Communication preferences and perceptions of cancer patient during their first medical oncology appointment.

BACKGROUND: The first medical oncology appointment serves as a platform for patients to comprehend their diagnosis and prognostic implications of cancer. This study aimed to determine patients' communication preferences during their first medical oncology appointment and to assess the disparities between patients' preferences and perceptions. METHODS: A total of 169 cancer patients participated by completing the Communication in First Medical Oncology Appointment Questionnaire (C-FAQ), a two-section questionnaire designed to assess patients' preferences and perceptions regarding Content (information provided and its extent), Facilitation (timing and location of information delivery), and Support (emotional support) during their first medical oncology appointment. A comparative analysis was conducted to assess the variations between preferences and perceptions. RESULTS: Content emerged as the most significant dimension compared to Facilitation and Support. The physician's knowledge, honesty, and ability to provide clear information were considered the most important attributes. Patients evaluated most of their preferences as "very important". Patients' perception of the communication dimensions present during their appointment was below preferences for 11 items, indicating significant discrepancies in clinical practice. CONCLUSIONS: Patients highly valued their preferences concerning Content, Facilitation, and Support dimensions of communication. However, patient preferences were more prominently oriented towards the Content dimension. The discrepancies between preferences and perceptions should be viewed as an opportunity for enhancing communication skills through training.

Socio-Environmental Risks Linked with Mine Tailings Chemical Composition: Promoting Responsible and Safe Mine Tailings Management Considering Copper and Gold Mining Experiences from Chile and Peru.

There is a need to define mine tailings in a clear, precise, multidisciplinary, transdisciplinary, and holistic manner, considering not only geotechnical and hydraulic concepts but also integrating environmental and geochemical aspects with implications for the sustainability of mining. This article corresponds to an independent study that answers questions concerning the definition of mine tailings and the socio-environmental risks linked with mine tailings chemical composition by examining the practical experience of industrial-scale copper and gold mining projects in Chile and Peru. Definitions of concepts and analysis of key aspects in the responsible management of mine tailings, such as characterization of metallic-metalloid components, non-metallic components, metallurgical reagents, and risk identification, among others, are presented. Implications of potential environmental impacts from the generation of acid rock drainage (ARD) in mine tailings are discussed. Finally, the article concludes that mine tailings are potentially toxic to both communities and the environment, and cannot be considered as inert and innocuous materials; thus, mine tailings require safe, controlled, and responsible management with the application of the most high management standards, use of the best available technologies (BATs), use of best applicable practices (BAPs), and implementation of the best environmental practices (BEPs) to avoid risk and potential socio-environmental impact due to accidents or failure of tailings storage facilities (TSFs).

Human Health Risk Assessment for Exposure to Heavy Metals via Dietary Intake of Rainbow Trout in the Influence Area of a Smelting Facility Located in Peru.

Abandoned mining-metallurgical sites can significantly impact the environment and human health by accumulating heavy metals in aquatic ecosystems. The water in the sub-basin near an abandoned smelting facility in the city of La Oroya, Peru, is primarily used for pisciculture. The objective of this study was to assess the risk to human health from exposure to heavy metals via dietary intake of rainbow trout (Oncorhynchus mykiss) in the influence area of a smelting facility located in the central Andean region of Peru. The bioconcentration factor, biosediment accumulation factor, and consumption risks were evaluated using the Monte Carlo method. The results showed that the concentrations of elements (Zn > Pb > Cu > As) in rainbow trout muscle did not exceed the maximum limit (ML). However, the water significantly exceeded the ML for Pb in all sectors and As in the lower and middle parts of the river. The concentration of Pb in sediments also significantly exceeded the ML in the upper and lower parts of the river. Consequently, rainbow trout consumption in the study area presents risks to human health due to the bioaccumulation of heavy metals, with a 1.27% carcinogenic risk in samples from the lower part of the river.

Microbial and potentially toxic elements risk assessment in high Andean river water based on Monte Carlo simulation, Peru.

The study evaluated microbial and Potentially Toxic Elements-PTEs risks in high Andean river water in Peru using Monte Carlo simulation. A total of 144 water samples were collected from four rivers and evaluated for physicochemical parameters, PTEs and bacterial pathogens. The microbial risk analysis for exposure to pathogens present in the water was based on the probability of occurrence of diseases associated with Escherichia coli, Pseudomonas aeruginosa and enterococci. PTEs risk analysis was performed using a Monte Carlo simulation approach. The results showed that the highest microbial risk due to exposure to water contaminated by E. coli, P. aeruginosa and enterococci was recorded in the Miraflores and Chia rivers. Meanwhile, the analysis of carcinogenic and non-carcinogenic risk by PTEs in adults and children revealed that the Chia river presents a high risk of contamination by PTEs, especially the carcinogenic risk for children. The Monte Carlo simulation indicated a 56.16% and 94.85% probability of exceeding the limit value of 0.0001 for carcinogenic risk in adults and children, respectively. It can be concluded that children consuming the waters of the Chia river are potentially at risk of As toxicity.

Diversity of enterobacterales in sediments of lagoons with fish farming activity and analysis of antibiotic resistance.

The use of antibiotics in fish production can induce bacterial populations to develop resistance to multiple antibiotics and transfer antibiotic resistance genes to other bacteria, including clinically relevant bacteria. This study evaluated the diversity of Enterobacterales in sediment from lagoons with fish farming activity and analyzed antibiotic resistance in the central region of Peru. Sediment samples were collected from four fish-active ponds and transported to the laboratory for analysis. Bacterial diversity was analyzed using DNA sequencing and antibiotic resistance was tested using the disk diffusion method. The results showed variability of bacterial diversity in the ponds with fish farming activity. Simpson's index indicated that the Habascocha lagoon is the most diverse in bacterial species of the order Enterobacterales (0.8), but the least dominant. The Shannon-Wiener index revealed that it is the most diverse (2.93) and the Margalef index revealed that species richness in this lagoon is high (5.72). Similarity percentage analysis (SIMPER) allowed the identification of the main Enterobacterales with the highest percentage contribution in the frequencies of individuals. In general, the Enterobacterales species isolated showed multi-resistance to the antibiotics used and Escherichia coli was the most resistant.

Assessment of toxic metal contamination, distribution and risk in the sediments from lagoons used for fish farming in the central region of Peru.

Toxic metal contamination, distribution and risk were evaluated in the sediments of three lagoons used for fish farming in the central region of Peru. The distribution of toxic metals in the sediment was in the following descending order of Zn > V > Ni > Cu > Pb > As > Cr > Co > Cd > Sb. Contamination factor (Cf) and geoaccumulation index (Igeo) values for Co, Cr, Cu, Ni, Pb, Sb, V and Zn indicated low contamination and for Cd moderate contamination. The pollution load index (PLI) ranged from 0.3856 to 0.5622; indicating no appreciable contamination and the modified degree of contamination (mCd) corroborated this result. The potential ecological risk (Ri) in the Tranca Grande and Pomacocha lagoons revealed a low potential ecological risk and in Tipicocha a moderate potential ecological risk. HI values < 1 indicated that non-carcinogenic adverse effects were negligible. In adults, the Total carcinogenic risk (TCR) values for As, Cd, Cr, Ni and Pb were less than 1.00E-04, indicating no significant carcinogenic risk. In children, TCR values showed similar behavior with the exception of As. Therefore, considering that fish production for domestic consumption and export is carried out in these lagoons, it is important to continue monitoring toxic metals to protect the health of these ecosystems and human health.

Microbial diversity in intensively farmed lake sediment contaminated by heavy metals and identification of microbial taxa bioindicators of environmental quality.

The cumulative effects of anthropogenic stress on freshwater ecosystems are becoming increasingly evident and worrisome. In lake sediments contaminated by heavy metals, the composition and structure of microbial communities can change and affect nutrient transformation and biogeochemical cycling of sediments. In this study, bacterial and archaeal communities of lake sediments under fish pressure contaminated with heavy metals were investigated by the Illumina MiSeq platform. Despite the similar content of most of the heavy metals in the lagoon sediments, we found that their microbial communities were different in diversity and composition. This difference would be determined by the resilience or tolerance of the microbial communities to the heavy metal enrichment gradient. Thirty-two different phyla and 66 different microbial classes were identified in sediment from the three lagoons studied. The highest percentages of contribution in the differentiation of microbial communities were presented by the classes Alphaproteobacteria (19.08%), Cyanophyceae (14.96%), Betaproteobacteria (9.01%) y Actinobacteria (7.55%). The bacteria that predominated in sediments with high levels of Cd and As were Deltaproteobacteria, Actinobacteria, Coriobacteriia, Nitrososphaeria and Acidobacteria (Pomacocha), Alphaproteobacteria, Chitinophagia, Nitrospira and Clostridia (Tipicocha) and Betaproteobacteria (Tranca Grande). Finally, the results allow us to expand the current knowledge of microbial diversity in lake sediments contaminated with heavy metals and to identify bioindicators taxa of environmental quality that can be used in the monitoring and control of heavy metal contamination.

Human risk associated with the ingestion of artichokes grown in soils irrigated with water contaminated by potentially toxic elements, Junin, Peru.

The contamination of water, air and soil with potentially toxic elements (PTE) compromises the supply of contaminant free food. Vegetables grown in contaminated soils can absorb and accumulate PTE at concentrations that are toxic to human health. In this context, the human risk associated with the intake of artichokes grown in soils irrigated with PTE contaminated water was assessed. 120 samples of surface soil and artichoke heads were collected and the concentrations of Cu, Fe, Pb, Zn and As were determined. The results showed that the concentrations of Cu, Fe and Zn in soil did not exceed the standards of the Ministry of Environment of Peru, but they did exceed those of Pb (125.45 mg kg-1) and As (28.70 mg kg-1). The decreasing order of mean PTE concentration in artichoke heads was Fe > Zn > Cu > Pb > As, exceeding the permissible levels of FAO/WHO CODEX Alimentarius. However, the concentrations of As comply with the maximum limits of inorganic contaminants in vegetables (0.3 mg kg-1) established in the MERCOSUR regulations. The non-carcinogenic and carcinogenic risk of Pb and As indicated that the ingestion of artichoke heads does not represent a health risk.

Stem cells in end-to-side neurorrhaphy. Experimental study in rats.

PURPOSE: To evaluate the influence of mesenchymal stem cells from adipose tissue in the end-to-side neurorrhaphy, focusing in the nerve regeneration and the muscle reinnervation in acute trauma. METHODS: 140 animals were randomly divided in seven groups: control, denervated, end-to-side neurorrhaphy between distal stump of common peroneal nerve and tibial nerve (ESN), ESN wrapped in fascia, ESN wrapped in fascia and platelet gel, ESN wrapped in platelet gel, ESN wrapped in fascia and platelet gel within stem cells (without culture) removed from the adipose tissue. Mass measurements of the animal and of cranial tibial muscles, electromyography, walking track analysis tests and histological examinations of the nerves and muscles after 180 days was performed. RESULTS: In the groups where the ESN was performed, the results were always better when compared to the denervated group, showing reinnervation in all ESN groups. The most sensitive methods were walking track and histological analysis. Only the group with stem cells showed values similar to the control group, as well as the functional indices of peroneal nerve and the number of nerve fibers in the peroneal nerve. CONCLUSIONS: Stem cells were effective in ESN according with the functional index of the peroneal nerve, evaluated by walking track analysis and the number of nerve fibers in the peroneal nerve.

Toxicological assessment of coated versus uncoated rubber granulates obtained from used tires for use in sport facilities.

Reuse of tire crumb in sport facilities is currently a very cost-effective waste management measure. Considering that incorporation of the waste materials in artificial turf would be facilitated if the rubber materials were already colored green, coatings were specifically developed for this purpose. This paper presents an experimental toxicological and environmental assessment aimed at comparing the obtained emissions to the environment in terms of polycyclic aromatic hydrocarbons (PAHs), heavy metals, and ecotoxicity for coated and noncoated rubber granulates. This study is a comprehensive evaluation of the major potential critical factors related with the release of all of these classes of pollutants because previous studies were not systematically performed. It was concluded that between the two types of coatings tested, one is particularly effective in reducing emissions to the environment, simultaneously meeting the requirements of adherence and color stability.

[Bacterial colonization after applying an educational program: A quasi-experimental study]. / Colonización bacteriana después de la aplicación de un programa educativo: estudio cuasi experimental.

INTRODUCTION: Educational interventions can raise awareness and understanding in population groups and may help to achieve changes in behavior. OBJECTIVE: To determine if the educational handwashing program applied to high-school students reduces the colonization of infectious bacteria on the hands. METHODS: A non-randomized quasi-experimental study was carried out using consecutive sampling of the students of the last year of high-school who were divided into an intervention group and a control group. Data were obtained before and after the implementation of the educational program. Samples were taken from the dominant hand for bacterial culture, and a questionnaire was applied that assessed knowledge of hand hygiene before and after the program. The program was aimed at improving the level of understanding and attitudes of students regarding hand hygiene. RESULTS: Of 208 samples obtained, the most frequent agents before and after the educational program were Staphylococcus epidermidis (39% versus 23%) and Staphylococcus aureus (21% versus 15%). The average number of colonies was 236 and 183 respectively (p = 0.35). CONCLUSION: The educational program managed to improve the level of understanding about hand hygiene; however, it was not enough to reduce bacterial colonization, so other behaviors such as direct supervision should be considered.

INTRODUCCIÓN: La intervención en poblaciones por medio de programas educativos logra aumentar el conocimiento en un determinado grupo y además, en algunos casos, se logra un cambio de conducta. OBJETIVO: Determinar si el programa educativo de lavado de manos aplicado a los estudiantes de educación secundaria reduce la colonización de bacterias infecciosas en las manos. METODOLOGÍA: Se realizó un estudio cuasi experimental no aleatorizado mediante muestreo consecutivo a los alumnos del último año de secundaria, quienes fueron divididos en dos grupos de intervención y control, analizados en dos etapas antes y después de la aplicación del programa educativo. Se tomaron las muestras de la mano dominante para el cultivo bacteriano. Además, se aplicó un cuestionario que evaluó los conocimientos sobre higiene de manos antes y después de la aplicación del programa, que estuvo dirigido a mejorar el nivel de conocimiento y de las actitudes de los estudiantes en relación a la higiene de manos. RESULTADOS: De 208 muestras obtenidas los agentes más frecuentes antes y después de la aplicación del programa educativo fueron Staphylococcus epidermidis (39% versus 23%) y Staphylococcus aureus (21%versus15%); el promedio del número de colonias fue 236 y 183 respectivamente (p = 0,35). CONCLUSIÓN: La aplicación del programa educativo logró mejorar el nivel de conocimiento sobre la higiene de manos. Sin embargo, no fue suficiente para reducir la colonización bacteriana, por lo que debería agregarse otras conductas como la supervisión directa.

Metagenomic data on the composition of bacterial communities in lake environment sediments for fish farming by next generation Illumina sequencing.

This article contains data on the bacterial communities of lagoon sediments with fish potential in the Central Andes of Peru. The surface sediment samples were collected from four lagoons destined for continental water fish farming. DNA extraction was performed from 0.5 g of sample through the Presto™ Soil DNA Extraction Kit. Bacterial sequencing of the 16S rRNA amplicon was performed on the DNA extracted from the sediment. At least 36 Phyla bacteria were detected, the bacterial communities being dominated by Proteobacteria, Cyanobacteria, Actinobacteria, Firmicutes, Chloroflexi. These data can be used for predictive analysis to gain a better understanding of the dynamics of bacterial communities in environments under pressure from fish farming.

Data on the concentration of heavy metals and metalloids in lotic water of the Mantaro river watershed and human risk assessment, Peru.

This article contains data on the concentration of heavy metals and metalloids in the water of seven rivers in the Mantaro river watershed in the central Andes of Peru, collected during the autumn of 2019. The concentrations of Cu, Fe, Pb, Zn and As were determined by flame atomic absorption spectrophotometry to assess human risk. The concentration of heavy metals and arsenic varied according to the sector of the rivers evaluated. The cluster analysis identified four different groups among the observation sectors. The risk assessment for humans was conducted on the basis of exposure doses to heavy metals and arsenic in water by ingestion and dermal pathways, using standard methods established by USEPA. These data can be reused as a basis for estimating the cancer risk or as a comparison group for future risk studies. They can also be useful to public health policy makers when proposing surveillance and control programmes using remedial technologies.

Symptom clusters and survival in Portuguese patients with advanced cancer.

This study aimed to identify clusters of symptoms, to determine the patient characteristics associated with identified, and determine their strength of association with survival in patients with advanced cancer (ACPs). Consecutively eligible ACPs not receiving cancer-specific treatment, and referred to a Tertiary Palliative Care Clinic, were enrolled in a prospective cohort study. At first consultation, patients rated 9 symptoms through the Edmonton Symptom Assessment System (0-10 scale) and 10 others using a Likert scale (1-5). Principal component analysis was used in an exploratory factor analysis to identify. Of 318 ACPs, 301 met eligibility criteria with a median (range) age of 69 (37-94) years. Three SCs were identified: neuro-psycho-metabolic (NPM) (tiredness, lack of appetite, lack of well-being, dyspnea, depression, and anxiety); gastrointestinal (nausea, vomiting, constipation, hiccups, and dry mouth) and sleep impairment (insomnia and sleep disturbance). Exploratory factor analysis accounted for 40% of variance of observed variables in all SCs. Shorter survival was observed for patients with the NPM cluster (58 vs. 23, P < 0.001), as well as for patients with two or more SCs (45 vs. 21, P = 0.005). In a multivariable model for survival at 30-days, age (HR: 0.98; 95% CI: 0.97-0.99; P = 0.008), hospitalization at inclusion (HR: 2.27; 95% CI: 1.47-3.51; P < 0.001), poorer performance status (HR: 1.90, 95% CI: 1.24-2.89; P = 0.003), and NPM (HR: 1.64; 95% CI: 1.17-2.31; P = 0.005), were associated with worse survival. Three clinically meaningful SC in patients with advanced cancer were identifiable. The NPM cluster and the presence of two or more SCs, had prognostic value in relation to survival.

[Pain Intensity and Time to Death of Cancer Patients Referred to Palliative Care]. / Associação da Intensidade de Dor no Tempo Até à Morte dos Doentes Oncológicos Referenciados aos Cuidados Paliativos.

INTRODUCTION: Pain is a common symptom experienced by cancer patients, especially in those with advanced disease. Our aim was to describe pain intensity in advanced cancer patients, referred to the palliative care unit, the factors underlying moderate to severe pain and its prognostic values. MATERIAL AND METHODS: This was a prospective observational study. All patients with mestastatic solid tumors and with no specific oncologic treatment were included. Pain intensity was accessed using the pain scale from Edmonton Symptom Assessment Scale, rated from 0 to 10 on a numerical scale, where zero = no pain and 10 = worst possible pain. RESULTS: Between October 2012 and June 2015, a total of 301 patients participated in the study. The median age was 69 years, (37 - 94); most of the patients were men (57%) and 64.8% had a performance status of 3/4. About 42% reported pain severity ≥ 4 and 74% were medicated with opioids. Multivariate analysis indicated a correlation between performance status and reported pain (OR: 1.7; IC 95%: 1.0 - 2.7; p = 0.045). Median overall survival was 37 days (IC 95%: 28 - 46). Patients reporting moderate to severe pain (pain severity ≥ 4) had a median survival of 29 days (IC 95%: 21 - 37), comparing with those who had no or moderate pain with median survival of 49 days (IC 95%: 35 - 63) (p = 0.022). DISCUSSION: The performance status was associated with more intense pain. The performance status, hospitalization, intra-abdominal metastization and opioid analgesia were associated with shorter time to death in advanced cancer patients referred to palliative care. CONCLUSION: Cancer pain continues to be a major clinical problem in advanced cancer patients.

Introdução: A dor é uma experiência frequente nos doentes com cancro, especialmente naqueles em fase final de vida. Com este estudo, pretendemos estudar a intensidade de dor nos doentes com cancro avançado, referenciados aos cuidados paliativos, analisar os factores associados à ocorrência de dor moderada ou intensa e avaliar a sua relação com o tempo até à morte destes doentes. Material e Métodos: Estudo prospectivo observacional que incluiu consecutivamente todos os doentes referenciados aos cuidados paliativos com tumores sólidos metastizados e sem tratamento oncológico específico. Foi considerada a intensidade de dor da escala de Edmonton, de acordo com a graduação zero a 10, onde 0 = ausência de dor e 10 = máxima dor possível. Resultados: Entre outubro de 2012 e junho de 2015, foram incluídos 301 doentes, com idade mediana de 69 anos (37 - 94), 57% homens e 64,8% dos doentes com performance status 3/4. Aproximadamente 42% dos doentes apresentaram dor ≥ 4 e cerca de 74,4% estavam medicados com analgesia opióide. A intensidade de dor esteve associada ao performance status dos doentes, de acordo com a análise multivariável (OR: 1,7; IC 95%: 1,0 - 2,7; p = 0,045). A mediana do tempo de sobrevivência foi de 37 dias (IC 95%: 28 - 46), tendo os doentes com dor moderada ou intensa (intensidade de dor ≥ 4) uma mediana de sobrevivência de 29 dias (IC 95%: 21 - 37), comparada com os 49 dias (IC 95%: 35 - 63) para os doentes sem dor ou dor ligeira (p = 0,022). Discussão: O performance status, para além de ter estado associado a uma maior intensidade de dor, esteve associado a um menor tempo até à morte dos doentes com cancro avançado referenciados aos cuidados paliativos. Também o internamento, a presença de metastização intra-abdominal e a analgesia opióide estiveram associados de forma negativa ao tempo até à morte destes doentes. Conclusão: A dor oncológica continua a ser um problema clinicamente relevante nos doentes com cancro avançado.

Capuchin mission and tentehar resistance: rereadings of the conflict of alto alegre / Mission capucine et résistance tentehar: relectures du conflit dans la municipalité dalto alegre / Misión capuchina y resistencia a tentehar: relecturas del conflicto de alto alegre / Missão capuchinha e resistência tentehar: releituras do conflito de alto alegre

Abstract The article analyzes the genesis, power relations and social impacts of the indigenous mission of the Capuchin Friars Minor in the Republican Maranhão State, from the perspective of the conflict and the indigenous resistance movement that destroyed the Colônia de Alto Alegre and its boarding school for Indian girls. A theoretical-methodological line was adopted that reconstructs analytically testimonies and archival documentation as they are investigated from the perspective of the indicative paradigm and placed in dialogue with various studies. There is emphasis on sociological, anthropological and historical works. The results show that the conflicting relations between indigenous people and missionaries, contrary to the catechesis and civilization project of the nations of origin, have generated very positive sociopolitical consequences for the Tentehar people.

RÉSUMÉ L'article analyse la genèse de la mission amérindienne des Frères mineurs Capucins dans le Maranhão dans la période républicaine (1889-1930), ainsi que les relations de pouvoir et les impacts sociaux de cette mission sous l'angle du conflit et du mouvement de résistance indigène ayant mis fin à la colonie d'Alto Alegre et à son pensionnat pour filles amérindiennes. La ligne de recherche théorique-méthodologique adoptée vise à reconstituer analytiquement les témoignages et la documentation archivistique dans la perspective du paradigme indiciaire et à les mettre en dialogue avec d'autres travaux, notamment d'ordre sociologique, anthropologique et historique. Les résultats s'inscrivent dans une perspective allant à l'encontre du projet de catéchèse et de civilisation des nations originales selon laquelle les relations conflictuelles entre les autochtones et les missionnaires ont entrainé des conséquences sociopolitiques très positives pour le peuple Tentehar.

Resumen Este trabajo analiza la génesis, las relaciones de poder y los impactos sociales de la misión indígena de los Frailes Menores Capuchinos en el Maranhão republicano, desde la perspectiva del conflicto y del movimiento de resistencia indígena que puso fin a la colonia de Alto Alegre y su internado de niñas indígenas. Se adopta una línea teórica y metodológica que reconstruye analíticamente testimonios y documentación de archivos a medida que se investigan desde la perspectiva del paradigma indiciario y se ponen en diálogo con diversos estudios, especialmente los sociológicos, antropológicos e históricos. Los resultados se inscriben en la comprensión de que las relaciones conflictivas entre indígenas y misioneros, a contramano del proyecto de catequesis y civilización de las naciones originarias, generaron consecuencias sociopolíticas muy positivas para el pueblo.

Resumo O artigo analisa a gênese, as relações de poder e os impactos sociais da missão indígena dos Frades Menores Capuchinhos, no Maranhão republicano, sob a ótica do conflito e do movimento de resistência indígena que pôs fim à Colônia de Alto Alegre e ao seu internato de meninas índias. É adotada uma linha teórico-metodológica que reconstrói analiticamente depoimentos e documentação arquivística à medida que são investigados sob a perspectiva do paradigma indiciário e colocados em diálogo com variados estudos, com ênfase para os trabalhos sociológicos, antropológicos e históricos. Os resultados estão inscritos na compreensão de que as relações conflitivas entre indígenas e missionários, na contramão do projeto de catequese e civilização das nações originárias, geraram consequências sociopolíticas muito positivas para o povo Tentehar.

Colonización bacteriana después de la aplicación de un programa educativo: estudio cuasi experimental / Bacterial colonization after applying an educational program: A quasi-experimental study

INTRODUCCIÓN: La intervención en poblaciones por medio de programas educativos logra aumentar el conocimiento en un determinado grupo y además, en algunos casos, se logra un cambio de conducta. OBJETIVO: Determinar si el programa educativo de lavado de manos aplicado a los estudiantes de educación secundaria reduce la colonización de bacterias infecciosas en las manos. METODOLOGÍA: Se realizó un estudio cuasi experimental no aleatorizado mediante muestreo consecutivo a los alumnos del último año de secundaria, quienes fueron divididos en dos grupos de intervención y control, analizados en dos etapas antes y después de la aplicación del programa educativo. Se tomaron las muestras de la mano dominante para el cultivo bacteriano. Además, se aplicó un cuestionario que evaluó los conocimientos sobre higiene de manos antes y después de la aplicación del programa, que estuvo dirigido a mejorar el nivel de conocimiento y de las actitudes de los estudiantes en relación a la higiene de manos. RESULTADOS: De 208 muestras obtenidas los agentes más frecuentes antes y después de la aplicación del programa educativo fueron Staphylococcus epidermidis (39% versus 23%) y Staphylococcus aureus (21%versus15%); el promedio del número de colonias fue 236 y 183 respectivamente (p = 0,35). CONCLUSIÓN: La aplicación del programa educativo logró mejorar el nivel de conocimiento sobre la higiene de manos. Sin embargo, no fue suficiente para reducir la colonización bacteriana, por lo que debería agregarse otras conductas como la supervisión directa.

INTRODUCTION: Educational interventions can raise awareness and understanding in population groups and may help to achieve changes in behavior. OBJECTIVE: To determine if the educational handwashing program applied to high-school students reduces the colonization of infectious bacteria on the hands. METHODS: A non-randomized quasi-experimental study was carried out using consecutive sampling of the students of the last year of high-school who were divided into an intervention group and a control group. Data were obtained before and after the implementation of the educational program. Samples were taken from the dominant hand for bacterial culture, and a questionnaire was applied that assessed knowledge of hand hygiene before and after the program. The program was aimed at improving the level of understanding and attitudes of students regarding hand hygiene. RESULTS: Of 208 samples obtained, the most frequent agents before and after the educational program were Staphylococcus epidermidis (39% versus 23%) and Staphylococcus aureus (21% versus 15%). The average number of colonies was 236 and 183 respectively (p = 0.35). CONCLUSION: The educational program managed to improve the level of understanding about hand hygiene; however, it was not enough to reduce bacterial colonization, so other behaviors such as direct supervision should be considered.

Breast cancer presents with a paraneoplastic neurologic syndrome.

BACKGROUND: Paraneoplastic neurologic syndromes (PNS) pose quite an uncommon neurological complication, affecting less than 1% of patients with breast cancer. Nearly one third of these patients lack detectable onconeural antibodies (ONAs), and improvement in neurologic deficits with concomitant cancer treatments is achieved in less than 30% of cases. CASE PRESENTATION: A 42-year-old, premenopausal woman presented with facial paralysis on the central left side accompanied by a left tongue deviation, an upward vertical nystagmus, moderate spastic paraparesis, dystonic posturing of the left foot, lower limb hyperreflexia and bilateral extensor plantar reflex. After ruling out all other potential neurologic causes, PNS was suspected but no ONAs were found. A PET-CT scan detected increased metabolism in the right breast, as well as an ipsilateral thoracic interpectoral adenopathy. Core biopsy confirmed the presence of an infiltrating duct carcinoma. After breast surgery, the neurologic symptoms disappeared. One week later, the patient was readmitted to the hospital with a bilateral fatigable eyelid ptosis, and two weeks later, there was a noticeable improvement in eyelid ptosis, accompanied by a rapid and progressive development of lower spastic paraparesis. She started adjuvant treatment with chemotherapy with marked clinical and neurological improvement, and by the end of radiotherapy, there were no signs of neurologic impairment. CONCLUSION: This case study highlights the importance of a high level of vigilance for the detection of PNS, even when ONAs are not detected, as the rapid identification and treatment of the underlying tumor offers the best chance for a full recovery.