A transgenic male-only strain of the New World screwworm for an improved control program using the sterile insect technique.

BACKGROUND: The New World screwworm, Cochliomyia hominivorax, is a devastating pest of livestock endemic to subtropical and tropical regions of the Western hemisphere. The larvae of this species feed on the tissue of living animals, including man, and can cause death if untreated. Over 60 years ago, the sterile insect technique (SIT) was developed with the aim of eradicating this pest, initially from Florida but subsequently from all of North and Central America. From the outset it was appreciated that SIT would be more efficient if only sterile males were released in the field, but this was not possible until now. RESULTS: Here, we report on the development and evaluation of the first sexing strains of C. hominivorax that produce only males when raised on diet without tetracycline. Transgenic lines have been developed that possess a tetracycline repressible female-lethal genetic system. Ten of these lines show high female lethality at the late larval/pupal stages and three of them present dominant female lethality. Most of the lines were comparable to the wild type parental strain in several fitness parameters that are relevant to mass rearing in a production facility. Further, three lines performed well in male mating success and male competition assays, suggesting they would be sexually competitive in the field. Consequently, one transgenic line has been selected by the New World Screwworm Program for evaluation under mass rearing conditions. CONCLUSIONS: We conclude that the promising characteristics of the selected sexing strains may contribute to reduce production costs for the existing eradication program and provide more efficient population suppression, which should make a genetic control program more economical in regions were C. hominivorax remains endemic.

An alternative chicken-based diet for mass-rearing screwworm flies.

Screwworm flies are mass-reared and released along the Panama-Colombia border to prevent reinfestation of Central and North America. The cost of the production facility, labor, and diet materials makes mass-rearing the most expensive component of the program. The mass-rearing diet has a large impact on the quality and quantity of insects produced, both of which are necessary for the successful implementation of the sterile insect technique. The diet currently used to rear screwworm flies in Panama contains dried bovine red blood cells, dried bovine plasma, egg powder, milk replacement powder, cellulose (thickening agent), formaldehyde (antimicrobial), and water. Here, we tested an alternative diet containing 2 chicken by-products, which cost less and are locally available, to replace the egg powder and milk replacement powder currently used in the diet. We used 2 screwworm colony strains in our test, the current production strain (Jamaica) and an early female-lethal strain. The chicken diet performed similarly to the production diet with the Jamaica strain, while further optimization will likely be needed for transgenic strain. Finally, nutritional analysis conducted on 7 diet ingredients will assist with diet optimization and the identification of alternative diet ingredients.

Doxycycline is a viable alternative to tetracycline for use in insect Tet-Off transgenic sexing systems, as assessed in the blowflies Cochliomyia hominivorax and Lucilia cuprina (Diptera: Calliphoridae).

Transgenic insect strains with tetracycline repressible (Tet-Off) female-lethal genes provide significant advantages over traditional sterile insect techniques for insect population control, such as reduced diet and labor costs and more efficient population suppression. Tet-Off systems are suppressed by tetracycline-class antibiotics, most commonly tetracycline (Tc) or doxycycline (Dox), allowing for equal sex ratio colonies of transgenic insects when reared with Tc or Dox and male-only generations in their absence. Dox is a more stable molecule and has increased uptake than Tc, which could be advantageous in some insect mass-rearing systems. Here, we evaluated the suitability of Dox for rearing Tet-Off female-lethal strains of Australian sheep blowfly, Lucilia cuprina (Wiedemann, 1830) (Diptera: Calliphoridae), and New World screwworm, Cochliomyia hominivorax (Coquerel, 1858) (Diptera: Calliphoridae), and the effects of dosage on strain performance. For both species, colonies were able to be maintained with mixed-sex ratios at much lower dosages of Dox than Tc. Biological yields of C. hominivorax on either antibiotic were not significantly different. Reduction of Dox dosages in C. hominivorax diet did not affect biological performance, though rearing with 10 or 25 µg/mL was more productive than 50 µg/mL. Additionally, C. hominivorax mating performance and longevity were equal on all Dox dosages. Overall, Dox was a suitable antibiotic for mass-rearing Tet-Off female-lethal L. cuprina and C. hominivorax and was functional at much lower dosages than Tc.

NGSEP 4: Efficient and accurate identification of orthogroups and whole-genome alignment.

Whole-genome alignment allows researchers to understand the genomic structure and variation among genomes. Approaches based on direct pairwise comparisons of DNA sequences require large computational capacities. As a consequence, pipelines combining tools for orthologous gene identification and synteny have been developed. In this manuscript, we present the latest functionalities implemented in NGSEP 4, to identify orthogroups and perform whole genome alignments. NGSEP implements functionalities for identification of clusters of homologus genes, synteny analysis and whole genome alignment. Our results showed that the NGSEP algorithm for orthogroups identification has competitive accuracy and efficiency in comparison to commonly used tools. The implementation also includes a visualization of the whole genome alignment based on synteny of the orthogroups that were identified, and a reconstruction of the pangenome based on frequencies of the orthogroups among the genomes. NGSEP 4 also includes a new graphical user interface based on the JavaFX technology. We expect that these new developments will be very useful for several studies in evolutionary biology and population genomics.

Passive multi-unit field-pilot for acid mine drainage remediation: Performance and environmental assessment of post-treatment solid waste.

This study evaluated the performance of a passive multi-unit field-pilot operating for 16 months to treat acid mine drainage (AMD) from a coal mine in Colombia Andean Paramo. The multi-unit field-pilot involved a combination of a pre-treatment unit (550 L) filled with dispersed alkaline substrate (DAS), and six passive biochemical reactors (PBRs; 220 L) under two configurations: open (PBRs-A) and closed (PBRs-B) to the atmosphere. The AMD quality was 1200 ± 91 mg L-1 Fe, 38.0 ± 1.3 mg L-1 Mn, 8.5 ± 1.6 mg L-1 Zn, and 3200 ± 183.8 mg L-1 SO42-, at pH 2.8. The input and output effluents were monitored to establish AMD remediation. Physicochemical stability of the post-treatment solids, including metals (Fe2+, Zn2+, and Mn2+) and sulfates for environmental contamination from reactive mixture post-treatment, was also assessed. The passive multi-unit field-pilot achieved a total removal of 74% SO42-, 63% Fe2+, and 48% Mn2+ with the line of PBRs-A, and 91% SO42-, 80% Fe2+, and 66% Mn2+ with the line of PBRs-B, as well as 99% removal for Zn2+ without significant differences (p < 0.05) between the two lines. The study of the physicochemical stability of the post-treatment solids showed they can produce acidic leachates that could release large quantities of Fe and Mn, if they are disposed in oxidizing conditions; contact with water or any other leaching solutions must be avoided. Therefore, these post-treatment solids cannot be disposed of in a municipal landfill. The differences in configuration between PBRs, open or closed to the atmosphere, induced changes in the performance of the passive multi-unit field-pilot during AMD remediation.

Genomic analyses of a livestock pest, the New World screwworm, find potential targets for genetic control programs.

The New World Screwworm fly, Cochliomyia hominivorax, is a major pest of livestock in South America and Caribbean. However, few genomic resources have been available for this species. A genome of 534 Mb was assembled from long read PacBio DNA sequencing of DNA from a highly inbred strain. Analysis of molecular evolution identified 40 genes that are likely under positive selection. Developmental RNA-seq analysis identified specific genes associated with each stage. We identify and analyze the expression of genes that are likely important for host-seeking behavior (chemosensory), development of larvae in open wounds in warm-blooded animals (heat shock protein, immune response) and for building transgenic strains for genetic control programs including gene drive (sex determination, germline). This study will underpin future experiments aimed at understanding the parasitic lifestyle of the screwworm fly and greatly facilitate future development of strains for efficient systems for genetic control of screwworm.

Urban Transformations and Health: Methods for TrUST-a Natural Experiment Evaluating the Impacts of a Mass Transit Cable Car in Bogotá, Colombia.

Background: Cable cars provide urban mobility benefits for vulnerable populations. However, no evaluation has assessed cable cars' impact from a health perspective. TransMiCable in Bogotá, Colombia, provides a unique opportunity to (1) assess the effects of its implementation on the environmental and social determinants of health (microenvironment pollution, transport accessibility, physical environment, employment, social capital, and leisure time), physical activity, and health outcomes (health-related quality of life, respiratory diseases, and homicides); and (2) use citizen science methods to identify, prioritize, and communicate the most salient negative and positive features impacting health and quality of life in TransMiCable's area, as well as facilitate a consensus and advocacy-building change process among community members, policymakers, and academic researchers. Methods: TrUST (In Spanish: Transformaciones Urbanas y Salud: el caso de TransMiCable en Bogotá) is a quasi-experimental study using a mixed-methods approach. The intervention group includes adults from Ciudad Bolívar, the area of influence of TransMiCable. The control group includes adults from San Cristóbal, an area of future expansion for TransMiCable. A conceptual framework was developed through group-model building. Outcomes related to environmental and social determinants of health as well as health outcomes are assessed using questionnaires (health outcomes, physical activity, and perceptions), secondary data (crime and respiratory outcomes) use of portable devices (air pollution exposure and accelerometry), mobility tracking apps (for transport trajectories), and direct observation (parks). The Stanford Healthy Neighborhood Discovery Tool is being used to capture residents' perceptions of their physical and social environments as part of the citizen science component of the investigation. Discussion: TrUST is innovative in its use of a mixed-methods, and interdisciplinary research approach, and in its systematic engagement of citizens and policymakers throughout the design and evaluation process. This study will help to understand better how to maximize health benefits and minimize unintended negative consequences of TransMiCable.

Specific Gene Disruption in the Major Livestock Pests Cochliomyia hominivorax and Lucilia cuprina Using CRISPR/Cas9.

Cochliomyia hominivorax and Lucilia cuprina are major pests of livestock. Their larvae infest warm-blooded vertebrates and feed on host's tissues, resulting in severe industry losses. As they are serious pests, considerable effort has been made to develop genomic resources and functional tools aiming to improve their management and control. Here, we report a significant addition to the pool of genome manipulation tools through the establishment of efficient CRISPR/Cas9 protocols for the generation of directed and inheritable modifications in the genome of these flies. Site-directed mutations were introduced in the Chominivorax and Lcuprina yellow genes (ChY and LcY) producing lightly pigmented adults. High rates of somatic mosaicism were induced when embryos were injected with Cas9 ribonucleoprotein complexes (RNPs) pre-assembled with guide RNAs (sgRNAs) at high concentrations. Adult flies carrying disrupted yellow alleles lacked normal pigmentation (brown body phenotype) and efficiently transmitted the mutated alleles to the subsequent generation, allowing the rapid creation of homozygous strains for reverse genetics of candidate loci. We next used our established CRISPR protocol to disrupt the Chominivorax transformer gene (Chtra). Surviving females carrying mutations in the Chtra locus developed mosaic phenotypes of transformed ovipositors with characteristics of male genitalia while exhibiting abnormal reproductive tissues. The CRISPR protocol described here is a significant improvement on the existing toolkit of molecular methods in calliphorids. Our results also suggest that Cas9-based systems targeting Chtra and Lctra could be an effective means for controlling natural populations of these important pests.

Quimioterapia adyuvante en cáncer epitelial de ovario en estadios avanzados / Adjuvant chemotherapy in advanced stage epithelial ovarian cancer

Objetivo: describir la experiencia en el manejo de quimioterapia adyuvante en pacientes con cáncer epitelial avanzado de ovario en el Hospital de San José, Bogotá, Colombia, entre 2016 y 2020. Materiales y métodos: estudio de cohorte histórica descriptiva de pacientes con diagnóstico de cáncer epitelial del ovario, citorreducción quirúrgica completa y que recibieron 6 ciclos de quimioterapia con carboplatino-paclitaxel. El tiempo del seguimiento fue aproximadamente 1 año. Resultados: de 45 pacientes estudiadas con citorreducción óptima el cáncer progresó después de la quimioterapia adyuvante en 13/45 casos (29%), presentó respuesta parcial en 2/45 casos (4%) y completa en 30/45 (66.6). En estadio quirúrgico avanzado (estadios III y IV FIGO 2014) la neoplasia progresó en 12/36 pacientes (33.3%), hubo respuesta parcial en 2/36 (5.6%) y completa en 22/36 (61%). Los efectos adversos al tratamiento de quimioterapia fueron (n = 45/45, 100%), alopecia (n = 45/45, 100%), náuseas y vómito (n = 30/45, 67%), artralgias (n = 10/45, 22%), neuropatías periféricas reportada como parestesias en manos y pies (n = 6/45, 13%) y un caso (2%) de toxicidad hematológica grado I (neutropenia leve). Conclusiones: 66,6% de las pacientes con cáncer epitelial de ovario manejadas con citorreducción óptima y quimioterapia adyuvante tuvieron respuesta completa a la quimioterapia, con mejor tolerancia a los efectos adversos de la quimioterapia (carboplatino-paclitaxel).

Objective: to describe the efficacy of adjuvant chemotherapy in patients with advanced epithelial ovarian cancer in Hospital de San José, Bogotá, Colombia, between 2016 and 2020. Materials and methods: a descriptive historical cohort study in patients with epithelial ovarian cancer managed with complete surgical cytoreduction followed by 6 carboplatin-paclitaxel chemotherapy cycles. The follow-up time was approximately 1 year. Results: out of the 45 studied patients managed with optimal cytoreduction followed by adjuvant chemotherapy, cancer progression was observed in 13/45 (29%) cases, 2/45 (4%) showed partial response and 30/45 (66.6%) showed complete response. Chemotherapy-related adverse effects occurred in (n = 45/45, 100%), including alopecia (n = 45/45, 100%), nausea and vomiting (n = 30/45, 67%), arthralgia (n = 10/45, 22%), peripheral neuropathy reported as hands and feet paresthesia (n = 6/45, 13%) and one case (2%) had grade I hematologic toxicity (mild neutropenia). Conclusions: 66.6% of patients with epithelial ovarian cancer treated with optimal cytoreduction and adjuvant chemotherapy exhibited complete response to chemotherapy with better tolerance to chemotherapy (carboplatin-paclitaxel) related adverse effects.

Sindrome poliglandular autoinmune tipo iii-c asociado con vitiligo; reporte de caso en honduras / Polyglandular autoimmune syndrome type iii-c associated with vitiligo; case report in Honduras

Los síndromes poliglandulares autoinmunes son una serie de anomalías funcionales que causan desregulación inmunitaria y afectan a múltiples glándulas endocrinas del organismo. Las patologías crónicas en un paciente adulto no siempre son independientes una de otra, sino más bien, múltiples presentaciones clínicas con un origen en común. Presentamos el caso de una paciente femenina de tercera edad, con antecedentes de vitÍligo, alopecia, hipertensión arterial y diabetes mellitus tipo 2, acude a consulta por presentar astenia, adinamia y somnolencia de aproximadamente 10 meses de evolución, al examen físico biotipo pícnico, mixedema, piel seca más bocio, laboratorio reporta TSH (12 UI/ml), T4 libre (0.2 ng/dl), Anti TPO 168.70 UI/ml, USG que determina bocio tiroideo y patrón micro nodular, se hace el diagnóstico de tiroiditis de Hashimoto. Es así que el análisis de los antecedentes patológicos junto al padecimiento actual, nos permitieron diagnosticar un síndrome poli glandular autoinmune tipo III-C.

Polyglandular autoimmune syndromes (PAS) are a series of functional anomalies that can cause immunitary deregulation affecting multiple endocrine glands. Chronic pathologies in adult patients are not always independent from one another, but rather, are unique defects with multiple clinical presentations.We report an elderly female patient with a history of vitiligo, alopecia, hypertension and type 2 diabetes mellitus who came into a consultation for asthenia, adynamia and drowsiness for approximately 10 months. The physical exam showed a pyknic biotype, myxedema, dry skin and goiter.Test results show TSH (12 lU/ml), free T4 (0. 2 ng/dl), Anti TPO 168.70 lU/ml, USG reported thyroid goiter and a micro nodular pattern where the diagnosis of Hashimoto's thyroiditis is made. This study demonstrated that, through understanding the pathological history alongside the current disease, we can diagnose a polyglandular autoimmune syndrome type III-C.

Harlequin color change in a newborn who was positive for COVID-19: report of a case

Harlequin color change is a benign, idiopathic, self-limiting disorder characterized by the appearance of skin divided into two distinctly colored areas. Its etiology is unknown but thought to be caused by immaturity of hypothalamic regulation of peripheral vascular tone. COVID-19 infection in neonates is infrequent and rarely symptomatic, with only a few cases described in the literature. In isolation, both conditions have a low incidence. It is the first case reported in the world literature of harlequin color change in a newborn who tested positive for COVID-19. There isn't a single publication that links harlequin color change to COVID-19.

El cambio de color arlequín es un trastorno benigno, idiopático y autolimitado que se caracteriza por una apariencia de la piel dividida en dos zonas de color distinto. Su etiología es desconocida, pero se cree que está causada por una inmadurez hipotalámica del tono vascular periférico. La infección por COVID-19 en neonatos es infrecuente y raramente sintomática, con sólo unos pocos casos descritos en la literatura. De forma aislada, ambas afecciones tienen una baja incidencia. Este es el primer caso descrito en la literatura mundial de cambio de coloración arlequín en un recién nacido que dio positivo a COVID-19. Aun no existe ninguna publicación que relacione el cambio de color arlequín con COVID-19.

[A treatment-adherence study based on diabetic patients' behaviour in Cartagena, Colombia]. / Adherencia al tratamiento basado en comportamientos en pacientes diabéticos Cartagena de Indias, Colombia.

OBJECTIVE: Ascertaining levels of self-reported adherence and metabolic control (from a bio-psychosocial perspective) aimed at putting forward culturally-sensitive strategies leading to better results being achieved by diabetes programmes. METHODS: A descriptive study was conducted, involving 131 diabetic patients who were affiliated to one of the largest health insuring entities in the city of Cartagena, Colombia. Interviews were held for ascertaining the levels of self-reported adherence; glucosylated haemoglobin A1c was measured to evaluate metabolic control. RESULTS: The average adherence score obtained on a scale from 0 to 7 was of 4.6 (3.8-5.4 95 %CI). The highest scores were 6.6 for non-tobacco use (5.5-7.8 95 %CI) and 6.2 for medication (5.9-6.6 95 %CI). The lowest ones were 0.4 for self-monitoring (0.4-0.5 95 %CI), 3.4 for physical exercise (2.8-4.0 95 %CI) and 4.4 for consuming vegetables (3.7-5.2 95 %CI). The desired metabolic control was achieved in 58 % of patients; however, these results were not consistent with self-reported adherence. CONCLUSIONS: The authors recommend independently evaluating adherence for each pattern to strengthen non-pharmacological treatment as part of diabetes' programmes and to implement relevant action for achieving greater accessibility to such programmes.

Niñez afectada con VIH/SIDA: Uso y acceso a Servicios de Salud en cinco ciudades colombianas / Children Affected with HIV/AIDS: Use and access to Health Services in five colombian cities

Objetivos: Describir patrones de uso y barreras de acceso a servicios de salud en población infantil afectada con VIH/SIDA residente en Cali, Buenaventura, Barranquilla, Santa Marta y Cartagena. Materiales y métodos: 286 encuestas personales realizadas a 11 menores que conocían su diagnóstico para VIH y 275 a cuidadores de menores que no conocían su situación de afectación para VIH. Empleándose instrumento diseñado por los autores, se realizó análisis descriptivo de datos y tabulación en SPSS, versión 15, en español. Resultados: [96,2 % (n=275)] de los cuidadores retrasan la entrega del diagnóstico por temor al estigma en caso de que el menor revele involuntariamente su diagnóstico a otras personas, y para protegerlo del posible daño psicológico que genere la noticia. Se encontró patrón de utilización frecuente del servicio de salud con tiempo de espera superior a 30 minutos [53,8 % (n=154)]. La mayoría de los menores no reciben atención domiciliaria [85,7% (n=245)]. Los cuidadores expresan que reciben atención en salud respetuosa y amable [70,6% (n=259)]; no obstante, en los testimonios de grupos focales en Buenaventura se manifiesta una- ausencia de garantía de un servicio respetuoso y que brinde la confidencialidad necesaria respecto al diagnóstico de seropositividad para VIH/SIDA. Discusión: Los servicios de salud deben superar algunos obstáculos para asegurar no solo el acceso a la atención, sino también incrementar la disponibilidad, equidad, integralidad y calidad desde la perspectiva de derechos y con objeto de beneficiar a las personas seropositivas para VIH/SIDA.

Objective: To describe patterns of use and barriers to access to health services for children affected with HIV/AIDS living in Cali, Buenaventura, Barranquilla, Santa Marta and Cartagena. Materials and methods: 286 personal surveys conducted with 11 children who knew their HIV diagnosis and, 275 caregivers of children who did not know their HIV status of involvement. Using an instrument designed by the authors, a descriptive analysis and tabulation was performed of data and tabulation in SPSS, version 15, in Spanish. Results: [96.2% (n=275)] of the caregivers reported the delivery delay of diagnosis for fear of stigma if the child discloses the diagnosis inadvertently to other people and, to protect it from possible psychological damage that generates the news. A Pattern was found of frequent use of health service whose waiting time exceeds 30 minutes [53.8% (n=154)]. Most children do not receive home care [85.7% (n=245)]. Caregivers reported receiving health care respectfully and friendly [70.6% (n=259)], however, in the testimonies of focus groups in Buenaventura shows the lack of guarantee of a respectful and, to provide the necessary confidentiality regarding the diagnosis of HIV/AIDS. Discussion: Health services must overcome some obstacles to ensuring not only access to care, but also to increase the availability, fairness, integrity and quality from the perspective of rights and in order to benefit people living with HIV/AIDS for HIV / AIDS.

Estimating the length of incomplete long bones: forensic standards from Guatemala.

We report on new standards for estimating long bone length from incomplete bones for use in forensic and archaeological contexts in Central America. The measurements we use closely follow those defined by Steele ([1970] Personal Identification in Mass Disasters; Washington, DC: Smithsonian Institution), but we add several new landmarks. We measured the femur, humerus, tibia, and fibula of 100 Maya skeletons (68 males, 32 females) recovered from forensic exhumations. We derived the equations by regressing bone segment length on bone length, and solved for bone length to maximize the utility of the equations for taller populations. We generated equations for all segments that were significantly correlated with bone length for males, for females, and for both sexes combined, but accepted only regressions with r(2) > 0.85 as reliable. Landmarks defined by muscle attachment sites were more variable in location than landmarks on articular architecture; thus we retained few equations that use these landmarks. We tested the male and combined sex equations on 36 males of unknown ethnicity exhumed from a military base in Guatemala, and found that the equations performed satisfactorily. We also evaluated the performance of equations by Steele ([1970] Personal Identification in Mass Disasters; Washington, DC: Smithsonian Institution) and Jacobs ([1992] Am J Phys Anthropol 89:333-345) on the Maya bones, and conclude that significant population variation in long bone proportions hinders their application in Central America.

Niñez afectada con VIH/SIDA: calidad de vida, funcionalidad familiar y apoyo social en cinco ciudades colombianas / Children affected with HIV/AIDS: quality of life, family function and social support in five Colombian cities

Objetivo: Describir calidad de vida, funcionalidad familiar y apoyo social en menores de 18 años afectados con VIH/sida y cuidadores residentes en Cali, Buenaventura, Barranquilla, Santa Marta y Cartagena. Materiales y métodos: 286 encuestas personales realizadas a 11 menores que conocían su diagnóstico de seropositivos para VIH y 275, a cuidadores de menores que aún no conocían situación de afectación para VIH; se aplicaron en instituciones de salud tanto del sector estatal como del privado, empleándose los instrumentos EuroQol (EQ-5D), APGAR familiar y apoyo social MOS. Se realizó análisis descriptivo de los datos y tabulación en SPSS, versión 15, en español. Resultados: Las razones para retrasar la entrega del diagnóstico que reportaron profesionales de salud y cuidadores de los menores afectados [96.2% (n=275)] se relacionan con evitar daño psicológico o estrés emocional al menor; temor a causar situaciones de estigmatización ante la revelación involuntaria a otros, y falta de capacitación respecto al procedimiento y edad para entregar esta información. Las dimensiones de calidad de vida indicaron que los menores presentan dolor/malestar y angustia/depresión entre modera- do/severo [15.4% (n=44); 9.8% (n=28)], respectivamente. Se encontró normofuncionalidad familiar [73.8% (n=211)] y percepción de apoyo social máximo [74.1% (n=212)] en los participantes. Conclusiones: La baja tasa de divulgación del estado serológico para VIH/sida en población infantil encontrada en el estudio, indica que dentro del manejo integral en salud es prioritario desarrollar un modelo clínico de divulgación que favorezca procesos de apoyo a familias afectadas...

Objective: To describe quality of life, family functioning and social support for children under 18 years affected with HIV/AIDS and caregivers living in Cali, Buenaventura, Barranquilla, Santa Marta and Cartagena.Materials and methods: 286 personal surveys conducted in 11 children who knew their diagnosis of HIV seropositivity and, 275 to caregivers of children who did not know their HIV status of involvement in health institutions belonging to the State and private sectors. Instruments were used EuroQol (EQ-5D), Family APGAR and MOS Social Support. We performed descriptive analysis of data and tabulation in SPSS Version 15 in Spanish. Results: The reasons for delaying the delivery of diagnosis, reported by health professionals and caregivers of affected children [96.2% (n=275)] are related to avoid psychological or emotional harm to a child, fear of inadvertent disclosure to others leading to situations of stigma and lack of training regarding the procedure and age to deliver this information. The dimensions of quality of life indicated that children have pain/discomfort and anxiety/ depression, moderate/severe [15.4% (n=44), 9.8% (n=28)] respectively. Normal family function was found [73.8% (n=211)] and perception of social support maximum [74.1% (n=212)] in participants. Conclusions: The low rate of disclosure of HIV status to HIV/AIDS on children found in the study, indicating that it is a priority to develop an outreach clinical model in the health management process that encourages support for affected families...

Control glucémico y metabólico integral: dos metas complementarias para el paciente diabético / Glucemic and metabolic integral control: two additional goals for the diabetic patient

Frecuentemente, cuando se menciona control de diabetes se piensa en el sostenimiento de cifras glucémicas cercanas a la normalidad, y se descuidan otras variables de riesgo cardiovascular. Objetivo: Evaluar el control glucémico mediante Hemoglobina glucosilada A1c (HbA1c) y determinar la presencia de hipertensión arterial, perfil lipídico alterado y obesidad, para conocer cómo se relacionan y sus limitaciones evaluativas cuando se asumen individualmente para definir el grado de control metabólico integral alcanzado. Materiales y métodos: Se realizó un estudio poblacional transversal en 131 pacientes diabéticos, mayores de 30 años, usuarios de una Entidad Promotora de Salud, en Cartagena de Indias (Colombia), durante el año 2006, en los cuales, previa solicitud de consentimiento informado, se tomaron medidas antropométricas, de presión arterial y muestras de sangre para análisis bioquímicos. Resultados: El 58% de los pacientes mostró control glucémico adecuado y 18% inadecuado. Los niveles séricos promedio fueron: glucosa, 150 mg/dL; LDL-Colesterol, 133 mg/dL y trigliceridos, 151 mg/dL. Los factores de riesgo cardiovascular con mayor presencia fueron obesidad, LDL-Colesterol e hipertensión arterial (78%, 73% y 47%) y están presentes también en pacientes con niveles de hemoglobina glucosiladas normales. Conclusión: Es insuficiente la medida aislada de HbA1c como evaluadora del estado metabólico integral del paciente diabético. Es necesario fortalecer las estrategias para reducir el riesgo cardiovascular en esta población...

Often, when you mention diabetes control people think about keeping glycemics levels close to normal, neglecting other variables of cardiovascular risks. Objectives: It was to assess glycemic control as measured by hemoglobin glycosylated A1c and to determinate the presence of hypertension, obesity and altered lipid profile, to learn how they interrelate, and observed its evaluative limitations when taken apart in defining the extent of integral metabolic control achieved. Materials and methods: There were carried out a populational cross-sectional study in 131 diabetic patients older than 30 years, users of an Healthcare Program, in Cartagena de Indias, Colombia, during the year 2006, in which, previous informed assent, anthropometrics measurements were taken in body, arterial pressure and a sample of blood for biochemical analysis. Results: The 58% of the patients showed adequate glycemic control and 18% inappropriate. The average serum levels were: glucose, 150 mg/dL; LDL-cholesterol, 133 mg/dL and triglycerides, 151 mg/dL. The cardiovascular risk factors with greater presence were obesity, LDL-cholesterol and hypertension (78%, 73% and 47%) and they are also present in patients with normal glycated hemoglobin levels. Conclusions: The study concludes that the measure of HbA1c alone is inadequate as an evaluator of the comprehensive metabolic state of a patient who is diabetic, and that there is a necessity to strengthen strategies to reduce cardiovascular risks in this population...

Adherencia al tratamiento basado en comportamientos en pacientes diabéticos Cartagena de Indias, Colombia / A treatment-adherence study based on diabetic patients' behaviour in Cartagena, Colombia

Objetivo Conocer los niveles de adherencia auto-reportada y control metabólico, interpretados desde un enfoque biopsicosocial, con el fin de proponer estrategias culturalmente adaptadas que permitan el logro de mejores resultados en los programas impartidos. Métodos se realizó un estudio descriptivo que incluyó 131 pacientes diabéticos usuarios de una empresa promotora de salud (EPS) de la ciudad de Cartagena de Indias, Colombia. Se aplicaron entrevistas para conocer los niveles de adherencia auto-reportada y se midió hemoglobina glucosilada A1C para evaluar control metabólico. Resultados En una escala de 0 a 7, el puntaje promedio de adherencia obtenido fue de 4,6 (IC 95 por ciento 3,8-5,4). Los mayores puntajes fueron 6,6 para no tabaquismo (IC 95 por ciento 5,5-7,8) y 6,2 para medicación (IC 95 por ciento 5,9-6,6). Los menores fueron 0,4 para automonitoreo (IC 95 por ciento 0,4-0,5); 3,4 para ejercicio físico (IC 95 por ciento 2,8-4,0) y 4,4 para consumo de vegetales (IC 95 por ciento 3,7-5,2). El control metabólico deseable se logró en el 58 por ciento de los pacientes, pero no guardó relación con la adherencia auto-reportada (p>0,05). Conclusiones Se recomienda evaluar la adherencia de manera independiente para cada comportamiento, fortalecer los pilares no farmacológicos del tratamiento en los programas dirigidos a pacientes diabéticos e implementar las acciones pertinentes para lograr mayores niveles de accesibilidad a éstos.

Objective Ascertaining levels of self-reported adherence and metabolic control (from a bio-psychosocial perspective) aimed at putting forward culturally-sensitive strategies leading to better results being achieved by diabetes programmes. Methods A descriptive study was conducted, involving 131 diabetic patients who were affiliated to one of the largest health insuring entities in the city of Cartagena, Colombia. Interviews were held for ascertaining the levels of self-reported adherence; glucosylated haemoglobin A1c was measured to evaluate metabolic control. Results The average adherence score obtained on a scale from 0 to 7 was of 4,6 (3,8-5,4 95 percentCI). The highest scores were 6.6 for non-tobacco use (5,5-7,8 95 percentCI) and 6,.2 for medication (5,9-6,6 95 percentCI). The lowest ones were 0.4 for self-monitoring (0,4-0,5 95 percentCI), 3,4 for physical exercise (2,8-4,0 95 percentCI) and 4,4 for consuming vegetables (3,7-5,2 95 percentCI). The desired metabolic control was achieved in 58 percent of patients; however, these results were not consistent with self-reported adherence. Conclusions The authors recommend independently evaluating adherence for each pattern to strengthen non-pharmacological treatment as part of diabetes' programmes and to implement relevant action for achieving greater accessibility to such programmes.

Manejo de las pacientes con endometriosis a través de cirugía láser CO2 en el centro de fertilidad y esterilidad

Se estudiaron 191 pacientes que consultaron en un período de dos años por dolor pélvico, dismenorrea y /o infertilidad. Se clasificó el estadio de endometriosis y se les dio tratamiento con rayo láser de CO2 por vía translaparoscópica. Se evalúan los resultados del tratamiento de acuerdo a la desaparición de los síntomas o la consecuación de un embarazo