Antibiotic residues and microbial contamination in pasteurized whole milk intended for human consumption.

Background and Aim: Milk contamination for human consumption is one of the biggest concerns worldwide. To prevent milk contamination, it is important to implement sustainable production practices that ensure animal health and guarantee veterinary drugs have been used properly. This study aimed to detect antibiotic residues and microbial contamination in commercially available pasteurized whole milk intended for human consumption. Materials and Methods: We conducted a cross-sectional study on all brands of pasteurized milk (n = 17) for human consumption in Medellín, Colombia, from February 30 to April 30, 2022. Six milk samples of each brand were collected every 15 days, resulting in 102 samples. IDEXX SNAPduo™ ST Plus test (IDEXX Laboratories Inc, Maine, USA) was used to detect cephalosporins residues to detect beta-lactam and tetracyclines. We detected mesophilic aerobic bacteria and coliforms using Chromocult Coliform Agar® (Merck KGaA, Darmstadt, Germany) and Plate-Count Agar® (Merck KGaA), respectively. Results: Beta-lactam residues were found in 24.4% of the brands. No tetracyclines or cephalosporins were detected. Mesophilic aerobic bacteria and coliform contamination were detected in 42.6% and 12.8% of the brands, respectively. No fecal coliform contamination was detected. Conclusion: This study demonstrated the presence of antibiotic residues and microbial contamination in commercially available pasteurized whole milk intended for human consumption in the study area, highlighting its potential public health implications.

Guided Imagery for Symptom Management of Patients with Life-Limiting Illnesses: A Systematic Review of Randomized Controlled Trials.

Background: Patients with life-limiting illnesses receiving palliative care have a high symptom burden that can be challenging to manage. Guided imagery (GI), a complementary and integrative therapy in which patients are induced to picture mental images with sensory components, has proven in quasi-experimental studies to be effective as a complementary therapy for symptom management. Objective: To systematically review randomized controlled trials that report evidence of guided imagery for symptom management in patients with life-limiting illnesses. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed for this review and the search strategy was applied in Medline, CINHAL, and Web of Science. The quality of articles was evaluated using the Cochrane Collaboration's Risk-of-Bias Tool 2 (RoB 2). The results are presented using the Guidance on the Conduct of Narrative Synthesis in Systematic Reviews. Results: A total of 8822 studies were initially identified through the search strategy, but after applying exclusion criteria, 14 randomized controlled trials were included in this review. The quality assessment revealed that four studies had a high risk of bias, nine had some concerns, and one had a low risk of bias. Out of the 14 studies, 6 evaluated oncological diagnosis, while the remaining 8 focused on nononcological diagnoses across 6 different diseases. GI was found to be effective in managing symptoms in 10 out of the 14 studies. Regardless of the disease stage, patients who received guided imagery experienced relief from anxiety, depression, pain, sleep disturbances, and fatigue. Conclusion: GI therapy has shown promising results regarding symptom management in palliative care patients with life-limiting illnesses at different stages.

On the need of in vivo verifications as quality control for intraoperative electron radiotherapy in breast cancer.

INTRODUCTION: Intraoperative electron radiotherapy (IOERT) is a technique aiming to deliver radiotherapy during oncological surgery. In breast IOERT, the applicator and shielding disc placement are correlated with organs at risk (OAR) irradiation, in vivo verification of these parameters is scarcely reported. The aim of our study is to report and analyze possible causes of the misalignment using radiochromic films and compare our results to others reported in the bibliography. METHODS: From November 2019 to April 2023, in vivo verifications were performed for 33 patients. IOERT was performed using a LIAC 10 MeV (Sordina, Italy) electron accelerator. We attached a radiochromic film to the upper side of the polytetrafluoroethylene cover of the shielding disc. The percentage of the irradiation area outside the disc was recorded and various parameters (applicator angulations, prescription depth, tumor location and breast size) were analyzed to find possible correlations. RESULTS: For 29 patients, 20 Gy were prescribed while 10 Gy were prescribed to 4 patients. The average irradiated area outside the disc was 19% (0-56%) corresponding to a surface of 4.5 cm2 (0-17.4 cm2). The applicator of 5 cm was used for most of the patients. The mean prescription depth was 1.4 cm (0.5-2.5 cm). We found no correlation between the analyzed parameters and misalignment. CONCLUSION: This study confirms the presence and magnitude of the misalignments. We strongly recommend in vivo verifications as a quality check during IOERT procedures. The misalignment has no correlation with tumor localization parameters, so the solution could be based on technical improvements of the applicator.

Prevention and treatment of cisplatin-induced ototoxicity in adults: A systematic review.

OBJECTIVES: Ototoxicity is a common disabling side effect of platinum-based chemotherapy. This study aimed to assess the evidence on the management of platinum-induced ototoxicity in adult cancer patients. METHODS: Four databases were searched up to 1 November 2022. Original studies were included if they reported on a pharmacologic or non-pharmacologic intervention to prevent or treat platinum ototoxicity in adults. The articles' quality was assessed via two grading scales. RESULTS: Nineteen randomised controlled trials and five quasi-experimental studies with 1673 patients were analysed. Eleven interventions were identified, nine pharmacological and two non-pharmacological. Six of the interventions (sodium thiosulphate, corticoids, sertraline, statins, multivitamins and D-methionine) showed mild benefits in preventing cisplatin-induced ototoxicity. Only one trial assessed corticoids as a potential treatment. Overall, only six trials were deemed with a low risk of bias. The majority of studies inadequately documented intervention-related adverse effects, thereby limiting safety conclusions. CONCLUSIONS: Current interventions have mild benefits in preventing cisplatin-induced ototoxicity in adult cancer patients. Sodium thiosulphate is the most promising intervention as a preventive strategy. Rigorous, high-quality research is warranted, encompassing an evaluation of all potential symptoms and innovative treatment modalities.

Development of novel spray-dried and air-dried formulations of Metarhizium robertsii blastospores and their virulence against Dalbulus maidis.

The present research addressed spray-drying and air-drying techniques applied to Metarhizium robertsii blastospores to develop wettable powder (WP) formulations. We investigated the effect of co-formulants on blastospore viability during drying and assessed the wettability and stability of formulations in water. The effect of oxygen-moisture absorbers was studied on the shelf life of these formulations stored at 26 °C and 4 °C for up to 90 days. Additionally, we determined the virulence of the best spray-dried and air-dried formulations against the corn leafhopper Dalbulus maidis. While sucrose and skim milk played an essential role as osmoprotectants in preserving air-dried blastospores, maltodextrin, skim milk, and bentonite were crucial to attain high cell survival during spray drying. The lowest wettability time was achieved with spray-dried formulations containing less Ca-lignin, while charcoal powder amount was positively associated with formulation stability. The addition of oxygen-moisture absorbers inside sealed packages increased from threefold to fourfold the half-life times of air-dried and spray-dried formulations at both storage temperatures. However, the half-life times of all blastospore-based formulations were shorter than 3 months regardless of temperature and packaging system. Spray-dried and air-dried WP formulations were as virulent as fresh blastopores against D. maydis adults sprayed with 5 × 107 blastospores mL-1 that induced 87.8% and 70.6% mortality, respectively. These findings bring innovative advancement for M. robertsii blastospore formulation through spray-drying and underpin the importance of adding protective matrices coupled to oxygen-moisture absorbers to extend cell viability during either cold or non-refrigerated storage. KEY POINTS: • Cost-effective wettable powder formulations of M. robertsii blastospores were developed. • Bioefficacy of formulations against the corn leafhopper was comparable to fresh blastospores. • Cold storage and dual oxygen-moisture absorber are critical for extended shelf life.

Geographical and socioeconomic disparities in opioid access in Mexico, 2015-19: a retrospective analysis of surveillance data.

BACKGROUND: In 2015, Mexico implemented regulatory changes and an electronic system to improve access to prescription opioids. We aimed to investigate trends in opioid dispensing after the implementation of these changes and assess how opioid dispensing varied geographically and by socioeconomic status. METHODS: In this retrospective analysis of prescription medication surveillance data, we analysed dispensing data for group 1 medications (all opioids, including morphine, methadone, hydromorphone, oxycodone, tapentadol, fentanyl, sufentanil, and remifentanil) obtained from the Federal Commission for the Protection against Sanitary Risk database for 32 states and six large metropolitan areas in Mexico. We calculated crude annual opioid prescriptions per 10 000 people at the national, state, and municipal levels. Adapting methods from the report of the Lancet Commission on Palliative Care and Pain Relief, we calculated the need for palliative opioids by state, and then assessed the observed opioid dispensing rates as a percentage of expected need by geographical socioeconomic status. Within the six major metropolitan areas, we mapped the geocoded location of opioid prescriptions and assessed the association between opioid dispensing and socioeconomic status as well as the association between opioid dispensing and time to US border crossing for areas on the US-Mexico border. FINDINGS: Between June 25, 2015, and Oct 7, 2019, opioid dispensing rates increased by an average of 13% (95% CI 6·8-19·6) per quarter (3 months). The overall national opioid dispensing rate during the study period was 26·3 prescriptions per 10 000 inhabitants. States with a higher socioeconomic status had higher opioid dispensing rates than states with lower socioeconomic status (rate ratio [RR] 1·88, 95% CI 1·33-2·58, p=0·00016) after controlling for the estimated opioid requirement per state, the presence of methadone clinics, and the presence of tertiary hospitals and cancer centres. The same association between opioid dispensing and socioeconomic status was observed in the metropolitan areas, and in those metropolitan areas on the US-Mexico border a 20% decrease (RR 0·80, 95% CI 0·75-0·86) in opioid dispensation was observed per each SD increase (SD 17·1 min) in travel time to the border. INTERPRETATION: Measures introduced by the Mexican federal Government to increase opioid access for patients with palliative care needs were only marginally successful in raising opioid prescription rates. Opioid access should be improved for patients with palliative care needs who live in geographical areas of lower socioeconomic status. FUNDING: US National Institutes of Health.

Síndrome de dificultad respiratoria aguda en el contexto de la pandemia por COVID-19 / Acute respiratory distress syndrome in times of the COVID-19 pandemic

Resumen Introducción: el síndrome de dificultad respiratoria aguda es una enfermedad frecuente con una elevada morbimortalidad. Recientemente, ha ganado relevancia por la pandemia generada por la infección por SARS-CoV-2, en la que un gran número de pacientes han necesitado ventilación mecánica y manejo del síndrome secundario. Previendo la necesidad de una redistribución emergente del talento humano en salud, realizamos una revisión narrativa sobre el síndrome de dificultad respiratoria aguda con los principales artículos relacionados con su tratamiento. Métodos: se revisaron bases de datos (PubMed, MEDLINE, Lilacs) incluyendo textos multidisciplinarios, guías de práctica y estudios clínicos escritos en inglés y español hasta abril 2020. Resultados: las principales medidas relacionadas con la disminución de la mortalidad son la ventilación protectora y la ventilación en prono. Algunas estrategias terapéuticas como el uso restrictivo hídrico no demostraron impactar en mortalidad, pero sí en eventos secundarios. El uso de membrana de oxigenación extracorpórea no ha demostrado disminuir la mortalidad. Conclusiones: el síndrome de dificultad respiratoria aguda es la manifestación severa más frecuente de la infección por SARS-CoV-2. Las estrategias terapéuticas son de obligatorio conocimiento para los profesionales que enfrentan un paciente con COVID-19. Pocas estrategias impactan la mortalidad y los eventos secundarios, entre ellas la ventilación mecánica protectora y la ventilación en prono. El uso de membrana de oxigenación extracorpórea continúa siendo considerada una medida compasiva.

Abstract Background: Acute respiratory distress syndrome (ARDS) is a frequent entity in critical care with significant morbidity and mortality. Recently, it has gained relevance due to the pandemic caused by SARS-CoV2 infection, in which large numbers of patients have required mechanical ventilation and treatment for a secondary ARDS. Anticipating the need for a redistribution of human health resources, we conducted a narrative review on Acute Respiratory Distress Syndrome (ARDS) with the main articles related to management of this clinical entity. Methods: Databases (PubMed, MEDLINE, Lilacs) were searched for relevant literature including multidisciplinary texts, clinical practice guidelines and clinical studies written in English and Spanish until April 2020. Results: The main measures related to decreased mortality are protective ventilation and prone ventilation. Some therapeutic strategies, such as restrictive fluid management, have not been shown to impact mortality but rather secondary events. The use of extracorporeal oxygenation membrane has not been shown to decrease mortality. Conclusions: Acute respiratory distress syndrome is the most frequent severe manifestation of infection with SARS-CoV2. Therapeutic strategies are mandatory knowledge for professionals who face a patient with COVID-19. Few strategies impact mortality and secondary events, including protective mechanical ventilation and prone ventilation. ECMO continues to be considered a compassionate measure.

Diagnóstico clínico de COVID-19 con pruebas moleculares negativas consecutivas / Clinical diagnosis of COVID-19 with consecutive negative molecular tests

Resumen Una de las dificultades dentro de la pandemia actual por COVID-19 es la poca especificidad y sensibilidad de las pruebas diagnósticas. Distintas sociedades científicas han planteado algoritmos diagnósticos que incluyen pruebas moleculares, síntomas clínicos, pruebas de laboratorio e imágenes. En nuestro medio se utiliza la prueba de RT-PCR, obtenida de lavado nasofaríngeo, aun conociendo sus limitaciones en términos de sensibilidad. Se presenta el caso de un paciente masculino a quien finalmente se le confirma el diagnóstico de COVID-19 a pesar de tener múltiples pruebas moleculares negativas previas.

Abstract One of the difficulties within the current COVID-19 pandemic is the lack of specificity and sensitivity of diagnostic tests. Different societies have proposed diagnostic algorithms that include molecular tests, clinical symptoms, laboratory tests, and diagnostic imaging. In our setting, we use the RT-PCR in nasopharyngeal lavage, even knowing its limitations in terms of sensitivity. In this article, we present the case of a male patient in whom COVID-19 is confirmed even after multiple negative molecular tests.

Growth kinetic and nitrogen source optimization for liquid culture fermentation of Metarhizium robertsii blastospores and bioefficacy against the corn leafhopper Dalbulus maidis.

The cosmopolitan entomopathogenic and root endophytic fungus Metarhizium robertsii has a versatile lifestyle and during liquid fermentation undergoes a dimorphic transformation from hyphae to conidia or microsclerotia, or from hyphae to blastospores. In all cases, these processes are mediated by environmental and nutritional cues. Blastospores could be used in spray applications to control arthropod pests above ground and may serve as an attractive alternative to the traditional solid-grown aerial conidial spores of Metarhizium spp. found in commercial products. Nitrogen is a vital nutrient in cell metabolism and growth; however, it is the expensive component in liquid cultures of entomopathogenic fungi. Our goals in this study were to optimize nitrogen sources and titers for maximum production of M. robertsii blastospores cultured in shake flasks at highly aerated conditions and to further determine their virulence against the corn leafhopper Dalbulus maidis, an important vector of serious pathogens in maize crops worldwide. Our fermentation studies revealed that the low-cost corn steep liquor (CSL) was the most suitable nitrogen source to improve blastospore growth in M. robertsii. The growth kinetic assays determined the optimal titer of 80 g L-1 and a yield up to 4.7 × 108 cells mL-1 within 5 days of cultivation (3 days preculture and 2 days culture), at a total cost of US$0.30 L-1. Moreover, the blastospore growth kinetic was strongly dependent on glucose and nitrogen consumptions accompanied by a slight drop in the culture pH. Insect bioassays evidenced a high virulence of these blastospores, either as dried or fresh cells, to D. maidis adults fed on maize plants. Our findings provide insights into the nutritional requirements for optimal and cost-efficient production of M. robertsii blastospores and elucidate the potential of blastospores as an ecofriendly tool against the corn leafhopper.

Aplicación del bilirrubinómetro no invasivo en recién nacidos / Application of non-invasive bilirubinometry in newborns

Introducción: Las pautas para prevención y tratamiento de hiperbilirrubinemia neonatal recomiendan medición de bilirrubina sérica total (BST) o bilirrubina transcutánea (BTc) para determinar el grado de ictericia antes del alta del recién nacido (RN); ésta última no invasiva, proporciona información instantánea y de calidad superior a la evaluación clínica. A pesar de ello aún no ha sido aplicada en forma sistemática en los hospitales de Paraguay. Objetivo: evaluar la aplicación en nuestro medio de la medición de bilirrubinemia transcutánea antes del alta correlancionando con la bilirrubina sérica. Materiales y Métodos: Estudio observacional, descriptivo con componente analítico, de corte transversal. Fueron incluidos RN con edad gestacional ≥ a 35 semanas, con peso ≥ a 2000 gramos, luego de las 24 hs de vida hasta los 8 días; bajo consentimiento informado de los padres, durante un año. Los datos fueron consignados en una planilla de Microsoft Excel y procesado por el software IBM SPSS Statistics ®. Resultados: De 271 RN que ingresaron al estudio, en la primera medición con el Bilirrubinómetro transcutáneo, cumplían con criterios para toma de bilirrubina sérica 90 (33,2%) de ellos. En los restantes 181 RN (66,8%), los datos emparejados no estaban disponibles debido a que siguiendo las recomendaciones de las guías actuales no fue necesario medir la bilirrubina sérica. El valor del coeficiente de correlación para la primera medición fue r = 0.574. Para la segunda medición las medidas emparejadas estaban disponibles para 131 RN. En este caso se encontró correlación positiva entre ambos métodos de 0,590. Conclusión: La bilirrubina transcutánea puede utilizarse en forma rápida, segura y válida, como un test de screening para la detección de hiperbilirrubinemia y podría evitar una proporción importante de toma de muestras sanguíneas, mejorando la seguridad del paciente.

Introduction: The guidelines for prevention and treatment of neonatal hyperbilirubinemia recommend measurement of total serum bilirubin (BST) or transcutaneous bilirubin (BTc) to determine the degree of jaundice before discharge of the newborn (NB); the latter non-invasive method provides instant information which is superior to the clinical evaluation. Despite this, it has not yet been systematically applied in hospitals in Paraguay. Objective: to evaluate transcutaneous measurement of bilirubin concentration as compared to serum bilirubin levels prior to discharge in our setting. Materials and Methods: This was an observational, cross-sectional, descriptive study with an analytical component. For a period of one year, we tracked NBs with a gestational age ≥ 35 weeks, weighing ≥ 2000 grams, from 24 hours of life until 8 days of life, obtaining the informed consent of the parents. The data was entered in a Microsoft Excel spreadsheet and processed by the IBM SPSS Statistics ® software. Results: Of 271 NBs who entered the study, 90 (33.2%) met criteria for measurement of serum bilirubin at their first measurement with the transcutaneous bilirubinometer. In the remaining 181 RN (66.8%), the paired data were not available as measurement of serum bilirubin was not required per the recommendations of current guidelines. The correlation coefficient value for the first measurement was r = 0.574. For the second measurement, paired measurements were available for 131 NBs. In this case, a positive correlation was found between both methods of 0.590. Conclusion: Transcutaneous bilirubin can be used quickly, safely and accurately as a screening test for the detection of hyperbilirubinemia and could avoid a significant proportion of blood sampling, improving patient safety.

Varones y masculinidades en clave feminista: trascendiendo invisibilidades, ausencias y omisiones / Homens e masculinidades sob uma chave feminista: transcendendo invisibilidades, ausencias e omissões / Men and masculinities on a feminist key: transcending invisibilities, absences and omissions

Resumen: Este texto realiza un recuento del recorrido académico llevado a cabo por una activista, investigadora y docente de los temas relacionados con género y salud durante dos décadas de trabajo. Se recupera el sentido de las preguntas emergentes sobre los hombres y las masculinidades desde la perspectiva de género que asume una postura relacional, histórica, inclusiva, dialéctica para entender las relaciones de poder y subordinación que subyacen en los encuentros y desencuentros de hombres y mujeres. Los recorridos colombianos en el tema son contextualizados en paralelo con los Coloquios Internacionales de Estudios de Varones y Masculinidades y referencias puntuales a la mirada "género sensible" y "socio sanitaria" compartida con la Red Latinoamericana de Género y Salud Colectiva de la Asociación Latinoamericana de Medicina Social, con el ánimo de contribuir a la memoria de la trayectoria compartida por un colectivo de personas que confluyen y se reconocen como Red Internacional de Estudios de Varones y Masculinidades generada en ese mismo caminar, que sigue activo hasta la fecha.

Resumo: Este texto reconta o percurso acadêmico de uma ativista, pesquisadora e docente em temas relacionados ao gênero e saúde durante duas décadas de trabalho. São recuperados os sentidos das perguntas emergentes sobre os homens e as masculinidades a partir da perspectiva de gênero que assume uma postura relacional, histórica, inclusiva e dialética para entender as relações de poder e subordinação que subjazem aos encontros e desencontros de homens e mulheres. Os itinerários Colombianos na temática são contextualizados em paralelo como os Colóquios Internacionais de Estudos de Homens e Masculinidades, e referências pontuais a perspectiva "sensível ao gênero" e "sócio sanitária" compartilhada com a Rede Latino-Americana de Medicina Social, com o objetivo de contribuir com a memória de uma trajetória compartilhada por um coletivo de pessoas que confluem e se reconhecem como Rede Internacional de Estudos de Homens e Masculinidades, gerada neste mesmo caminho e que continua ativa atualmente.

Abstract: This text recalls the two-decade long academic journey of an activist, researcher and teacher on topics related to gender and health. It restores the meaning of emerging questions about men and masculinities from a gender perspective, taking a relational, historical, inclusive, dialectical stand to address power, and the relations of subordination underlying when men and women met or miss each other. Colombian itineraries are contextualized in parallel with the International Men and Masculinities Studies Colloquia Series, and specific references to a "gender-sensitive" and "social health" approach shared with the Gender and Collective Health Network with the Latin American Association of Social Medicine, in order to contribute to the memory of an itinerary by a collective of people who gather at and recognize themselves as part of the Men and Masculinities Studies International Network, generated in that same path, still active today.

Postura de la Red Latinoamericana de Género y Salud Colectiva de ALAMES frente a la cobertura universal de salud / Position of the Latin American Network of Gender and Collective Health of ALAMES on the universal health coverage

Los lineamientos y contenidos del trabajo académico, social y político que venimos desarrollando en la Red Latinoamericana de Género y Salud Colectiva de la Asociación Latinoamericana de Medicina Social se presentan en este escrito de forma sintética y organizada en los siguientes elementos: a) derechos sexuales y derechos reproductivos plenos, implicaciones de sus alcances y logros desde las redes y desde la región, b) materialización de la agenda regional y continental frente a la prevención y detección de la violencia de género en todas sus formas, c) regresión en materia de derechos relacionados con la salud sexual y la salud reproductiva de la población en los gobiernos latinoamericanos. La Red está conformada en su mayoría por mujeres y algunos varones; dedicada o vinculada a la vida académica, al activismo, a las organizaciones, movimientos y colectivos de América Latina del área de la salud con formación sociosanitaria y sensibilidad de género. Se parte del principio del derecho a la salud como derecho humano fundamental garantizado de forma indelegable por el Estado. Las y los integrantes de la Red promovemos y defendemos la agenda pública de salud mediante sistemas universales de salud que garanticen cobertura universal capaz de confrontar las actuales exclusiones del sistema y la formación para la atención integral en materia de derechos sexuales y derechos reproductivos, desde el enfoque diferencial, desde la intersectorialidad de los derechos humanos. Solo así se puede abordar las iniquidades y las exclusiones en salud que las mujeres latinoamericanas enfrentan en su día a día, ya sea por la precarización y terciarización laboral de la que son objeto, como por el despojo, el destierro y el desplazamiento forzado por proyectos geoestratégicos, por el capital transnacional y los intereses extractivistas apoyados por fuerzas estatales, paraestatales y narcomilitares -en algunos países de la región- que abundan en Centro y Sur América. El cuerpo de las mujeres y las niñas en este contexto está sometido a situaciones que vulneran la integridad, la salud mental y física, por estar sujeto a la lógica del conflicto en la región donde se hace presente. Ante la situación de orden público y de crisis socioeconómica de los países latinoamericanos y del caribe se han planteado prioridades al sector de la salud que pasan necesariamente por el reconocimiento de la necesidad de sistemas universales de salud que garanticen total cobertura, con prioridad en la atención integral sujeta a derecho y en la garantía básica de acceso efectivo a la atención en salud, que evite la revictimización de los ciudadonos y responda a la reparación, no repetición, justicia y protección para la salud y la vida de la población(AU)

The guidelines and contents of the academic, social and political work that we have been developing in the Latin American Gender and Collective Health Network of the Latin American Association of Social Medicine were presented in this article in an abridged form and organized by the following elements: a) full sexual and reproductive rights, implications of their scope and achievements seen from the networks and from the region, b) materialization of the regional and continental agenda for the prevention and detection of all forms of gender violence; c) regression observed in Latin American governments in terms of sexual and reproductive health rights of the population. The Network is mostly made up of women and some men, is devoted or linked to academic life, activism, organizations, movements and groups from the health area in Latin America, with social and health formation and gender sensitivity. It is based on the principle of right to health as a basic human right that is guaranteed by the state. The members of the Network promote and defend the public health agenda through universal health systems which assure universal coverage that may face the present exclusions of the system and the formation for the comprehensive care of individuals as to sexual and reproductive health on the basis of the differential approach and the inter-sector linking with the human rights. It is just this way that inequities and exclusions in health, which are daily faced by Latin American women, can be addressed. Such inequities and exclusions are due unsafe work and tertiarization, exile and forced displacement encouraged by the geostrategic interests, the transnational capitals and the extractivist interests supported by state, parastate and narcomilitary forces that are abundant in some countries of Central and South America. In this context, women's and girls' bodies are subjected to some situations that damage their integrity and their mental and physical health since they respond to the logics of conflicts occurring in a particular region. Taking into account the situation of public order and of socio-economic crisis in Latin American and Caribbean nations, some priorities have been set for the health care sector, which necessarily consider the need of universal health system capable of assuring total coverage, as priority, in the law-binding comprehensive care and in the basic assurance of effective access to health. The above-mentioned will prevent revictimizing the population and will respond to health repair, not repetition, to justice and protection of health and life of this population(AU)

Angiogenic and inflammatory markers in acute respiratory distress syndrome and renal injury associated to A/H1N1 virus infection.

Acute kidney injury (AKI) is often associated to acute respiratory distress syndrome (ARDS) due to influenza A/H1N1 virus infection. The profile of angiogenic and inflammatory factors in ARDS patients may be relevant for AKI. We analyzed the serum levels of several angiogenic factors, cytokines, and chemokines in 32 patients with A/H1N1 virus infection (17 with ARDS/AKI and 15 ARDS patients who did not developed AKI) and in 18 healthy controls. Significantly higher levels of VEGF, MCP-1, IL-6, IL-8 and IP-10 in ARDS/AKI patients were detected. Adjusting by confusing variables, levels of MCP-1 ≥150 pg/mL (OR=12.0, p=0.04) and VEGF ≥225 pg/mL (OR=6.4, p=0.03) were associated with the development of AKI in ARDS patients. Higher levels of MCP-1 and IP-10 were significantly associated with a higher risk of death in patients with ARDS (hazard ratio (HR)=10.0, p=0.02; HR=25.5, p=0.03, respectively) even taking into account AKI. Patients with influenza A/H1N1 infection and ARDS/AKI have an over-production of MCP-1, VEGF and IP-10 possibly contributing to kidney injury and are associated to a higher risk of death.

Seasonal and pandemic influenza H1N1 viruses induce differential expression of SOCS-1 and RIG-I genes and cytokine/chemokine production in macrophages.

BACKGROUND: Infection with pandemic (pdm) A/H1N1 virus induces high levels of pro-inflammatory mediators in blood and lungs of experimental animals and humans. METHODS: To compare the involvement of seasonal A/PR/8/34 and pdm A/H1N1 virus strains in the regulation of inflammatory responses, we analyzed the changes in the whole-genome expression induced by these strains in macrophages and A549 epithelial cells. We also focused on the functional implications (cytokine production) of the differential induction of suppressors of cytokine signaling (SOCS)-1, SOCS-3, retinoid-inducible gene (RIG)-I and interferon receptor 1 (IFNAR1) genes by these viral strains in early stages of the infection. RESULTS: We identified 130 genes differentially expressed by pdm A/H1N1 and A/PR/8/34 infections in macrophages. mRNA levels of SOCS-1 and RIG-I were up-regulated in macrophages infected with the A/PR/8/34 but not with pdm A/H1N1 virus. mRNA levels of SOCS-3 and IFNAR1 induced by A/PR/8/34 and pdm A/H1N1 strains in macrophages, as well as in A549 cells were similar. We found higher levels of IL-6, TNF-α, IL-10, CCL3, CCL5, CCL4 and CXCL8 (p < 0.05) in supernatants from cultures of macrophages infected with the pdm A/H1N1 virus compared to those infected with the A/PR/8/34 strain, coincident with the lack of SOCS-1 and RIG-I expression. In contrast, levels of INF-α were higher in cultures of macrophages 48h after infection with the A/PR/8/34 strain than with the pdm A/H1N1 virus. CONCLUSIONS: These findings suggest that factors inherent to the pdm A/H1N1 viral strain may increase the production of inflammatory mediators by inhibiting SOCS-1 and modifying the expression of antiviral immunity-related genes, including RIG-I, in human macrophages.

Relación entre síndrome de burnout, estrategias de afrontamiento y engagement / Relation between burnout syndrome, coping strategies and engagement

Este artículo tiene como nalidad analizar, a partir de las teorías existentes, la relación entre las estrategias de afrontamiento, el síndrome de burnout y el engagement. El síndrome de burnout si bien se desarrolla en un contexto organizacional, es individual y ello ya implica la existencia de factores de riesgo que llegan a activarse (ya sea para posibilitar su aparición por las estrategias de afrontamiento que se asumen o evitar su desarrollo, cuando hay engagement) en contextos laborales donde hay presencia de alta carga laboral, bajas recompensas por el ocio llevado a cabo y ambientes laborales en los que no se posibilita la participación para la toma de decisiones.

This article has as a main objective to analyze from existing theories, the relationship between coping strategies, burnout syndrome, and engagement. Burnout Syndrome although developed in an organizational context is an individual syndrome and this already implies the existence of risk factors that become activated (either to allow an appearance by the Coping Strategies that are assumed or prevent their development - when there is engagement) in working contexts where there is the presence of high workload, low for the work done and employment context where participation is not allowed in decision making.

Derecho a la salud de la población desplazada: el caso de las mujeres del auto 092, Medellín, Antioquia / Direito à saúde da população refugiada: o caso das mulheres do auto 092, Medellín, Antioquia / The right to health of internally displaced population: the case of women of auto 092, Medellin, Antioquia

Medellín es la segunda ciudad receptora de población desplazada por el conflicto armado en el país, y, aunque la violencia sexual en este contexto es un crimen de Estado, de lesa humanidad que no prescribe, el país apenas está iniciando las acciones para abordar la problemática junto con los procesos de reparación, restitución y no repetición, desde un enfoque diferencial, y desde la mirada género-sensible. Es muy importante abordar la violencia sexual por actores de conflicto armado desde el reconocimiento de la salud como derecho humano fundamental y desde la mirada génerosensible y socio-sanitaria. Sin embargo, en lo avanzado hasta ahora se puede afirmar que las garantías esenciales del derecho que tienen estas mujeres en su condición de víctimas apenas alcanzan a ser administrativas, que corren un alto riesgo de ser revictimizadas en un proceso donde las diferentes instancias gubernamentales, entre ellas las de salud encargadas de su atención, no guardan los mínimos protocolos de atención en las circunstancias particulares de estas mujeres.

Medellin is the second largest city in the reception of internally displaced population, product of the armed conflict of the country. Even though sexual violence in this context is a State crime against humanity without limitations of power to prosecute, the country is barely beginning actions to undertake the problem, together with the processes of reparation, restitution and non-repetition, from Differential Treatment and gender-sensitive approaches. It is crucial to approach sexual violence from the actors of the armed conflict through the recognition of health as a fundamental human right, and from the gender-sensitive and socio-sanitary perspectives. However, in the advancement made so far, it can be argued that the essential guaranties of the right that these women have –in their condition of victims- become scarcely administrative, and they have a high risk of being re-victimized, in a process whereby the different governmental instances –including the instances of health care in charge of the attention to this population- do not keep the minimal attention protocols in the particular circumstances of these women.

A cidade de Medellín é a segunda receptora da população refugiada ocasionada pelo conflito armado na Colômbia, e ainda que a violência sexual neste contexto é um crime de Estado, de lesa a humanidade que não prescreve, o país está somente agora começando a tomar às ações necessárias para abordar a problemática junto com os processos de reparação, restituição e não repetição, desde um enfoque diferencial, e desde um ponto de vista gênero-sensível. É muito importante abordar a violência sexual causada pelos atores do conflito armado desde o reconhecimento da saúde como direito fundamental do ser humano e desde um ponto de vista gênero-sensível e sócio sanitário. Entretanto, até agora é possível afirmar que as garantias essenciais do direito que estas mulheres têm na sua condição de vítimas são apenas administrativas, e correm um alto risco de ser vítimas novamente em um processo onde as diferentes instâncias governamentais, entre as quais se encontram as de saúde que são responsáveis pelo seu atendimento, não possuem nenhum tipo de protocolo de atendimento para as circunstâncias especiais destas mulheres.

La atención de los varones en el espacio público de la salud en México Distrito Federal desde la mirada género sensible y sociosanitaria / Male attention in the public health space in México Federal District from a gender sensible and socio-sanitary perspective / Atenção dos homens no espaço público de saúde no México Distrito Federal desde um olhar gênero sensível e sócio-sanitário

El trabajo aborda las prácticas institucionales del personal de salud del sistema público de atención en la Secretaría de Salud del Gobierno del Distrito Federal (SSGDF) en varios hospitales de la red, forma parte de un trabajo más amplio, que constituye una tesis doctoral que se llevó a cabo entre 2003 y 2008 en la Ciudad de México. En esta ocasión se hace particular énfasis en el análisis y discusión de los hallazgos encontrados alrededor de la atención en salud a varones hetero y homosexuales, tanto en la población atendida como en la situación laboral del personal de salud identificada como homosexual prestando el servicio. Desde una mirada género sensible se puede concluir que ser hombre es un factor de riesgo para la atención y el cuidado de la salud y la prevención de la enfermedad; que, con población masculina hetero y homosexual, prevalecen los prejuicios sociales más que la preparación, desarrollo de habilidades y capacidades de atención de la problemática específicamente masculina dentro de los servicios. La exclusión, la discriminación, la desinformación muestran que el bagaje anatomofisiológico y la técnica quirúrgica o el conocimiento farmacéutico no son suficientes para brindar atención de calidad que hagan verdaderamente integrales las prácticas institucionales de salud llevadas a cabo por hombres y mujeres en el Sistema Público de atención de la Secretaría de Salud del Gobierno del Distrito Federal en México.

This article discusses the institutional practices of the health personnel from the public attention system from the Department of Health of the Federal District Government (SSGDF) in varioushospitals. The article is also part of a broader study, which constitutes a doctoral dissertation carried out between 2003 and 2008 in the city of Mexico. The study emphasizes analysis and discussions about the findings regarding health care to hetero and homosexual males, in both the population served, as well as people identified as homosexual within the personnel offering the health services. Concluding, from a gender sensitive perspective, being a male is a risk factorin health care and attention, as well as in disease prevention. Social prejudice still prevails with the hetero and homosexual male population, more than preparation and development ofattention skills specific to the male problem within health services. Exclusion, discrimination, and lack of information illustrate that the anatomy-physiologic burden and surgical technique or pharmaceutical knowledge are not enough to provide quality care. Care that could make the institutional health practices of the Department of Health of the Federal District Government in Mexico, truly comprehensive.

La violencia de género en las prácticas institucionales de salud: afectaciones del derecho a la salud y a las condiciones de trabajo en salud / Precautionary principle: perspectives involving human health aspects and environmental pollution

Este artículo tiene como objetivo analizar la violencia de género presente en las prácticas institucionales de salud ejercida al interior de los servicios ofrecidos por la Red Pública de Atención Hospitalaria de la Secretaría de Salud del Gobierno del Distrito Federal -SSGDF-. El abordaje se realizará desde la perspectiva de género, la salud colectiva y la medicina social. La problematización de las prácticas institucionales se hace a partir de la observación directa de diez de los veintiocho hospitales públicos de la red y el abordaje a profundidad de uno de ellos; por supuesto sus conclusiones no pretenden ser generalizables al sistema público de atención del Distrito Federal. Alientan este trabajo la reflexión en tres planos: la formación del recurso humano en salud, las relaciones de poder-subordinación, la relación médico-paciente y las posibilidades de concretar en el contexto institucional los derechos de las personas que son atendidas allí como de las personas que trabajan en la red.

This article has objective analyzed the gender violence in the health institutional practices in to the services offered by Public Network of hospitalary attention of the Health Secretary of Federal District Government of Mexico City. The approach has been made by gender perspective, collective health and social medicine. The problemize of institutional practices its made since direct observation exercise by ten to the twenty-eight public hospitals of the network and the deeply approach by one of them; of course, their conclusions don’t pretend be generalized to all public health systems by Federal District of Mexico City. Inspired this work the three lines of reflection: the human resources in health, formation, subordination-power relationship,medical-patient relationships and the possibilities of concrete in the institutional context the rights persons attended, like the rights of the persons that work there.

La masculinidad en el área de la salud sexual y reproductiva: un campo por descubrir / The masculinity en the field of reproductive and sexual health: a field to discover

El texto tiene varias lecturas: desde la sociodemografía; desde la salud sexual y reproductiva y desde la perspectiva de género. Tales lecturas llevan a proponer como tópicos a abordar en el texto dos referentes generales y uno específico. El primero es la investigación en masculinidad, un área que está en construcción; el segundo está constituído por las relaciones económicas, espacio en el cual también se lleva a cabo la interrelación de hombres y mujeres y por lo tanto, la construcción de sociedad. El eje específico alude a la salud sexual y reproductiva como parte del área de la salud y por consiguiente, del actual Sistema General de Seguridad Social en Salud; este apartado remite a consideraciones relacionadas con los servicios de salud, el relacionamiento sexual y reproductivo de las parejas, los derechos reproductivos, la formación del personal de salud, los programas institucionales, los requerimientos y demandas de los usuarios y el pacto relacional básico del paternar y el maternar