Knowledge, attitudes, and practices towards COVID-19 and associated factors in the mexican population

Introduction: The COVID-19 disease has been one of the most harmful pandemics for humanity; therefore, ensuring adherence to preventive and control measures is essential. This adherence largely depends on the population's knowledge, attitudes, and practices (KAP) towards COVID-19. Objective: To identify the level of knowledge, attitudes, and practices towards COVID-19 prevention and its associated factors in Oaxaca, Mexico. Materials and Methods: This cross-sectional and analytical study surveyed adults online regarding KAP. Descriptive statistics and Chi-square or Fisher's exact tests were used for categorical comparisons. Factors associated with higher KAP levels were analyzed by calculating odd ratios (ORs) through logistic regression. Results: A total of 176 people participated, of whom 82.42% were women, and 81.83% were <30 years old. Among the participants, 90.88% identified direct contact with infected individuals as the main mode of transmission, 73.86% correctly identified the incubation period, and 93.22% referred to handwashing as the main preventive measure. The KAP scores were 65.34%, 32.95%, and 40.91%, respectively, with no differences by sex or age. Discussion: Participants with higher COVID-19 knowledge and more positive attitudes towards the pandemic were associated with more frequent preventive practices [OR:1.89 (CI:1.17-3.73)] and [OR:3.21 (CI:1 .62-6.35)], respectively, compared to those with lower scores. Conclusions: The study population has a low level of KAP; greater knowledge about COVID-19 and more positive attitudes towards the pandemic increase preventive practices.

Introducción: La enfermedad de COVID-19 ha sido una de las pandemias más perjudiciales para la humanidad, por lo cual, garantizar la adherencia a medidas preventivas y de control es fundamental. Esta adherencia depende en gran medida de los conocimientos, actitudes y prácticas (CAP) de la población frente al COVID-19. Objetivo: Identificar el nivel de conocimientos, actitudes y prácticas hacia la prevención de COVID-19 y sus factores asociados en Oaxaca, México. Materiales y Métodos: Estudio transversal y analítico, en mayores de edad a través de una encuesta en línea sobre CAP. Se aplicó estadística descriptiva, y chi cuadrada o exacta de Fisher para comparaciones categóricas. Se analizaron los factores asociados a un mayor nivel de CAP calculando OR´s a través de regresión logística. Resultados: En total 176 personas participaron, de los cuales 82,42% fueron mujeres y 81,83% fueron <30 años. El 90,88% identificó como principal medio de transmisión el contacto directo con personas enfermas, 73,86% identificó correctamente el periodo de incubación y el 93,22% refirió el lavado de manos como principal medida preventiva. Las puntuaciones CAP fueron 65,34%, 32,95% y 40,91% respectivamente, sin diferencias por sexo y edad. Discusión: Los participantes con mayor conocimiento sobre COVID-19 y actitudes más positivas hacia la pandemia se asociaron con tener prácticas preventivas más frecuentes, [OR:1,89 (IC:1,17-3,73)] y [OR:3,21(IC:1,62-6,35)] respectivamente, en comparación con aquellos con menor puntuación. Conclusiones: La población de estudio tiene un bajo nivel de CAP. Un mayor conocimiento sobre COVID-19 y actitudes más positivas hacia la pandemia aumentan las prácticas preventivas.

Introdução: A doença COVID-19 tem sido uma das pandemias mais prejudiciais para a humanidade, portanto, garantir a adesão às medidas preventivas e de controle é fundamental. Esta adesão depende em grande parte dos conhecimentos, atitudes e práticas (CAP) da população relativamente à COVID-19. Objetivo: Identificar o nível de conhecimento, atitudes e práticas em relação à prevenção da COVID-19 e seus fatores associados em Oaxaca, México. Materiais e Métodos: Estudo transversal e analítico, em adultos através de inquérito online sobre CAP. Estatísticas descritivas e qui-quadrado ou estatística exata de Fisher foram aplicadas para comparações categóricas. Os fatores associados ao maior nível de CAP foram analisados por meio do cálculo de OR por meio de regressão logística. Resultados: Participaram no total 176 pessoas, das quais 82,42% eram mulheres e 81,83% tinham <30 anos. 90,88% identificaram o contacto direto com pessoas doentes como principal meio de transmissão, 73,86% identificaram corretamente o período de incubação e 93,22% referiram a lavagem das mãos como principal medida preventiva. Os escores do CAP foram de 65,34%, 32,95% e 40,91% respectivamente, sem diferenças por sexo e idade. Discussão: Participantes com maior conhecimento sobre a Covid-19 e atitudes mais positivas frente à pandemia foram associados a práticas preventivas mais frequentes, [1,89 (IC:1,17-3,73)] e [3,21(IC:1,62-6,35)] respectivamente, comparados para aqueles com pontuação mais baixa. Conclusões: A população estudada apresenta baixo nível de CAP. Maior conhecimento sobre a COVID-19 e atitudes mais positivas frente à pandemia aumentam as práticas preventivas.

Dietary patterns associated with physical activity and sedentary behavior in university students in Mexico

Dietary patterns (DPs) are conditioned by a large number of factors, including physical activity and sedentary lifestyle, however, there is limited information on their interaction. This study aimed to identify DPs and their associations with physical activity and sedentary behavior among university students from Mexico. We conducted a cross-sectional, observational and analytical study. The participants were university students from Southwest Mexico. A total of 419 participants who did not suffer from any disease that affects oral nutrition or that prevented them from performing physical activity were included. DPs were generated from a principal component analysis and associations were analyzed using a logistic regression model. Three DPs were identified: "western", "prudent" and "traditional". The traditional pattern was significantly associated with high physical activity (OR: 2.78; 95% CI: 1.34-5.75) and was a protective factor against sedentary lifestyle (OR: 0.35; 95% CI: 0.13-0.93). The results show that a high physical activity and a lower sedentary lifestyle were associated with a healthier dietary pattern in the study population. It is important to implement interventions towards nutrition, physical activity and sedentary behavior for the population being studied.

Los patrones dietéticos están condicionados por una gran cantidad de factores, entre ellos la actividad física y el sedentarismo, sin embargo, existe poca información sobre su interacción. Este estudio tuvo como objetivo identificar patrones dietéticos y sus asociaciones con la actividad física y el comportamiento sedentario entre estudiantes universitarios del suroeste de México. Se trata de un estudio transversal, observacional y analítico. Los participantes fueron estudiantes universitarios del suroeste de México. Se incluyeron un total de 419 participantes que no padecían alguna enfermedad que condicionara su nutrición oral, ni condición que les impidiera realizar actividad física. Se realizó un análisis de componentes principales para determinar los patrones dietéticos, mientras que se utilizó un modelo de regresión logística para verificar las asociaciones. Se identificaron tres patrones dietéticos: "occidental", "prudente" y "tradicional". El patrón tradicional se asoció significativamente con actividad física elevada (OR: 2,78; IC 95%: 1,34-5,75) y fue un factor protector contra el sedentarismo (OR: 0,35; IC 95%: 0,13-0,93). Los resultados muestran que una alta actividad física y un menor sedentarismo se asociaron con un patrón dietético más saludable en la población de estudio. Es importante implementar intervenciones hacia la nutrición, la actividad física y el sedentarismo para la población en estudio.

Enfermedad pulmonar intersticial difusa secundaria a neumonitis por hipersensibilidad de patrón mixto: reporte de caso y revisión de literatura / Diffuse interstitial lung disease secondary to mixed pattern hypersensitivity pneumonitis: Case report and literature review

La enfermedad pulmonar intersticial difusa (EPID) supone un amplio grupo heterogéneo de enfermedades caracterizadas por hallazgos en su intersticio pulmonar, específicamente relacionados con su engrosamiento, lo cual impacta significativamente en el intercambio gaseoso y la mecánica ventilatoria del paciente. El diagnóstico se genera acorde a la clínica del paciente, el uso de imágenes y la histopatología. El tratamiento guarda relación directa con el patrón pulmonar estructural que presente la EPID. Se presenta el caso clínico de una paciente femenina de 32 años, indígena, quien ingresa por exacerbación de disnea, con antecedente de neumonitis por hipersensibilidad, adicional a otros antecedentes clínicos que guardan relación estrecha con la EPID.

Diffuse interstitial lung disease (ILD) is a large heterogeneous group of diseases characterized by findings in the pulmonary interstitium, specifically changes related to thickening of the interstitium, which significantly impacts the patient's gas exchange and ventilatory mechanics. The diagnosis is generated according to the patient's clinical presentation, imaging and histopathology. The treatment is directly related to the structural pulmonary pattern of ILD. We present the clinical case of a 33-year-old female patient of indigenous ethnicity who is admitted for exacerbation of dyspnea, with a history of hypersensitivity pneumonitis in addition to other clinical antecedents that are closely related to ILD.

Intra-aneurysmatic thrombectomy in a distal anterior cerebral artery aneurysm

Thrombectomy procedures following intra-aneurysmatic lesions are extremely rare, and few cases have been reported. This article describes a microsurgical intra-aneurysmatic thrombectomy (MIaT) for a distal anterior cerebral artery (DACA) aneurysm. We present the case of a 48-year-old female that was admitted to the emergency room, showing neurologic deterioration with focal deficits. A computed tomography angiography (CTA) scan revealed an aneurysm located in the distal segment of the left anterior cerebral artery. During the surgical procedure, after clipping, a wellformed clot was visualized through the aneurysm’s wall obstructing the left DACA flow. We proceeded to open the aneurysm’s dome to remove the thrombus and clip the aneurysm neck, re-establishing the flow of the left DACA.Intra-aneurysmatic thrombosis can occur as a complication during clipping, obstructing the distal flow of vital arteries and causing fatal results in the patient’s postoperative status. MIaT is a good technique for restoring the flow of the affected vessel and allows a secure aneurysm clipping after thrombus removal.

Unilateral approach for bilateral clipping of posterior communicating artery aneurysms in a hybrid operating room: A technical note

Bilateral posterior communicating (pComm) artery aneurysms represent only 2% of mirror intracranial aneurysms. Usually, these are surgically approached through bilateral craniotomies for clipping. We present the case of a 50-year-old female presenting with headache and horizontal diplopia. Neurological examination revealed a left oculomotor palsy, with no other neurological deficits. Imaging studies revealed bilateral aneurysmatic lesions in both internal carotid arteries (ICA). A conventional left pterional approach was planned in order to treat the symptomatic aneurysm, and, if deemed feasible, a contralateral clipping through the same approach. The procedure was performed in a hybrid operating room (HOR), performing an intraoperative digital subtraction angiography (DSA) and roadmapping assistance during dissection and clipping. Transoperatively, a post-fixed optic chiasm was identified, with a wide interoptic space, which allowed us to perform the contralateral clipping through a unilateral approach. This technique for clipping bilateral pComm aneurysms can be performed when the proper anatomical features are met.

Utilidad de la medición de los músculos psoas y paraespinales mediante tomografía computarizada y resonancia magnética / Usefulness of the measurement of the psoas and paraspinal muscles by computed tomography and magnetic resonance

Introducción: La sarcopenia está revistiendo importancia en el estudio de diferentes enfermedades para predecir la morbimortalidad en el perioperatorio. Los objetivos de este estudio fueron evaluar la eficacia de la tomografía y la resonancia en la medición de la musculatura del psoas y los paraespinales, y comparar estos índices con la edad, el sexo y la enfermedad. materiales y métodos: Se utilizaron las tomografías computarizadas y las resonancias magnéticas de pacientes ambulatorios. La medición de los músculos se realizó en los pedículos de L3 y L4. Resultados: El estudio incluyó 18 tomografías y 34 resonancias. El rango de edad de los pacientes era de 15 a 80 años, divididos en grupos etarios. En los promedios globales, en ambos estudios, el sexo masculino estaba por encima del promedio global. Con respecto a los rangos etarios, se observó que el primer grupo (15-29 años) tenía un mayor volumen muscular y de unidades Hounsfield en el psoas comparado con el grupo >60 años. Los pacientes que consultaron por espondilolistesis tenían menos masa muscular que aquellos con discopatías. Conclusiones: No existe diferencia entre la resonancia magnética y la tomografía computarizada en cuanto a la medición de los músculos paraespinales y psoas. Queda en evidencia que la disminución del volumen muscular es común en pacientes de mayor edad y con enfermedades que afectan el balance espinal. Nivel de Evidencia: IV

background: Sarcopenia is becoming increasingly significant in the research of various diseases to predict morbidity and mortal-ity in the perioperative period. Objectives: The objectives of this study were to evaluate the efficacy of computed tomography and magnetic resonance imaging in measuring the psoas and paraspinal muscles and to compare these indexes with age, sex, and pathology. materials and methods: Computed tomography and magnetic resonance imaging of outpatients were used. Muscle measurements were taken at the L3 and L4 pedicles. Results: The study included 18 CT and 34 MRI scans. The patients were divided into groups based on their age range, which was 15 to 80 years. In the overall averages, males were above the global average in both studies. Regarding age ranges, it was observed that the first group (15-29 years) had a higher muscle volume and Hounsfield units in the psoas compared to the >60 age group. Patients consulting for spondylolisthesis had less muscle mass than those with discopathy. Conclusions: There is no difference between magnetic resonance imaging and computed tomography in measuring the paraspinal and psoas muscles. It is evident that the decrease in muscle volume is common in older patients and those with diseases that affect spinal balance. Level of Evidence: IV

Signo del fluido facetario e inestabilidad vertebral segmentaria / Facet fluid sign and segmental instability of the spine

Introducción: La enfermedad degenerativa de la columna lumbar es frecuente, pero aún existen dudas en relación con los criterios de inestabilidad. Objetivos: Analizar la relación del signo del fluido facetario lumbar como criterio de inestabilidad vertebral segmentaria. materiales y métodos: Pacientes con enfermedad lumbar crónica, que presentan hidrartrosis facetaria en la resonancia magnética y las radiografías de columna lumbar dinámicas. Se analizan la prevalencia del sexo, la edad, la sintomatología principal y el dolor a la extensión unilateral o bilateral. Resultados: Se evaluó a 139 pacientes (62% mujeres), con un promedio de edad de 50.8 años; el principal motivo de consulta fue lumbalgia (76%). El 65% refería dolor en extensión; el 35%, dolor unilateral y el 30%, dolor bilateral. El 14% tenía espondilolistesis de bajo grado en L4-L5 y el 7%, en L5-S1. La hidrartrosis era unilateral en el 20% y bilateral en el 80%; el nivel de hidrartrosis más frecuente era en L4-L5 (58%). El 6% tenía solo inestabilidad traslacionaly el 2%, mixta. Un 8% presentaba Modic I y un 5%, Modic II. Conclusiones: La presencia de fluido facetario no es un criterio de inestabilidad vertebral segmentaria, al margen del nivel y el segmento localizado, o la presentación facetaria lumbar unilateral o bilateral. Nivel de Evidencia: IV

Introduction: Degenerative lumbar spine disease is prevalent, however, the criteria for instability are still debated. Objectives:To analyze the presence of the lumbar facet fluid sign as a criterion for segmental instability of the spine. materials and meth-ods: Patients with chronic lumbar disease, who present facet hydrarthrosis on MRI and dynamic lumbar spine radiographs. The prevalence of sex, age, main symptomatology, and pain on unilateral or bilateral extension was investigated. Results: A total of 139 patients (62% women) were evaluated, with an average age of 50.8 years; the main reason for consultation was low back pain (76%). Sixty-five percent reported pain in extension, with 35% reporting unilateral pain and 30% reporting bilateral pain. Fourteen percent had low-grade spondylolisthesis at L4-L5 and 7% at L5-S1. Hydrarthrosis was unilateral in 20% and bilateral in 80%; the most frequent level of hydrarthrosis was L4-L5 (58%). Six percent had only translational instability and 2% had mixed instability. 8% and 5%, respectively, had Modic I and Modic II changes. Conclusions: The presence of facet fluid is not a criterion for segmental instability of the spine, regardless of the level and localized segment, or the unilateral or bilateral lumbar facet presentation. Level of Evidence: IV

Uso de endoprótesis para el tratamiento de enfermedades no neoplásicas de la rodilla / Use of endoprosthesis for the treatment of non-neoplastic pathologies of the knee

Introducción: Las endoprótesis son el método de elección para la reconstrucción luego de las resecciones oncológicas. Los avances en los materiales y diseños permitieron expandir las indicaciones a enfermedades no neoplásicas. Su montaje intraoperatorio simple y rápido, y su estabilidad mecánica inmediata permiten una rehabilitación y una recuperación funcional tempranas. Sin embargo, la tasa de fallas es elevada, aunque distinta de la de las enfermedades oncológicas. Las causas predominantes son diferentes. Objetivos: Analizar nuestra experiencia con el uso de endoprótesis de rodilla y compararla con los estudios publicados, evaluando los resultados funcional y radiográfico, la supervivencia del implante y las causas de su eventual falla. Materiales y Métodos: Se seleccionaron pacientes con enfermedad no neoplásica compleja de rodilla que requirieran una reconstrucción con endoprótesis. Para el examen clínico y la evaluación funcional se utilizó el puntaje de la Musculoskeletal Tumor Society, y para las fallas de los implantes, la clasificación de Henderson y cols. modificada. Resultados:Se estudiaron 12 endoprótesis, con un seguimiento promedio de 3.8 años. Se registraron 2 fallas (18%), con un tiempo promedio hasta la falla de 47.5 meses. Una fue tipo 2 (aflojamiento aséptico) y la otra, tipo 4 (infección). No hubo otras complicaciones. En la evaluación funcional, el puntaje final medio fue del 76,6%. Conclusión: Nuestros resultados respaldan el uso de endoprótesis para enfermedades complejas no neoplásicas de rodilla en pacientes cuidadosamente seleccionados, pese a ser un procedimiento quirúrgico complejo y con muchas complicaciones. Nivel de Evidencia: IV

Introduction: Endoprosthesis is the gold standard for reconstruction after oncological resections. The advances regarding its materials and designs allowed for the expansion of the indications to non-neoplastic pathologies. Its simple and fast intraoperative assembly and its immediate mechanical stability allow for early rehabilitation and functional recovery. However, the failure rate is high, although it is different from oncological pathologies. The predominant causes are varied. Objectives: To analyze our experience in the use of knee endoprosthesis and compare it with the literature, evaluating functional outcomes, radiographic outcomes, implant survival and causes of eventual failure. Materials and Methods: Patients with complex non-neoplastic knee pathology that required reconstruction with endoprosthesis were selected. Clinical history, anamnesis, physical examination, and radiographs were reviewed. For clinical examination and functional evaluation, the MusculoSkeletal Tumor Society Score (MSTS Score) was used. For implant failures, the modified Henderson et al. classification was used. Results: 12 endoprostheses were studied, with an average follow-up of 3.8 years. Failures were recorded in 2 (18%), with a mean time to failure of 47.5 months. One type 2 failure (aseptic loosening) and one type 4 failure (infection) were recorded. No other complications were noted. For the functional evaluation, the mean final score was 76.6%. Conclusion: Our results support the use of endoprostheses for complex non-neoplastic knee diseases in carefully selected patients, despite being a complex surgical procedure with many complications.Keywords: Endoprosthesis; knee; infection; complications. Level of Evidence: IV

Urgencia odontopediátrica asociada a Bola Adiposa de Bichat: informe de un caso / Pediatric dental emergency associated with Bichat ́s fat pad: a case report

Objetivo: Presentar la resolución quirúrgica de un caso clínico poco frecuente en un paciente pediátrico luego de ha- ber sufrido la herniación traumática de la Bola Adiposa de Bichat. Caso clínico: Un paciente de 3 años concurre a la guar- dia del Hospital Interzonal Especializado Materno Infantil "Don Victorio Tetamanti" de Mar del Plata, luego de haber sufrido un traumatismo que le provocó el desplazamiento par- cial de la Bola Adiposa de Bichat. Si bien este tipo de urgencias es poco frecuente, es impor- tante tener los conocimientos para un correcto diagnóstico y tratamiento (AU))

Aim: To present the surgical resolution of an infrequent clinical case in a pediatric patient who suffered traumatic herniation of Bichat's fat pad. Clinical case: A 3-year-old patient who visited the Emergency Service at the "Don Victorio Tetamanti" Hospital in Mar del Plata after suffering a trauma which caused the partial displacement of Bichat's fat pad. Although this type of emergency is quite rare, it is important to know how to per- form proper diagnosis and treatment (AU)

Correlation between the Optic Nerve Sheath Diameter Measurement and Intracranial Hypertension Tomographic Findings from a Colombian Hospital / Correlação entre a medição do diâmetro da bainha do nervo óptico e os achados tomográficos da hipertensão intracraniana em um hospital colombiano

Objective In the present study, we aimed at determining the correlation between tomographic findings of intracranial hypertension and ultrasound measurement of the optic nerve sheath diameter (ONSD). Methods Observational, descriptive, prospective, cross-sectional pilot study. The present research was performed in a tertiary hospital in Cali, Colombia, from March 2019 to October 2019. Twenty-five patients constituted the intracranial hypertension group, and 25 patients without intracranial hypertension constituted the control group. Ultrasound measurements of the ONSD were assessed using a Sonosite Turbo (SonoSite Inc., Bothell, WA, USA) ultrasound. The computed tomogra phy (CT) images obtained from each patient diagnosed with intracranial hypertension were available in the software of the hospital. The primary outcome was the ultrasound measurement of the ONSD. Results The ONSD values of the right eye of the intracranial hypertension group ranged from 5.2 to 7.6 mm, and the ONSD of the left eye ranged from 5.3 to 7.3 mm. The global ONSD values, obtained from the average between the right and left eye, were recorded between 5.25 and 7.45 mm. Overall, our study indicated that ultrasound measurements of the ONSD were effective in differentiating a group with intracranial hypertension, previously diagnosed by CT scan images, from patients without this condition. According to the ROC curve, the optimal cutoff point for detecting intracranial hypertension was 5.2 mm. Conclusions Ultrasound measurements of the ONSD correlated with the measurements obtained from CT scan images, suggesting that the ultrasound technique can be efficient in identifying patients with intracranial hypertension and valuable in cases when CT scan images are not an available option.

Objetivo No presente estudo, pretendemos determinar a correlação entre os achados tomográficos da hipertensão intracraniana e a medida ultrassonográfica do diâmetro da bainha do nervo óptico (DBNO). Métodos Estudo piloto, observacional, descritivo, prospectivo e transversal. A presente pesquisa foi realizada em um hospital terciário de Cali, na Colômbia, de março de 2019 a outubro de 2019. Vinte e cinco pacientes fizeram parte do grupo de hipertensão intracraniana e 25 pacientes sem hipertensão intracraniana fizeram parte do grupo controle. O ultrassom Sonosite Turbo (SonoSite Inc., Bothell, WA, EUA) foi utilizado para a medição ultrassonográfica do DBNO. As imagens tomográficas computadorizadas obtidas de cada paciente com diagnóstico de hipertensão intracraniana estavam disponíveis no software do Hospital. O resultado primário foi a medida ultrassonográfica do DBNO. Resultados Os valores de DBNO do olho direito do grupo de hipertensão intracraniana foram de 5,2 a 7,6 mm e o DBNO do olho esquerdo foi de 5,3 a 7,3 mm. No que se refere aos valores globais de DBNO obtidos a partir da média entre o olho direito e o olho esquerdo, registrou-se entre 5,25 e 7,45mm. No geral, o presente estudo indicou que as medições ultrassonográficas do DBNO foram eficazes na diferenciação de um grupo com hipertensão intracraniana, previamente diagnosticada por imagens de tomografia computadorizada (TC), de pacientes sem essa condição. De acordo com a curva ROC, o ponto de corte ideal para detectar hipertensão intracraniana foi de 5,2 mm. Conclusões De acordo com nossos achados, as medidas ultrassonográficas do ONSD se correlacionaram com as medidas obtidas nas imagens de TC, sugerindo que a técnica ultrassonográfica pode ser eficiente para identificar pacientes com hipertensão intracraniana e útil nos casos em que as imagens tomográficas não são uma opção disponível.

Uso de aloinjerto estructural e infecciones posquirúrgicas / Use of structural allograft and post-surgical infections

Introducción: El uso de aloinjertos conlleva el riesgo de complicaciones. Una de las más frecuentes es la infección. Un importante factor de riesgo de infección con el uso de injertos óseos es la transmisión de gérmenes a través del injerto. Nuestros objetivos fueron determinar si existe una relación entre la posible contaminación de los injertos de este Banco y las infecciones posquirúrgicas; demostrar cómo la selección del donante, la procuración y el procesado del injerto adecuados disminuyen la tasa de contaminación e informar otras complicaciones relacionadas con la calidad del injerto. Materiales y métodos: Se seleccionaron pacientes que recibieron injerto óseo estructural de nuestro Banco. Todos los injertos fueron estudiados microbiológicamente. Se revisaron las historias clínicas, y los pacientes fueron sometidos a una anamnesis y un examen físico, y se les tomaron radio-grafías para detectar infección y otras complicaciones. Se utilizó la Escala de Osteointegración ISOLS. Resultados: En ninguno de los injertos, se detectó contaminación. Se identificó un caso (7,7%) de infección por Klebsiella pneumoniae productora de carbapenemasas y 3 casos (23%) de falta de integración. La integración fue entre buena y excelente en el 77% de los casos, satisfactoria en el 8% y pobre en el 15%. No hubo otras complicaciones. Conclusiones: Existe riesgo de transmisión de infecciones con el aloinjerto estructural. Los criterios reglados de selección de donantes y el control de los procedimientos dentro del banco de huesos disminuyen el riesgo de infección por contaminación del injerto y de otras complicaciones relacionadas con la calidad del injerto. Nivel de Evidencia: IV

Introduction: The use of allografts carries the risk of various complications. Among the most frequent is infection. An important risk factor for infection with the use of bone grafts is the transmission of germs through the graft itself. Our objectives are to determine if there is a relationship between possible contamination of the grafts from this bank and postoperative infections; demonstrate how the proper donor selection, procurement, and processing of the graft decrease the rate of contamination; and report other complications related to the quality of the graft. Materials and methods: We selected patients who received structural bone grafts from our bank. All grafts were microbiologically studied. A review of the health records, anamnesis, physical examination, and radiographs was performed to evaluate infection and other complications. The ISOLS Osseointegration Scale was used to assess the consolidation of the grafts.Results: No graft contamination was detected. One case (7.7%) of infection by carbapenemase-producing Klebsiella pneumoniae (KPC) and 3 cases (23%) of nonunion were identified. Consolidation was good to excellent in 77% of cases, satisfactory in 8%, and poor in 15%. No other complications were found. Conclusion: There is a risk for infection transmission with structural allograft. Regulated donor selection criteria and control of bone bank procedures reduce the risk of infection due to graft contamination and other complications related to graft quality. Level of Evidence: IV

Efecto del componente arbóreo sobre la dinámica de crecimiento y calidad nutricional de una pradera mixta en trópico alto / Effect of tree component on the growth dynamics and nutritional quality of a mixed grassland in the high tropic

Resumen Los sistemas ganaderos se basan en el monocultivo de gramíneas. El pastoreo comúnmente no tiene en cuenta la fisiología de las especies, lo que afecta la persistencia y calidad del forraje. Los sistemas silvopastoriles favorecen la producción y calidad del forraje. Por eso es importante conocer la dinámica de crecimiento de la pastura para determinar el momento óptimo de pastoreo. Con base en esto, el objetivo de esta investigación fue evaluar el efecto de Acacia melanoxilum sobre la producción y calidad nutricional de una pradera mixta en trópico alto. La investigación se desarrolló en el Centro de Investigación y Capacitación "Santa María del Puyón", ubicado en Sopo, Colombia. Se evaluó una pradera de Cenchrus clandestinum y Lolium perenne, en pasturas en callejones se establecieron parcelas bajo y fuera de los árboles, y se evaluó el crecimiento (15, 30, 45 y 60 días) durante nueve meses. Luego se determinaron las propiedades fisicoquímicas del suelo, la altura sin disturbar del pasto, el número de hojas, el índice de área foliar y la producción y calidad de forraje. Después se utilizó un diseño al azar, y se realizó estadística descriptiva y análisis de varianza, mediante el programa Infostat® para el análisis de datos. Bajo los árboles se observó mayor pH, materia orgánica, minerales y capacidad de intercambio catiónico, mayor altura sin disturbar (p = 0,0001), diferencias en producción de forraje verde (p = 0,0128), composición botánica y mayor proteína cruda (p = 0,0061). Los árboles de A. melanoxilum favorecen el crecimiento y la calidad nutricional de praderas mixtas en trópico alto.

Abstract Livestock systems are based on the monoculture of grasses, grazing does not usually take into account the physiology of the species, this affects the persistence and quality of the forage. Silvopastoral systems favor forage production and quality, it is important to know the growth dynamics of the pasture to determine the optimal grazing moment. The objective of this work was to evaluate the effect of Acacia melanoxilum on the production and nutritional quality of a mixed meadow in the high tropics. The research was carried out at the "Santa María del Puyón" Research and Training Center, located in Sopo, Colombia. A meadow of Cenchrus clandestinum and Lolium perenne was evaluated, in alley pastures, plots were established under and outside the trees, the growth was evaluated (15, 30, 45 and 60 days) for nine months. The physicochemical properties of the soil, undisturbed height, number of leaves, leaf area index, production and quality of forage were determined. A random design was used, descriptive statistics and analysis of variance were performed. The Infostat® program was used for data analysis. Under the trees there is a higher ph, organic matter, minerals and cation exchange capacity, higher undisturbed height (p = 0.0001), differences in green forage production (p = 0.0128), botanical composition, and higher protein crude (p = 0.0061). A. Melanoxilum trees favor the growth and nutritional quality of mixed grasslands in the high tropics.

Determinação da despesa com energia elétrica na lavagem de filtro rápido de estação de tratamento de água / Electricity cost of rapid filter backwashing in a water treatment plant

RESUMO O estudo teve por objetivo determinar a despesa com energia elétrica na lavagem de filtro rápido de uma estação de tratamento de água (ETA), cuja vazão é de 45 L/s. Para isso, foi realizado monitoramento hidroenergético para a análise do desempenho no bombeamento de água de lavagem. Adicionalmente, foi monitorada a qualidade da água do efluente de três lavagens no filtro 4 e realizado um levantamento das informações tarifárias de energia elétrica da unidade de tratamento. Com os resultados obtidos, observou-se que os valores de turbidez do efluente, ao final das três lavagens, no caso, 31, 30 e 27 UNT, não atingiram os limites mínimos recomendados na literatura técnica, que é de, pelo menos, 15 UNT. Foi observada também a dificuldade de prolongamento do tempo de lavagem, a fim de alcançar o padrão da literatura, pois o reservatório elevado (REL) de água de lavagem (água tratada), também alimenta a rede de distribuição, e poderia esvaziar completamente. Levando em conta essas limitações e a qualidade final do efluente de lavagem, observou-se que as lavagens devem ser finalizadas aos 380 segundos (6,3 minutos), tempo que consome um volume de 23,36 m3/lavagem. A despesa de água de lavagem foi calculada em 1,36 R$/m3, o que resultou no valor de 31,83 R$/lavagem. Para as lavagens de todos os filtros da estação, as despesas foram de 254,64 R$/dia, 7.639,20 R$/mês e 91.670,4 R$/ano. Esses valores são considerados elevados para o sistema de tratamento estudado.

ABSTRACT This paper aims to determine the cost of electricity for rapid filter backwashing procedures at water treatment plants, whose flow rate is 45 L/s. Flow and electricity consumption were monitored in order to analyze the performance of the pumping systems. Additionally, the effluent water quality of three washes was monitored in filter 4 and a survey of the electricity fare data of the treatment unit was carried out. With the results obtained, it was observed that the effluent turbidity values at the end of the three washes, in this case 31, 30, and 27 NTU, did not reach the minimum values recommended in the technical literature, which is at least 15 NTU. It was also observed the impossibility of prolonging the backwashing time in order to reach the standard of the literature, due to the double function of the elevated washing water reservoir (treated water), whose main purpose is to provide treated water to the water distribution network. Taking into account these limitations and the final quality of the wash effluent, it was observed that the duration of backwashing procedures should be around 380 seconds (6.3 minutes), consuming 23.36 m3/wash. The backwashing procedure cost was estimated at R$ 1.36/m3, which resulted in R$ 31.83/wash. Considering the whole filtration unit, the backwashing procedure cost was R$ 254.64/day, R$ 7,639.20/month, and R$ 91,670.4/year. This value can be classified as too expensive considering the treatment plant studied.

Produção da Psicologia no Brasil sobre mulheres rurais: revisão sistemática / Psychology publications about rural women in Brazil: a systematic review / Producción de la Psicología en Brasil sobre mujeres rurales: revisión sistemática

O presente estudo tem como objetivo investigar as produções científicas na área da Psicologia no que diz respeito às mulheres em contextos rurais no Brasil. Realizada nas bases da BVS-Psi, SciELO, PePSIC, LILACS, BDTD, Portal CAPES, com os seguintes descritores de busca: "psicologia" AND "mulheres" AND "rural". Foram selecionados 22 estudos (14 artigos e 8 teses/dissertações). Os estudos versam sobre: a) movimento social e participação política; b) jovens mulheres e ruralidade e c) condições de vida, saúde mental e suporte psicossocial

The present study aimed to investigate scientific publication in Psychology regarding women in the rural context in Brazil. The search included the databases BVS-Psi, SciELO, PePSIC, LILACS, BDTD, Portal CAPES using the search terms "psychology" AND "women" AND "rural". Twenty two studies were selected (14 journal articles and 8 thesis/dissertations). The studies were about: a) social movement and political participation; b) young women and rurality and c) living conditions, mental health and psycho-social support

El presente estudio tiene por objetivo investigar las producciones científicas en el área de la Psicología en lo que se refiere a las mujeres en contextos rurales en Brasil. Llevadas a cabo en las bases de la BVS-Psi, SciELO, PePSIC, LILACS, BDTD, Portal CAPES, con los siguientes descriptores de búsqueda: "psicología" AND "mujeres" AND "rural". Se seleccionaron 22 estudios (14 artículos y 8 tesis/disertaciones). Los estudios versan sobre: a) movimiento social y participación política; b) jóvenes mujeres y ruralidad y c) condiciones de vida, salud mental y apoyo psicosocial

Intervención ambiental en las enfermedades respiratorias / Environmental intervention in respiratory disease

En los últimos años hubo un aumento significativo en la prevalencia de las enfermedades alérgicas pese a los avances en la comprensión de la patogénesis, la divulgación de guías para su control y tratamiento y la aparición de nuevos fármacos. La raz ón para este aumento no está totalmente estable cida, pero se considera que múltiples factores ambientales podrían estar involucrados en ello. El aire inspirado contiene numerosos agentes nocivos además de alérgenos ambientales; el asma y la rinitis alérgica son las principales expresiones clínicas respiratorias inmediatas posteriores a su inhalación. En la antropósfera, el entorno de la superficie terrestre habitada por los humanos, se han alterado los equilibrios naturales por la emisión de múltiples sustancias y se ha producido un creciente cambio climático. Este fenómeno global influye en la calidad del aire y consecuentemente en el desarrollo de enfermedades respiratorias. Dado que la bibliografía sobre el tema del control ambiental es muy amplia, y en ocasiones difícil de interpretar para poder realizar indicaciones precisas, válidas y sencillas de cumplir por parte de los pacientes, cuatro sociedades científicas de la República Argentina, dedicadas a este tipo de enfermedades, elaboraron un documento con información de fácil acceso a todo profesional médico que trate asma y/o rinitis, que expone medidas prácticas para los enfermos y alerta a los distintos actores involucrados en la salud pública acerca de las necesidades insatisfechas en este tema tan complejo, a fin de poder elaborar una agenda para su posible resolución.

In recent years there has been a significant increase in the prevalence of allergic diseases despite advances in the understanding of the pathogenesis, the dissemination of guidelines for its management and the emergence of new drugs. The reasons for this increase are not fully established, but it is suggested that multiple environmental factors may be involved. Inhaled air contains numerous harmful agents in addition to environmental allergens. The main immediate respiratory clinical expression after inhaling this contaminated air is asthma and rhinitis. The activity of human beings has altered the outdoor environment by the emission of multiple pollutants and has produced an increasing climate change. It also has a notable impact on the development of respiratory pathology and the modification of air quality. The bibliography on the subject of environmental control is very broad and sometimes difficult to interpret. In order to be able to make precise, valid and simple indications for patients to accomplish with, four scientific societies of the Argentine Republic that deal with this type of diseases, have elaborated a document that contains information of easy access to all medical personal involved in the treatment of patients with asthma and / or rhinitis, that provides practical measures for the patients and the different public health systems about unmet needs in this complex issue.

Maximum effort training performed in hypoxia alters the mood profile / Exercício físico máximo realizado em hipóxia altera o perfil de humor / Ejercicio físico máximo realizado en hipoxia altera el perfil del estado de ánimo

INTRODUCTION: Physical exercise at high altitude has become constant. However, the risks associated with this type of exercise represent a major concern, considering the influence of important stressors such as hypoxia and physical exercise on psychobiological and physiological responses. OBJECTIVE: Analyze the mood state and behavior of physiological variables of volunteers subjected to a progressive loading protocol until they reached maximum volitional exhaustion, both at sea level and at a simulated altitude of 4500 meters. METHOD: For both conditions studied, the volunteers responded to two instruments that assess mood responses: The Brunel Mood Scale and the Visual Analogue Mood Scale. They also underwent blood sampling to measure blood lactate levels and to evaluate oxygen-hemoglobin saturation. These procedures were performed before, immediately after, and 30 and 60 minutes after the end of the protocol. RESULTS: Hypoxia triggered negative effects on mood responses, especially when compared to sea level conditions. An increase in fatigue level (p=0.02) and mental confusion (p=0.04) was observed immediately after the exercise session, and reduction of vigor (p=0.03) was noted at 30 minutes, accompanied by a reduction in oxygen-hemoglobin saturation immediately after the session and at 30 minutes. There was also an increase in blood lactate levels immediately after the session (p=0.006). CONCLUSION: The particularities of the hypoxic environment associated with maximum exercise are able to cause a deterioration of mood and physiological responses, which can negatively modulate physical performance. This is a cross-sectional clinical study.

INTRODUÇÃO: Prática de exercícios físicos em elevadas altitudes tem se tornado constante. Entretanto, os riscos associados a esta representam uma grande preocupação, considerando a influência de importantes agentes estressores, como hipóxia e exercício físico, sobre as respostas psicobiológicas e fisiológicas. OBJETIVO: Analisar o perfil do humor e o comportamento de variáveis fisiológicas de voluntários submetidos a um protocolo de cargas progressivas até a Exaustão Voluntária Máxima no nível do mar e em altitude simulada de 4.500 metros. MÉTODOS: Para ambas as condições estudadas, os voluntários responderam a dois instrumentos que avaliam as respostas do humor, Escala de Humor de Brunel e o Visual Analogue Mood Scale, e foram submetidos à coleta de sangue para verificar a concentração de lactato sanguíneo, bem como para avaliar a saturação de oxi-hemoglobina. Esses procedimentos foram realizados antes, imediatamente depois e 30 e 60 minutos após o término do protocolo. RESULTADOS: A hipóxia desencadeou efeitos negativos sobre as respostas de humor, principalmente com relação ao nível do mar. Verificou-se aumento da fadiga (p = 0,02) e da confusão mental (p=0,04) imediatamente após a prática e redução do vigor (p = 0,03) aos 30 minutos; acompanhadas da diminuição da saturação da oxi-hemoglobina imediatamente após e aos 30 minutos; constatou-se ainda, o aumento da concentração de lactato sanguíneo no momento imediatamente após (p = 0,006). CONCLUSÃO: As particularidades do ambiente hipóxico associadas à realização do exercício físico máximo são capazes de piorar o estado de humor e as respostas fisiológicas, o que pode modular negativamente o desempenho físico. Este estudo é do tipo clínico transversal.

INTRODUCCIÓN: La práctica de ejercicios físicos en elevadas altitudes se ha vuelto constante. Entretanto, los riesgos asociados a ésta representan una gran preocupación, considerando la influencia de importantes agentes estresantes, como hipoxia y ejercicio físico, sobre las respuestas psicobiológicas y fisiológicas. OBJETIVO: Analizar el perfil del humor y el comportamiento de variables fisiológicas de los voluntarios sometidos a un protocolo de cargas progresivas hasta el Agotamiento Voluntario Máximo, al nivel del mar y a una altitud simulada de 4500 metros. MÉTODOS: Para ambas condiciones estudiadas, los voluntarios respondieron a dos instrumentos que evalúan las respuestas del humor: la Escala de Humor de Brunel y el Visual Analogue Mood Scale, y fueron sometidos a colecta de sangre para verificar la concentración de lactato sanguíneo, bien como para evaluar la saturación de oxihemoglobina. Estos procedimientos fueron realizados antes, inmediatamente después, y 30 y 60 minutos después de finalizar el protocolo. RESULTADOS: La hipoxia desencadenó efectos negativos sobre las respuestas de humor, principalmente con relación al nivel del mar. Se verificó aumento de fatiga (p = 0,02) y de la confusión mental (p = 0,04) inmediatamente después de la práctica y reducción del vigor (P = 0,03) a los 30 minutos; acompañadas de la disminución de la saturación de la oxihemoglobina inmediatamente después y a los 30 minutos; se constató además el aumento de la concentración de lactato sanguíneo en el momento inmediatamente después (p = 0,006). CONCLUSIÓN: Las particularidades del ambiente hipóxico asociadas a la realización del ejercicio físico máximo, son capaces de empeorar el estado de humor y las respuestas fisiológicas, lo que puede modular negativamente el desempeño físico. Este estudio es del tipo clínico transversal.

Prevalência e perfil de suscetibilidade a antimicrobianos de microrganismos isolados em culturas de cateter / Prevalence and antimicrobial susceptibility profile of isolated microorganisms in catheter cultures

Introdução: os cateteres intravenosos são de uso amplamente difundido em hospitais e por estarem em contato direto com a circulação sanguínea, tornam­se um potencial risco para a ocorrência de contaminação e infecção local e sistêmica, aumentando a mortalidade, o tempo de internação e consequentemente custos hospitalares. Objetivo: o presente estudo teve como objetivo realizar levantamento epidemiológico da prevalência de bactérias e fungos em pontas de cateteres provenientes de sete hospitais do município de Cascavel ­ Paraná. Metodologia: foi realizado um estudo transversal por meio da coleta de dados em laudos emitidos por um laboratório clínico privado do mesmo município, entre os anos de 2011 a 2014. Resultados: verificou­se positividade em 21,7% dos laudos analisados (248). O grupo dos bacilos Gram negativos fermentadores (BGN) foi o mais prevalente, sendo as principais bactérias encontradas Escherichia coli e Klebsiella pneumoniae (84 laudos), seguidos de BGN não­fermentadores (79 laudos) e cocos Gram positivos (67 laudos). Leveduras foram encontradas em 18 laudos. Staphylococcus aureus apresentaram uma resistência de 31,8% para oxacilina, sendo para Staphylococcus coagulase­negativa resistência de 86,9%. Klebsiella pnemoniae apresentou discreta resistência para ertapenem (9,5%), imipenem (7,1%) e meropenem (7,1%), sugerindo presença de carbapenemase. Espécies de Enterobacter foram resistentes a diversos antimicrobianos, não constatado resistência aos carbapenêmicos ertapenem, imipenem e meropenem. Acinetobacter baumanii e Pseudomonas aeruginosa apresentaram elevada resistência para imipenem e meropenem (77,1% e 45,2%; 80% e 51,6%, respectivamente). Candida albicans apresentou 100% de suscetibilidade aos antifúngicos utilizados. Conclusão: esses resultados demonstram a grande importância no manejo eficiente do controle de infecção hospitalar e uso responsável de antimicrobianos por hospitais.

Introduction: intravenous catheters are widely used in hospitals, and they become a potential risk for local and systemic contamination due to direct contact with blood circulation, increasing mortality, length of hospital stay and consequently hospital costs. Objectives: the present study aimed to conduct an epidemiological survey of bacteria and fungi prevalence in catheter tips from seven hospitals in Cascavel county ­ Paraná. Methodology: a cross­sectional study was performed by data collection in reports issued by a private clinical laboratory in the same municipality from 2011 to 2014. Results: positive results were found in 21.7% of analyzed reports (248). The Gram negative bacilli fermenting (BGN) group was the most prevalent, being main bacterias Escherichia coli and Klebsiella pneumoniae (84 reports), followed by non­fermenting BGN (79 reports) and Gram positive cocci (67 reports). Yeasts were found in 18 reports. Staphylococcus aureus showed a resistance of 31.8% for oxacillin, and resistance for Staphylococcus coagulase­negative of 86.9%. Klebsiella penmoniae presented a mild resistance to ertapenem (9.5%), imipenem (7.1%) and meropenem (7.1%), suggesting presence of carbapenemase. Enterobacter species were resistant to several antimicrobials, no resistance to carbapenems ertapenem, imipenem and meropenem. Acinetobacter baumanii and Pseudomonas aeruginosa presented high resistance to imipenem and meropenem (77.1% and 45.2%, 80% and 51.6%, respectively). Candida albicans showed 100% susceptibility to antifungals used. Conclusion: these results demonstrate great importance in the efficient management of hospital infection control and responsible use of antimicrobials by hospitals

Normal anion gap metabolic acidosis secondary to topiramate intake: case report

ABSTRACT Introduction: Topiramate is a drug used to treat various types of epilepsy and as prophylaxis in cases of migrainous headache. One of its mechanisms of action is the inhibition of carbonic anhydrase in the kidney that triggers the excretion of alkaline urine resulting in metabolic acidosis. Case presentation: 17-year-old female patient from Mexico City who regularly uses topiramate, quetiapine and sertraline for the management of depressive disorder. She developed normal anion gap metabolic acidosis secondary to topiramate intake. As a result, she required invasive ventilatory support due to reduced consciousness and respiratory distress. Adequate response to management with laxatives and bicarbonate was achieved, with full renal and neurological recovery. Discussion: Metabolic acidosis is the most common acid-base disorder observed in clinical practice. The difference between measurable cations and anions, known as anion gap, helps to classify the severity of acidosis. Bicarbonate losses or renal tubular disorders generate normal anion gap acidosis as opposed to acidosis resulting from an overproduction of endogenous acid or renal failure, which causes high anion gap. Topiramate is a little known cause of normal anion gap metabolic acidosis; by inhibiting carbonic anhydrase, it causes mixed renal tubular acidosis or type 3 acidosis, as a consequence of the inability to secrete hydrogen ions in the collecting tubule, and a limitation of bicarbonate reabsorption in the proximal tubule. Conclusion: Topiramate, either in therapeutic doses or in overdose, can lead to normal anion gap metabolic acidosis due to the inhibition of carbonic anhydrase in the kidneys. It is usually reversible after starting bicarbonate.

RESUMEN Introducción. El topiramato es un medicamento que se usa en el tratamiento de varios tipos de epilepsia y como profilaxis en casos de cefalea migrañosa. Entre sus mecanismos de acción, la inhibición de la anhidrasa carbónica en el riñón desencadena la excreción de orina alcalina ocasionando acidosis metabólica. Presentación del caso. Paciente femenino de 17 años procedente de la Ciudad de México con antecedente de consumo de topiramato, quetiapina y sertralina para manejo de síndrome depresivo, quien desarrolla acidosis metabólica de anión restante normal secundaria a ingesta de topiramato. La joven requiere soporte ventilatorio invasivo por deterioro del estado de conciencia y síndrome de dificultad respiratoria y presenta adecuada respuesta a manejo con catártico y bicarbonato sin compromiso renal y sin secuelas neurológicas. Discusión. La acidosis metabólica es la alteración ácido base más frecuente en la práctica clínica. La diferencia entre cationes y aniones medibles, conocida como anión restante o brecha aniónica, permite clasificar este tipo de acidosis. Las pérdidas de bicarbonato o trastornos de la función tubular renal generan acidosis de anión restante normal; por el contrario, la acidosis causada por sobreproducción de ácido endógeno o por insuficiencia renal genera anión restante elevado. El topiramato es una causa poco conocida de acidosis metabólica con anión restante normal; al inhibir la anhidrasa carbónica, se ocasiona una acidosis tubular renal mixta o tipo 3 debido a una in capacidad de secreción de hidrogeniones en el túbulo colector y una limitación en la reabsorción del bicarbonato en el túbulo proximal. Conclusión. El topiramato en dosis terapéutica o en sobredosis puede generar acidosis metabólica de anión restante normal debido a la inhibición de la anhidrasa carbónica a nivel renal. Se trata de un cuadro reversible en el cual el manejo con bicarbonato ha mostrado buenos resultados clínicos.