesto que puede ocasionar alto riesgo de brotes con manifestaciones clínicas graves similares a la de los virus Zika, Chikungunya y el Dengue países como Trinidad, Brasil, México, Venezuela, Honduras, Salvador, Costa Rica, Panamá, Perú, Argentina, Surinam, Guyana, Venezuela, Ecuador y Bolivia. Colombia está expectante de una aparición concomitante junto con ZIKV y CHIKV. Se realizó una búsqueda exhaustiva en PubMed, Science Direct, Clinical Key y Ebsco sobre el Mayaro virus, epidemiología, su estructura molecular, ciclo de transmisión, sintomatología clínica, métodos diagnósticos, factores de riesgo, control y prevención, así como tratamiento actual, para conocer un panorama más amplio sobre su problemática..(Au)

About Mayaro virus, there is currently little knowledge of its transmission and pathogenesis. It is known to inhabit different areas of the Western Hemisphere and is transmitted by the Aedes aegypti and albopictus (Diptera: Culicidae). Numerous authors have focused their research given coexistence in scenarios where the circulations of all these viruses can somehow overlap and generate mixed infections. This agent has been gaining prominence at the public health level, due to the possibility of causing high risk of outbreaks with serious clinical manifestations similar to that of Zika viruses, Chikungunya virus and Dengue, in several countries, such as Trinidad, Brazil, Mexico, Venezuela, Honduras, Salvador, Costa Rica, Panama, Peru, Argentina, Suriname, Guyana, Venezuela, Ecuador and Bolivia. Colombia is looking forward to a concomitant onset in the near future along with ZIKV and CHIKV. Taking into account the above, a thorough search was carried out of the existing literature, on Mayaro virus, its molecular structure, transmission cycle, clinical symptomatology, diagnostic methods, risk factors, control and prevention, as well as treatment, to learn a broader picture of the problem that lurks. All this, through search engines like PubMed, Science Direct, Clinical Key and Ebsco..(Au)

Women made visible: a different perspective on the history of the Institute of Tropical Medicine in Portugal, 1943-1966 / Mulheres visíveis: uma perspectiva diferente na história do Instituto de Medicina Tropical em Portugal, 1943-1966

Abstract This work focuses on the scientific research conducted by women at Portugal's Institute of Tropical Medicine between 1943 and 1966. The Institute's scientific journal documents the participation of women in tropical medicine during this period. Their publications addressed a variety of subjects and resulted from research carried out in the metropolis as well as Portugal's overseas colonies. Most of the articles written by these women were are co-authored by their male colleagues, reflecting the incorporation of female researchers into scientific networks already established by men. This work in progress provides a starting point to lend visibility to a group of scientific actors who are practically absent from the historiography of tropical medicine.

Resumo O foco deste trabalho é a pesquisa científica realizada por mulheres no Instituto de Medicina Tropical, em Portugal, entre 1943 e 1966. O periódico científico do Instituto documenta a participação das mulheres na medicina tropical nesse período. Suas publicações abordavam uma diversidade de temas e resultaram de pesquisas realizadas na metrópole, bem como nas colônias ultramarinas de Portugal. A maioria dos artigos escritos por mulheres contava com a coautoria de seus colegas homens, refletindo a incorporação de pesquisadoras às redes científicas já estabelecidas por homens. Este trabalho em andamento representa um ponto de partida para dar visibilidade a um grupo de atores científicos que está praticamente ausente da historiografia da medicina tropical.

Salubridad y enfermedad en las minas de oro de Marmato en el siglo XIX: entre la epidemia de viruela y la guerra de los mil días / Healthiness and disease in Marmato gold mines during the 19th century: Between the smallpox plague and the War of a Thousand Days

Resumen | La minería ha tenido una gran influencia en las sociedades humanas, permeando por igual las riquezas del suelo y la cultura, lo que ha tenido profundas implicaciones para los individuos dedicados a esta labor y para los lugares en los que se lleva a cabo. En el presente artículo, se describen las características socioculturales y de sanidad, así como las enfermedades más frecuentes en las minas de oro de Marmato (Caldas) durante el siglo XIX. Las precarias condiciones de salubridad y las enfermedades tropicales infecciosas persistieron en la población durante todo el siglo.

Abstract | Mining has had a great influence on human societies permeating the riches of the soil and culture in equal proportion. This has led to profound changes in the individuals dedicated to this work and the locations where it takes place. In this historical review, we describe the socio-cultural and health characteristics, as well as the diseases associated with gold mining in Marmato (Caldas) during the 19th century. Poor salubrity conditions and tropical and infectious diseases were constant during the whole century.

O Instituto de Medicina Tropical de São Paulo: marcas de sua criação, 1940-1959 / The Institute for Tropical Medicine of São Paulo: characteristics of its creation, 1940-1959 / El Instituto de Medicina Tropical de São Paulo: marcas de su creación, 1940-1959

Este artigo foi escrito a partir de um trabalho de perscrutação a jornais, relatórios e textos memorialísticos e objetiva oferecer um contributo historiográfico sobre a criação do Instituto de Medicina Tropical de São Paulo, sancionada em janeiro de 1959 após uma movimentação institucional liderada pelo professor Carlos da Silva Lacaz, seu primeiro diretor. Procura-se destacar aqui dois importantes eixos que contribuíram para a decisão em prover a capital paulista de um Instituto de Medicina Tropical: em primeiro lugar, a internacionalização da Medicina Tropical brasileira, nomeadamente sua relação com tropicalistas portugueses, consubstanciada com a ida de brasileiros - em especial, paulistas - aos institutos de Medicina Tropical na Europa e, em segundo lugar, a presença de endemias rurais no estado de São Paulo (Brasil), que começavam a tornar-se visíveis na capital em decorrência dos movimentos migratórios em direção à cidade.(AU)

This article was based on an examination of newspapers, reports, and memorial texts. It aims at offering a historiographical contribution about the creation of the Institute for Tropical Medicine (IMT, Instituto de Medicina Tropical), approved in January 1959 after an institutional movement led by Prof. Carlos da Silva Lacaz, who was also its first director. The objective is to highlight important factors that contributed to the decision of creating an institute of Tropical Medicine in the Brazilian city of São Paulo, capital of the state of São Paulo. The first of them was to internationalize the Brazilian Tropical Medicine, namely its relationship with Portuguese tropicalists that was consubstantiated with the migration of Brazilians, particularly from the city of São Paulo, to European institutes of Tropical Medicine. The presence of rural endemic diseases in the state, which were becoming increasingly visible in the capital due to migratory movements to the big city, also contributed to its creation.(AU)

Este artículo se escribió a partir de un trabajo de búsqueda en periódicos, informes y textos memorialísticos y tiene el objetivo de ofrecer una contribución historiográfica sobre la creación del Instituto de Medicina Tropical de São Paulo, sancionada en enero de 1959 después de un movimiento institucional liderado por el profesor Carlos da Silva Lacaz, su primer director. Se busca destacar aquí dos ejes importantes que contribuyeron para la decisión de proporcionar a la capital del Estado de São Paulo un instituto de Medicina Tropical: en primer lugar, la internacionalización de la Medicina Tropical brasileña, principalmente su relación con tropicalistas portugueses, consubstanciada con la ida de brasileños, en especial del estado de São Paulo, a los institutos de medicina tropical en Europa y, en segundo lugar, la presencia de endemias rurales en el Estado de São Paulo (Brasil) que comenzaban a ser visibles en la capital debido a los movimientos migratorios hacia la ciudad.(AU)

[Chikungunya fever - A new global threat]. / Fiebre chikungunya - Una nueva amenaza global.

The recent onset of epidemics caused by viruses such as Ebola, Marburg, Nipah, Lassa, coronavirus, West-Nile encephalitis, Saint Louis encephalitis, human immunodeficiency virus, dengue, yellow fever and Venezuelan hemorrhagic fever alerts about the risk these agents represent for the global health. Chikungunya virus represents a new threat. Surged from remote African regions, this virus has become endemic in the Indic ocean basin, the Indian subcontinent and the southeast of Asia, causing serious epidemics in Africa, Indic Ocean Islands, Asia and Europe. Due to their epidemiological and biological features and the global presence of their vectors, chikungunya represents a serious menace and could become endemic in the Americas. Although chikungunya infection has a low mortality rate, its high attack ratio may collapse the health system during epidemics affecting a sensitive population. In this paper, we review the clinical and epidemiological features of chikungunya fever as well as the risk of its introduction into the Americas. We remark the importance of the epidemiological control and mosquitoes fighting in order to prevent this disease from being introduced into the Americas.

Ardentes trópicos: febres e saúde pública no Brasil joanino / The scorching tropics: fevers and public health in Brazil during the Joanine period, 1808-1821

Resumo Com exceção da febre amarela, as febres ainda foram pouco exploradas pela historiografia da saúde brasileira. No século XIX, contudo, sua presença na vida social era quase incontornável, atingindo enormes parcelas da população. Suas vítimas padeciam de uma grande variedade de sintomas em que a identificação e a terapêutica eram objeto de intensos debates nos círculos médicos. A intelectualidade luso-brasileira, atenta tanto aos debates médicos europeus quanto a experiências clínicas, esforçou-se para fornecer respostas na forma de intensa produção impressa; no entanto, as manifestações febris encontradas nos trópicos representavam um desafio extra à sua formação europeia, forçando-a a conjugar experiências adquiridas em partes distintas do Império na constituição de saberes específicos sobre as febres tropicais.

Abstract Although fevers (with the exception of yellow fever) have not yet been fully explored by the historiography of Brazilian health, they were almost inevitable in nineteenth-century Brazilian society, affecting huge portions of the population. Their victims suffered from a wide variety of symptoms, and identification and treatment of these symptoms were the object of intense debates in medical circles. The Luso-Brazilian intelligentsia considered European medical debates as well as their own clinical experiences and attempted to provide answers in a flurry of publications. Even so, the manifestations of fever in the tropics presented a challenge that lay beyond their European training, forcing them to combine experiences acquired in different parts of the Empire to comprise specific knowledge on tropical fevers.

Breve reseña de vida y contribución del médico parasitólogo peruano César Gabriel Náquira Velarde / Brief review about the life and contribution of the peruvian parasitologist Cesar Gabriel Naquira Velarde

RESUMEN Las instituciones científicas y sus logros se construyen a partir de las personas y sus historias. En este caso, el Dr. César Náquira Velarde es una personalidad destacada en la salud pública del Perú, a la que contribuyó hasta días antes de su partida a los 85 años de edad. El Dr. Náquira participó activamente en la fundación del Instituto de Medicina Tropical Daniel A. Carrión de la Universidad Nacional Mayor de San Marcos desde donde −a través de la investigación y docencia− ha formado médicos y especialistas en el campo de la parasitología y medicina tropical. Sin embargo, su mayor contribución y aporte fue en el estudio de la enfermedad de Chagas. También se desempeñó como funcionario público y decisor, pues fue jefe del Instituto Nacional de Salud y permanente asesor técnico del Ministerio de Salud del Perú, en los temas de su especialidad. Destacamos su rol como maestro para muchas generaciones de médicos y su autoridad como experto en el campo de la parasitología médica.

ABSTRACT Scientific institutions and their achievements are built on people and their stories. In this case, Dr. César Náquira Velarde constitutes a prominent figure in Peru's public health, to which he contributed until days before his departure at 85 years of age. Dr. Náquira actively participated in the founding of the Daniel A. Carrión Institute of Tropical Medicine of the National University of San Marcos from where - through re search and teaching - he has trained doctors and specialists in the field of parasitology and tropical medici ne. However, his greatest contribution was in the study of Chagas disease. He also served as a public official and decision maker, as he was head of the National Institute of Health of Peru and permanent technical advisor of the Ministry of Health of Peru, in the areas of his specialty. We highlight his role as a teacher for many generations of doctors and his authority as an expert in the field of medical parasitology.

Medical diagnosis in resource-poor tropical countries. / El diagnóstico en medicina tropical en países con pocos recursos.

When working in healthcare centers in developing countries where diagnostic resources are limited, clinical skills are of considerable importance. This study presents the diagnostic tools available in resource-poor areas. Anamnesis and physical examination are key components for reaching a correct diagnosis. The laboratory has at its disposal hemograms, basic blood chemistry and urinalysis. The available basic microbiological tests are the study of fresh feces, smears for malaria, direct smears for bacilli in sputum and Gram staining of clinical exudates. Basic radiography of the chest, abdomen, bones and soft tissues are of considerable usefulness but are not available in all centers. Ultrasonography can be of considerable usefulness due to its simplicity and versatility. The diagnosis in low resource conditions should sharpen our clinical skills and should be supported by the use of additional basic tests.

"Hipnóticos" na metrópole: africanos no Hospital Colonial de Lisboa nas primeiras décadas do século XX / "Hypnotics" in the metropolis: Africans in the Colonial Hospital of Lisbon during the early twentieth century

Resumo No início do século XX, alguns médicos portugueses foram à África estudar a chamada doença do sono. Entre eles estava Ayres Kopke, membro da primeira missão médica à África Ocidental Portuguesa. De regresso a Lisboa, o professor da Escola de Medicina Tropical continuou suas pesquisas, inclusive por meio da observação de doentes trazidos para a metrópole. Desde 1903, as repartições de saúde nas colônias estavam incumbidas de enviar doentes com determinadas patologias exóticas para o Hospital Colonial de Lisboa. Com base em documentos desse hospital, incluindo fotografias dos doentes, então chamados de hipnóticos, o artigo aborda a importância das experiências com humanos na metrópole para o avanço da medicina tropical durante o colonialismo.

Abstract At the start of the twentieth century, some Portuguese physicians traveled to Africa to study sleeping sickness (African trypanosomiasis). One was Ayres Kopke, a member of the first medical mission to Portuguese West Africa and professor at the School of Tropical Medicine. After returning to Lisbon, Kopke continued his research, which included observation of patients brought to the metropolis. Starting in 1903, health departments in the colonies were responsible for sending patients with certain exotic diseases to the Colonial Hospital of Lisbon. Based on documents from this hospital including photographs of patients (who at that time were called "hypnotics"), this article discusses the importance of human experiments in Lisbon for advances in tropical medicine during the colonial period.

Modelo educativo para la gestión académica en el Instituto de Medicina Tropical "Pedro Kourí" / http://www.revhabanera.sld.cu/index.php/rhab/article/view/3228/2627

Introducción: La organización de la gestión académica de la educación de postgrado en el Instituto de Medicina Tropical "Pedro Kourí" (IPK), se corresponde con los resultados esperados en el desarrollo de la medicina tropical. Objetivo: Proponer un Modelo Educativo para la formación académica de postgrado, adecuado a las exigencias de la educación médica para el desarrollo de las Ciencias Biomédicas y la medicina tropical. Material y Métodos: Se realizó un estudio descriptivo, resultado de la sistematización de los informes de la Junta de Acreditación Nacional de los programas académicos del IPK, así como de los balances del Departamento de Docencia en el período comprendido desde 2008 a 2018. Para ello, se utilizaron: el análisis documental, sistematización y modelación, así como la consulta a expertos mediante el Método Delphy. Resultados: Apoyados en la experiencia de los autores y los resultados de la educación de postgrado en el IPK, se proponen los fundamentos y estructura de un Modelo Educativo para la formación académica de postgrado, ajustado a los requerimientos de la educación médica para el desarrollo de las Ciencias Biomédicas y la medicina tropical. Conclusiones: El Modelo Educativo para la formación académica de postgrado se convierte en una necesidad para los profesores, tutores y estudiantes en el IPK(AU)

Introduction: The organization of academic management in postgraduate education in Pedro Kouri Institute of Tropical Medicine (IPK) corresponds to the expected results in the development of tropical medicine. Objective: To propose an Educational Model for postgraduate academic training that responds to the requirements of medical education for the development of Biomedical Sciences and Tropical Medicine. Material and Methods: A descriptive study was conducted from the results of the systematization of the reports presented by the National Accreditation Board for the different curricula of the IPK and the assessment of the Teaching Department carried out during the period between 2008 and 2018. For this purpose, document analysis, systematization and modeling and experts' consultation were carried out using the Delphi method. Results: The basic principles and structure of an Educational Model for postgraduate academic training are proposed on the basis of the authors´ experience and the results of postgraduate education in the IPK, in correspondence with the requirements of medical education for the development of Biomedical Sciences and Tropical Medicine. Conclusions: The Educational Model for postgraduate academic training is a must for professors, tutors and students of the IPK(AU)