Diagnostic, treatment, and follow-up of osteoporosis-position statement of the Latin American Federation of Endocrinology.

The Latin American Federation of Endocrinology position statement on osteoporosis was developed by endocrinologists from 9 countries. It encompasses the definition, diagnosis, treatment, and follow-up of the disease, the identification of barriers to healthcare, and proposals to improve the disease care in the region. INTRODUCTION: There is a gap in the understanding of osteoporosis in Latin America. The objective of this work is to state the position of the Latin American Federation of Endocrinology on osteoporosis care in postmenopausal women to better bridge this gap. METHODS: An experts' panel was formed comprising of 11 endocrinologists from 9 countries. A data search was conducted with a conceptual approach and data selection was based on the hierarchy of the EBHC pyramid. Unpublished data was considered for local epidemiological data and expert opinion for the identification of barriers to healthcare. An expert consensus based on the Delphi methodology was carried out. Experts were asked to respond on a 5-point Likert Scale to two provided answers to guiding questions. RESULTS: Consensus was agreed on the answer for the questions with the higher median on the Likert scale and synthetized on 16 statements covering the definition of osteoporosis, diagnostic approach, treatment options, and follow-up. Besides clinical topics, unmet needs in osteoporosis were identified in relation to local epidemiological data, barriers to treatment, and misclassification of programs within health systems. CONCLUSIONS: Through a process based on recognized methodological tools, FELAEN's position on osteoporosis was developed. This made it possible to state an optimum scenario for the care of the disease and helped to identify knowledge gaps. There is great variability in the approach to osteoporosis in Latin America and barriers in all the stages of healthcare persist.

Welfare of broiler chickens reared in two different industrial house types during the winter season in Southern Brazil.

1. The following trial compared broiler chicken welfare in closed-sided (CS) versus open-sided (OS) industrial house types during the winter season in the South of Brazil.2. Ten flocks in each house type were evaluated as follows: a) bird health: contact dermatitis on the breast and abdominal areas (CDE), bird soiling (BSO), footpad dermatitis (FPD), hock burn (HBU), lameness (LAM), fractures (FRA), bruising (BRU), scratches (SCR), dead on arrival (DOA), and diseases (DIS); b) house environmental measurements: relative humidity (RHU), temperature (TEM), air velocity (AVE), illuminance (ILL), ammonia concentration (NH3), and carbon dioxide concentration (CO2), and c) bird behaviour and affective states: bird behaviour (BBE), touch test (TTE), and qualitative behaviour assessment (QBA).3. Statistical analyses were based on regression models for CDE, BSO, FPD, HBU, LAM and generalised linear models for DOA, FRA, BRU, SCR, and DIS. The Mann-Whitney test was used for RHU, TEM, AVE, ILL, NH3, CO2, and the t-test for TTE and LMO, with a specific regression model for BBE data and Principal Component Analysis for QBA.4. According to odds ratio for worse scores for CS relative to OS, birds were less likely to have severe scores for CDE (P = 0.040 and P = 0.007), BSO (P = 0.031, P = 0.016, and P = 0.038), and HBU (P = 0.017), and had higher median values for AVE (2.3, 0.0-7.8 m s-1 vs. 0.0, 0.0-4.3 m s-1), lower NH3 concentration (9.0, 0.0-64.0 ppm vs. 12.0, 0.0-60.0 ppm) and TTE scores (98, 96-100 vs. 67, 25-100). Worse results were observed in CS houses for higher stocking density (13.8 ± 0.2 birds/m2 vs. 12.0 ± 0.2 birds/m2), RHU (74.5, 50.7-99.9% vs 72.3, 47.4-99.9%), and TEM (23.9, 14.6-29.2°C vs. 21.7, 12.9-30.1°C), lower ILL (16.0, 1.0-60.0 lx vs. 161.0, 8.0-2380.0 lx), less drinking (P = 0.007), more inactive behaviour (P < 0.001) and lower positive emotions, according to QBA (P = 0.028).5. In the studied region and season, CS houses seemed to offer fewer welfare problems in terms of the health indicators; however, OS houses showed fewer behavioural restrictions and higher positive emotional states.

Unravelling the Photocatalytic Behavior of All-Inorganic Mixed Halide Perovskites: The Role of Surface Chemical States.

Within the most mesmerizing materials in the world of optoelectronics, mixed halide perovskites (MHPs) have been distinguished because of the tunability of their optoelectronic properties, balancing both the light-harvesting efficiency and the charge extraction into highly efficient solar devices. This feature has drawn the attention of analogous hot topics as photocatalysis for carrying out more efficiently the degradation of organic compounds. However, the photo-oxidation ability of perovskite depends not only on its excellent light-harvesting properties but also on the surface chemical environment provided during its synthesis. Accordingly, we studied the role of surface chemical states of MHP-based nanocrystals (NCs) synthesized by hot-injection (H-I) and anion-exchange (A-E) approaches on their photocatalytic (PC) activity for the oxidation of ß-naphthol as a model system. We concluded that iodide vacancies are the main surface chemical states that facilitate the formation of superoxide ions, O2●-, which are responsible for the PC activity in A-E-MHP. Conversely, the PC performance of H-I-MHP is related to the appropriate balance between band gap and a highly oxidizing valence band. This work offers new insights on the surface properties of MHP related to their catalytic activity in photochemical applications.

Barreras para la atención en salud del cáncer gástrico, Santander, Colombia. Etapa exploratoria / Barriers to Health Care for Gastric Cancer Patients in Santander, Colombia: Exploratory Stage

Resumen Introducción: el cáncer gástrico es un problema de salud pública; ocupa el quinto y tercer lugar en incidencia y mortalidad mundial, respectivamente. Objetivo: describir las barreras para la atención en salud percibidas por el adulto con cáncer gástrico, su cuidador y el médico tratante en el departamento de Santander, Colombia-etapa exploratoria en el período 2015-2016. Metodología: estudio cualitativo utilizando algunas técnicas del proceso de análisis de la teoría fundamentada a partir de la aplicación de entrevistas semiestructuradas que fueron codificadas y categorizadas con el software N-VIVO 10. Resultados: Emergieron 13 categorías, 182 códigos descritos en 6 ejes: el primero relacionado con el significado del cáncer y sus barreras; el segundo con las principales barreras para la atención en salud, cuyo orden de mayor a menor frecuencia fue: administrativas, económicas, culturales, de conocimiento, de comunicación e institucionales; el tercero es las estrategias para superar las barreras; el cuarto, las estrategias para disminuirlas; el quinto, sentimientos y el rol de la familia; y el sexto, necesidades del paciente. Conclusión: la fragmentación y segmentación del sistema de salud impone barreras que limitan el diagnóstico temprano del cáncer gástrico y su manejo oportuno. Además, amenazan la calidad de vida del adulto enfermo y su familia.

Abstract Introduction: Gastric cancer is a public health problem that ranks fifth in world incidence and third in mortality. Objective: The aim of the exploratory stage of this study was to describe the barriers to health care perceived by adults with gastric cancer, their caregivers, and their attending physicians in the department of Santander, Colombia in 2015 and 2016. Methodology: This is a qualitative study using process techniques and grounded theory analysis based on semi-structured interviews that were codified and categorized with N-VIVO 10. Results: Thirteen categories and 182 codes described along 6 axes emerged. The first axis is related to the meaning of cancer and its barriers. The second is related to the primary barriers to health care which are, in order from most frequent to least frequent: administrative, economic, cultural, knowledge, communication and institutional. The third axis consists of strategies to overcome barriers. The fourth consists of strategies to diminish barriers. The fifth is related to feelings and the role of the family, and the sixth contains the patient's needs. Conclusion: Fragmentation and segmentation of the health care system imposes barriers that limit early diagnosis of gastric cancer and timely management. In addition, they threaten the quality of life of the sick adult and her or his family.

Genetic associations between flight speed and growth traits in Nellore cattle.

The aim of the present study was to estimate genetic parameters for flight speed and its association with growth traits in Nellore beef cattle. The flight speed (FS) of 7,402 yearling animals was measured, using a device composed of a pair of photoelectric cells. Time interval data (s) were converted to speed (m/s) and faster animals were regarded as more reactive. The growth traits analyzed were weaning weight (WW), ADG from weaning to yearling age, and yearling scrotal circumference (SC). The (co)variance components were estimated using REML in a multitrait analysis applying an animal model. The model included random direct additive genetic and residual effects, fixed effects of contemporary groups, age of dam (classes), and age of animal as covariable. For WW, the model also included maternal genetic and permanent environmental random effects. The direct heritability estimate for FS was 0.26 ± 0.05 and direct heritability estimates for WW, SC, and ADG were 0.30 ± 0.01, 0.48 ± 0.02, and 0.19 ± 0.01, respectively. Estimates of the genetic correlation between FS and the growth traits were -0.12 ± 0.07 (WW), -0.13 ± 0.08 (ADG), and -0.11 ± 0.07 (SC). Although the values were low, these correlations showed that animals with better temperaments (slower FS) tended to present better performance. It is possible to infer that longterm selection for weight and scrotal circumference can promote a positive genetic response in the temperament of animals. Nevertheless, to obtain faster genetic progress in temperament, it would be necessary to perform direct selection for such trait. Flight speed is an easily measured indicator of temperament and can be included as a selection criterion in breeding programs for Nellore cattle.

Hematological characteristics of the spotted rose snapper Lutjanus guttatus (Steindachner, 1869) healthy and naturally infected by dactylogyrid monogeneans.

The aim of the present study was to obtain a basic knowledge of the hematology in order to determine changes in blood parameters of the spotted rose snapper Lutjanus guttatus. The morphological features of blood cells were described according to the observations made by light microscopy of Wright-Giemsa-stained blood films. The reference intervals and the mean value were determined for each hematological parameter evaluated in healthy fish and data were compared to those of naturally infected, with dactylogyrid monogeneans fish. Infected fish showed a prevalence of 100% and a mean intensity of 246.6 parasites per fish. Mean values of HCT, WBC, thrombocytes percentage and eosinophils percentage were significantly higher (P<0.05) in the infected fish. In addition, lymphocytes percentage and total protein were significantly lower (P<0.05) in the infected fish compared to healthy fish. Only total WBC count, lymphocytes percentage and eosinophils percentage in infected fish were outside reference interval. The hematology of the spotted rose snapper of this study might serve as a basis for future studies and diagnosis. Changes observed in blood parameters in infected fish suggest that the immune system of L. guttatus was affected by the presence of the parasites.

Comportamiento de las formulas índice de pronóstico nutricional adaptado (IPNa) de la original de Mullen y el índice de riesgo nutricional (IRN) en pacientes de cirugías electivas / Behavior of adapted nutritional prognostic index (NPIa) formulas and the nutritional risk index (NRI) in elective surgery patients

In 1999 the Mullen and Buzby's formula was adapted, eliminating hypersensitivity skin tests and removing the alfa factor with coefficients similar to the original, obtaining a new formula called adapted Nutritional Prognostic index (aNPI). Objective: To determine the behavior of this new formula and the nutritional risk index with post surgical complications. Methodology: 110 elective patients for surgery were studied by carrying out pre- and post-operational evaluation. Results: the average age was 50 years old; 52 percent showed signs of being overweight or obese; 89,15 percent had normal serum albumin and 60 percent showed a deficit of transferrine; 75ú percent had low risk NPIa and 62,7 percent had a normal NRI. The main surgeries were hysterectomies and cholecystectomies, 92 percent were without complications (p=0,001). It was found a statistically significant relationship between each classification of nutritional index with the presence o absence of complications (p=0.001). When comparing these indexes, the statistical difference is maintained (p= 0.00). The same was observed when comparing the classification ofthis two indexes with complications (p=0.00). When comparing these two indexes, the multiple regression analysis did not show any significant difference with the type of complication, although there was a significant difference with serum albumin levels and the type of surgery. Conclusion: in this study the a NPI and NRI behaved similarly with the majority of variables under study.

En 1999 se adaptó la formula de Mullen y Buzby suprimiendo las pruebas de hipersensibilidad cutánea removiendo el factor alfa con coeficientes similares a la fórmula original, obteniéndose una nueva fórmula denominada índice de Pronóstico Nutricional adaptado (INPa). Objetivo: Determinar el comportamiento de las fórmulas IPNa e IRN, con complicaciones postquirúrgicas. Metodología: Se estudiaron prospectivamente 110 pacientes de cirugías electivas realizando una valoración prequirúrgica y postquirúrgica. Resultados: La edad promedio fue 50 años; 52 por ciento con sobrepeso y obesidad; 89,15 por ciento la albuminemia fue normal, 60 por ciento con déficit de transferrina. El 75,5 por ciento presentaron un IPNa con bajo riesgo, y 62,7 por ciento un IRN normal. Las cirugías predominantes fueron histerectomías y colecistectomías, 92 por ciento sin complicaciones. Se encontró una relación estadísticamente entre la clasificación de cada uno de los índices nutricionales con la presencia o ausencia de complicaciones (p= 0,001). Al comparar estos dos índices, la diferencia estadística se mantiene (p=0,00), sin embargo, el análisis de regresión múltiple no mostró diferencia significativa de éstos índices con el tipo de complicaciones obteniendo significancia con albuminemia y tipo de cirugía. Conclusión: En este estudio el IPNa y el IRN se comportaron de manera semejante en la mayoría de las variables estudiadas.

The identification of sandfly species, from an area of Argentina with endemic leishmaniasis, by the PCR-based analysis of the gene coding for 18S ribosomal RNA.

The area around Río Blanco, in the Orán department in the north of the Argentinian province of Salta, is endemic for American tegumentary leishmaniasis. In an attempt to facilitate the identification of the Lutzomyia species in this area, sequences of the gene coding for the 18S ribosomal RNA (rRNA) of sandflies caught in a Shannon trap were explored, by a combination of PCR and analysis of restriction-fragment-length polymorphism (RFLP). The products from the PCR, which employed two primers developed specifically for this study (Lu.18S 1S and Lu.18S AR), were cloned into a commercial vector (pGEM-T Easy) so that their nucleotide sequences could be investigated. In the RFLP analysis, the products of single and double digestion with the AfaI and HapII restriction enzymes were separated by electrophoresis in 3% or 4% agarose. Taken together with the results of a morphological investigation of the flies, the resultant DNA fragment patterns were sufficient to identify most of the sandflies caught as Lu. neivai. Although two other species, Lu. cortelezzii and Lu. sallesi, were collected, they were relatively rare and only identified morphologically. A single digestion of the 18S-rRNA gene sequences with AfaI or HapII appeared sufficient and useful for the identification of Lu. neivai from the north of Salta province, and for several other Lutzomyia species.

[Coinfection with hepatitis G virus in chronic hepatitis C. Response to treatment with interferon alpha]. / Estudio de la coinfección por el virus de la hepatitis G en la hepatitis crónica C. Respuesta al tratamiento con interferón alfa.

BACKGROUND: It is thought that the cytopathic effect of HGV is not important. Nevertheless, the cytopathic effect on liver is less known in the cases of co-infection with HCV. The aim was to study the prevalence of co-infection in patients with chronic hepatitis C (CHC) and to analyse the clinical-epidemiological and histological data and the interferon (IFN) response. PATIENTS AND METHODS: We included 180 patients with CHC and the HGV-RNA was determined. RESULTS: The prevalence of co-infection was 12.2% (n = 22). No statistical differences were observed between the non co-infected and co-infected groups with regard to the age, sex, mechanism of transmission and alcohol abuse. Also, there were no differences in the hepatic biochemical, no organ-specific antibodies, histological lesions and Knodell index. The HCV biochemical response (BR) and virological response (VR) after 6 months post-IFN were the same in both groups (HGV negative: BR = 29%, VR = 12%; HGV positive: BR = 22%, VR = 18%). HGV was determined after 6 months posttreatment in the co-infected group (first cycle of IFN, n = 22; second cycle of IFN, n = 9): 12 (55%) were HGV-RNA negative and 5 (23%) HCV-RNA negative, (p = 0.021). When we compared the BR vs VR in this group, there were 12 HGV-RNA negative but only two had BR (NS). On the contrary, the BR was related to HCV-RNA negative (p = 0.023). CONCLUSION: The prevalence of HGV co-infection is important in our area (12.8%). The HGV does not increase the pathogenicity of HCV and does not change the IFN response, although the HGV is more IFN sensible than HCV. The determination of HGV is not necessary in patients with HCV.

Intento de suicidio: como enfrentarlo en una institucion no psiquiatrica / Suicide attempt: how toface in a non psychiatric hospital

El intento de suicidio, suele confrontar los sentimientos, valores y juicios de los individuos; cuidar a quien no quiere vivir cuando se defiende la vida es una paradoja que siempre plantea retos. Comprender al ser humano sin juzgarlo y ayudarlo a recuperar algo de bienestar son las tareas del personal de enfermería y las herramientas principales están en el plano de lo humano con el apoyo de la ciencia y la tecnología, pero sobre todo en la posibilidad de comunicar la esencia de la profesión: ayudar y acompañar a quien sufre y experimenta dolor y soledad

[Retrospective study of the incidence of hepatitis G virus infection in transfused patients]. / Estudio retrospectivo de la incidencia de infección por el virus de la hepatitis G en los pacientes transfundidos.

BACKGROUND: Recently the parenteral transmission of hepatitis G virus (HGV) has been shown. The aim of the study was to investigate the incidence of post-transfusion HGV. PATIENTS AND METHODS: HGV (RNA-HGV and anti-HGVE2) were retrospectively studied in 140 transfused patients. RESULTS: 12 (8.6%) were infected after transfusion: 9 of 12 (75%) the RNA-HGV remained detectable after 6 months and 3 (25%) seroconverted to anti-HGVE2. No patient had post-transfusional hepatitis criteria. In 5 (42%) the transaminases levels were slightly increased. The clinical evolution was favourable. No significant differences were found between patients with or without HGV infection. CONCLUSIONS: HGV is an agent associated with transfusion but it carries a low pathogenic capability.

Indice de infección por el virus de la hepatitis B (VHB) en personal de anestesiología y otras especialidades

La infección por el virus de la hepatitis B (VHB), representa un problema de salud pública en el mundo. Estudios realizados en Colombia desde 1980, han permitido conocer el índice de infección en varias zonas geográficas y en grupos institucionalizados. Con la finalidad de conocer el índice de infección del VHB en personal de anestesiología y otras especialidades, se estudió entre noviembre de 1992 y abril de 1993, un grupo de médicos residentes y especialistas del área quirúrgica y no quirúrgica del HUC: Se analizaron setenta (70) sueros, por el inmunoensayo enzimático (ELISA) para identificar a portadores del antígeno superficial y otros marcadores de infección activa, crónica o pasada del VHB: La frecuencia para cualquier marcador de infección del VHB fue del 27.14 por ciento; en catorce (14) sueros de identificó Anti-HBs; un suero resultó positivo para Anti-HBc IgM; cuatro (4) para Anti-HBc y ningún suero resultó positivo para AgHBs. El índice de infección por el VHB en el grupo de anestesiología fue del 24 por ciento, bastante similar al índice de infección del 29 por ciento encontrados en el grupo de médicos de las otras especialidades. La lacceración de piel con aguja o material quirúrgico fue el antecedente de infección más informado. La alta susceptibilidad de infección fue igual en el grupo de anestesiología en relación con otras especialidades

Tumores por virus HPV / Tumors by virus HPV

Los virus de los papilomas humanos (HPV) forman parte del grupo Papova, tiene un diámetro de 55 mm y pueden o no tener agrupación cristlaina. Recientemente se sabe que el DNA del virus existe como trozos de filamentos o minicromosomas. Estos minicromosomas pueden estar muy compactos para encajar entre las cáspides virales, que están compuestas por 72 capsómetros. Esta cápside es un polipéptido responsable de muchas de sus propiedades antigénicas, común a todos los papiloma virus y que se pone de manifiesto con la técnica de la peroxidasa antiperoxidasa sin importar el tipo o la especie.