[Women's rescuers network: Community support for self-managed abortion in Argentina]. / Socorristas en red: Soporte comunitario a la autogestión del aborto en Argentina.

The availability of medications to induce abortion, especially in contexts of restricted access, has transformed practices and allowed women and/or their community organizations to assist other women in obtaining abortions, whether or not they interact with the healthcare system. This study recovers the experience of a feminist community organization that, from the province of Neuquén, extends throughout the country, creating a network of community care. An exploratory descriptive study with a qualitative approach was conducted to analyze the experiences of women who facilitate access to permitted abortion in Argentina. Through in-depth interviews with three leaders of the feminist collective La Revuelta and semi-structured interviews with 33 members of the socorrista groups, conducted between November 2019 and December 2020, we describe their history and processes of work and growth; we explore their motivations and feelings and characterize the interactions of these organizations with public and private health systems. The results of this work align with the international conversation and bibliographic production about these organizations and their particularities, and with the need to incorporate these forms of care into institutional health systems.

La disponibilidad de medicamentos para producir un aborto, sobre todo en contextos de acceso restringido, transformó las prácticas y permitió que las propias mujeres y/o sus organizaciones comunitarias ayuden a otras mujeres a abortar, interactuando o no con el sistema de salud. Este estudio recupera la experiencia de una organización feminista de la comunidad que, desde la provincia de Neuquén, se extiende a todo el país, generando una red de cuidados comunitarios. Se realizó un estudio exploratorio descriptivo, con enfoque cualitativo con el propósito de analizar las experiencias de las mujeres que facilitan el acceso al aborto permitido en Argentina. A través de entrevistas en profundidad a tres líderes de la colectiva feminista La Revuelta y de entrevistas semiestructuradas a 33 integrantes de las grupas socorristas, realizadas entre noviembre de 2019 y diciembre de 2020, describimos su historia y los procesos de trabajo y crecimiento; exploramos sus motivaciones y sentimientos y caracterizamos las interacciones de dichas organizaciones con los sistemas de salud público y privado. Los resultados de este trabajo coinciden con la conversación y la producción bibliográfica internacional acerca de estas organizaciones y sus particularidades y con la necesidad de incorporar estos cuidados a los sistemas de salud institucionales.

Socorristas en red: Soporte comunitario a la autogestión del aborto en Argentina / Women's rescuers network: Community support for self-managed abortion in Argentina

RESUMEN La disponibilidad de medicamentos para producir un aborto, sobre todo en contextos de acceso restringido, transformó las prácticas y permitió que las propias mujeres y/o sus organizaciones comunitarias ayuden a otras mujeres a abortar, interactuando o no con el sistema de salud. Este estudio recupera la experiencia de una organización feminista de la comunidad que, desde la provincia de Neuquén, se extiende a todo el país, generando una red de cuidados comunitarios. Se realizó un estudio exploratorio descriptivo, con enfoque cualitativo con el propósito de analizar las experiencias de las mujeres que facilitan el acceso al aborto permitido en Argentina. A través de entrevistas en profundidad a tres líderes de la colectiva feminista La Revuelta y de entrevistas semiestructuradas a 33 integrantes de las grupas socorristas, realizadas entre noviembre de 2019 y diciembre de 2020, describimos su historia y los procesos de trabajo y crecimiento; exploramos sus motivaciones y sentimientos y caracterizamos las interacciones de dichas organizaciones con los sistemas de salud público y privado. Los resultados de este trabajo coinciden con la conversación y la producción bibliográfica internacional acerca de estas organizaciones y sus particularidades y con la necesidad de incorporar estos cuidados a los sistemas de salud institucionales.

ABSTRACT The availability of medications to induce abortion, especially in contexts of restricted access, has transformed practices and allowed women and/or their community organizations to assist other women in obtaining abortions, whether or not they interact with the healthcare system. This study recovers the experience of a feminist community organization that, from the province of Neuquén, extends throughout the country, creating a network of community care. An exploratory descriptive study with a qualitative approach was conducted to analyze the experiences of women who facilitate access to permitted abortion in Argentina. Through in-depth interviews with three leaders of the feminist collective La Revuelta and semi-structured interviews with 33 members of the socorrista groups, conducted between November 2019 and December 2020, we describe their history and processes of work and growth; we explore their motivations and feelings and characterize the interactions of these organizations with public and private health systems. The results of this work align with the international conversation and bibliographic production about these organizations and their particularities, and with the need to incorporate these forms of care into institutional health systems.

High Cardiac Troponin Levels in Infants with Acute SARS-CoV-2 Infection: A Prospective Comparative Study.

OBJECTIVE: To investigate the specific role of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in inducing elevation of marker of myocardial injury in infants with acute coronavirus disease 2019 (COVID-19). STUDY DESIGN: A prospective, multicentric 3-arm comparative study (March 2020 through March 2022) enrolling 152 infants hospitalized for COVID-19, 79 children with acute infections other than SARS-CoV-2, and 71 healthy controls. Determination of high-sensitivity cardiac troponin (hs-cTn) levels was the primary outcome. RESULTS: The proportion of children with hs-cTn values above the upper limit of normal (44 [28.9%]), as well as with a 3-fold increased value (20 [13.2%]) were significantly higher in the COVID-19 group than those in both control groups. The risk of presenting a 3-fold increased hs-cTn value was higher in children with SARS-CoV-2 infection compared with either healthy children (OR, 5.23; 95% CI, 1.19-23.02) or those with other infections (OR, 11.89; 95% CI, 1.56-89.79). In children with COVID-19, hs-cTn elevation was associated with neither clinical nor biochemical characteristics, nor perinatal risk factors, but with an age of <3 months (P < .001). After adjustment for age, sex, and underlying clinical conditions, elevated hs-cTn was independently associated with COVID-19 in a multivariable regression model. All children showed a progressive reduction of hs-cTn until normalization over time, without clinical, ECG, or echocardiographic manifestations up to 1 year of follow-up. CONCLUSIONS: Infants with acute SARS-CoV-2 infection may show a subclinical and transient alteration of myocardial injury markers, especially in the first months of life. hs-cTn levels normalized during follow-up and were not associated with cardiac functional impairment; nevertheless, long-term consequences are unknown and should be followed carefully.

Chemical Characterization, Antioxidant Capacity and Anti-Oxidative Stress Potential of South American Fabaceae Desmodium tortuosum.

It has been proposed that oxidative stress is a pathogenic mechanism to induce cytotoxicity and to cause cardiovascular and neuronal diseases. At present, natural compounds such as plant extracts have been used to reduce the cytotoxic effects produced by agents that induce oxidative stress. Our study aimed to evaluate the antioxidant and cytoprotective capacity of Desmodium tortuosum (D. tortuosum) extract in the co- and pre-treatment in EA.hy926 and SH-SY5Y cell lines subjected to oxidative stress induced by tert-butylhydroperoxide (t-BOOH). Cell viability, reactive oxygen species (ROS), nitric oxide (NO), caspase 3/7 activity, reduced glutathione (GSH), glutathione peroxidase (GPx), glutathione reductase (GR), and molecular expression of oxidative stress biomarkers (SOD2, NRF2 and NFκB1) and cell death (APAF1, BAX, Caspase3) were all evaluated. It was observed that the D. tortuosum extract, in a dose-dependent manner, was able to reduce the oxidative and cytotoxicity effects induced by t-BOOH, even normalized to a dose of 200 µg/mL, which would be due to the high content of phenolic compounds mainly phenolic acids, flavonoids, carotenoids and other antioxidant compounds. Finally, these results are indicators that the extract of D. tortuosum could be a natural alternative against the cytotoxic exposure to stressful and cytotoxic chemical agents.

Water quality analysis based on phytoplankton and metal indices: a case study in the Sauce Grande River Basin (Argentina).

The increasing landscape alterations due to anthropogenic activities is of global concern since it affects aquatic ecosystems, often resulting in compromise of the ecological integrity and the water quality. In this sense, the evaluation, monitoring, and prediction of the aquatic ecosystem quality becomes an important research subject. This study presents the first integrated water quality assessment of the Sauce Grande River Basin, in Argentina, based on the spatial distribution of the phytoplankton community, the physicochemical parameters, and the metal concentrations (Cd, Cu, Cr, Fe, Mn, Ni, Pb, and Zn) found in the particulate fraction. According to the trophic indices and the phytoplankton abundance, composition, and diversity, the water quality showed significant deterioration in the lower basin after the Sauce Grande lake. The trophic state index indicated that water was oligotrophic in over 75% of the sampling sites, increasing downstream, where two sites were characterized as mesotrophic, and one described as hypertrophic. The phytoplankton community was dominated by diatoms in zones with low anthropogenic impact and conductivity, whereas high densities of Euglenophyta, Chlorophyta, and Cyanobacteria were found in the middle-lower basin, associated with higher organic matter and eutrophication. The conductivity, turbidity, and most metal concentrations also increased towards the downstream area, even exceeding recommended levels for the metals Cu, Cr, Mn, and Pb in the middle and lower reaches of the basin (Cu: 3.5 µg L-1; Cr: 2.4 µg L-1; Pb: 1.2 µg L-1; Mn 170 µg L-1). This study generates a database for the water quality of the Sauce Grande River Basin and sets an example of how the water quality varies along a basin that crosses different topographic environments, land covers, and anthropogenic influences.

Experiences of women with Zika virus (ZIKV) versus the provision of health services in two cities in Colombia: A qualitative study.

BACKGROUND: In February 2016, the World Health Organization (WHO) declared the epidemic of the ZIKA virus (ZIKV) in Latin America to be a public health emergency. In Colombia, 11,944 pregnant women registered a ZIKV infection during the epidemic. So far, little is known about the experiences of women infected with ZIKV during their pregnancy, especially those relating to the provision of health services during the period of the epidemic. OBJECTIVE: To explore the experiences of pregnant women diagnosed with ZIKV infection about the provision of health services in two Colombian cities, considering the perspective of sexual and reproductive rights. METHODS: Qualitative study under the grounded theory approach, which uses semi-structured interviews as tools to explore the biographical experience of mothers during their gestation process and ZIKV infection, dividing the interview into two broad categories: before and during pregnancy. RESULTS: Twenty-two women were interviewed, 10 in Cali and 12 in Villavicencio. The average age at the time of pregnancy was 27.6 years. Most women were not planning at the time of pregnancy and the pregnancy was unwanted. Most campaigns focused on mosquito eradication rather than on sexual and reproductive health campaigns. The quality of health care was not sufficient, adequate, or appropriate. Also, the breakdown of the health system to deal with the pandemic was also noted. Some women were treated with disrespect by health professionals. Voluntary termination of pregnancy was inadequately advised, and women lost autonomy regarding decisions about their health. CONCLUSIONS: In the health care of ZIKV epidemics, it is necessary to include the gender perspective, more specifically, sexual and reproductive rights. In addition, these epidemics must be addressed through a comprehensive, appropriate, and not fragmented health system, in which sexual and reproductive rights must be mainstreamed in all health promotion and prevention programs.

Assessing threats, regulations, and strategies to abate plastic pollution in LAC beaches during COVID-19 pandemic.

Plastic use and production have dramatically increased globally over the past 65 years with the improvement of life quality by the daily use of plastic products. Still, around 50% of the plastic produced is disposable products that generate substantial waste. Several reports pointed out the adverse effects of plastic litter in coastal environments in recent years, emphasizing single-use plastics (SUP). In this manner, Latin America and the Caribbean (LAC) coastal environments are highly vulnerable due to wastewater treatment facilities scarcity and poor plastic waste management strategies. Since COVID-19 pandemic, the single-use plastic waste/person rate is expected to rise due to the use of personal protective equipment and SUP as health care measures. Based on literature research and the review of plastic waste regulations, this paper will assess the main COVID-19 plastic pollution threats and LAC beaches' regulations to suggest possible measures to abate this problem. The main findings suggest that unifying the ongoing fragmented and overlapped policies is key to abate plastic pollution, including plastic industry regulations and circular economies. In addition, increasing public risk perception about plastic pollution is critical to reducing plastic waste generation. Research advances in the adverse effects of plastic debris could improve the public's perception of plastic pollution risk, pushing forward global marine plastic governance.

Feasibility and functional correlates of left atrial volume changes during stress echocardiography in chronic coronary syndromes.

An enlarged left atrial volume index (LAVI) at rest mirrors increased LA pressure and/or impairment of LA function. A cardiovascular stress may acutely modify left atrial volume (LAV) within minutes. Aim of this study was to assess the feasibility and functional correlates of LAV-stress echocardiography (SE) Out of 514 subjects referred to 10 quality-controlled labs, LAV-SE was completed in 490 (359 male, age 67 ± 12 years) with suspected or known chronic coronary syndromes (n = 462) or asymptomatic controls (n = 28). The utilized stress was exercise in 177, vasodilator in 167, dobutamine in 146. LAV was measured with the biplane disk summation method. SE was performed with the ABCDE protocol. The intra-observer and inter-observer LAV variability were 5% and 8%, respectively. ∆-LAVI changes (stress-rest) were negatively correlated with resting LAVI (r = - 0.271, p < 0.001) and heart rate reserve (r = -.239, p < 0.001). LAV-dilators were defined as those with stress-rest increase ≥ 6.8 ml/m2, a cutoff derived from a calculated reference change value above the biological, analytical and observer variability of LAVI. LAV dilation occurred in 56 patients (11%), more frequently with exercise (16%) and dipyridamole (13%) compared to dobutamine (4%, p < 0.01). At multivariable logistic regression analysis, B-lines ≥ 2 (OR: 2.586, 95% CI = 1.1293-5.169, p = 0.007) and abnormal contractile reserve (OR: 2.207, 95% CI = 1.111-4.386, p = 0.024) were associated with LAV dilation. In conclusion, LAV-SE is feasible with high success rate and low variability in patients with chronic coronary syndromes. LAV dilation is more likely with reduced left ventricular contractile reserve and pulmonary congestion.

Utilidad de pGALS como prueba de tamizaje en niños y adolescentes en Colombia. Estudio transversal / Usefulness of pGALS as a screening test in children and adolescents in Colombia. Cross-sectional study

RESUMEN Introducción: La identificación temprana de trastornos del sistema musculoesquelético (SME) en pediatría permite realizar enfoque y tratamiento adecuado. pGALS (pediatric Gait, Arms, Legs and Spine) es una herramienta utilizada en la evaluación de niños con enfermedad osteomuscular previa. En la literatura revisada no se encontraron en Colombia estudios que apliquen pGALS como prueba de tamizaje. Objetivos: Identificar la utilidad de pGALS como prueba de tamizaje en niños y adolescentes en Colombia. Materiales y métodos: Estudio descriptivo, de corte transversal, que incluyó niños y adolescentes de 6 a 16 anos sin diagnóstico previo de enfermedad osteomuscular de etiología inflamatoria o autoinmune, a quienes se evaluó con pGALS en sus viviendas y sus colegios durante septiembre y octubre de 2018. Resultados: Se incluyeron 169 pacientes, edad promedio de 9,43 años. Se encontraron alteraciones en pGALS en el 66,85% de los participantes. La respuesta positiva a la primera pregunta de la exploración tuvo una sensibilidad del 91,3%, una especificidad del 53%, una razón de verosimilitud positiva de 1,9 y una razón de verosimilitud negativa de 0,16 para identificar alteraciones en el SME. La respuesta positiva a cualquiera de las tres preguntas tuvo asociación estadísticamente significativa para encontrar pGALS alterado (p = 0,001), sensibilidad 58%, especificidad 94%, razón de verosimilitud positiva de 9,3 y razón de verosimilitud negativa de 0,44. La aceptación de los pacientes de pGALS fue del 95,3%. El tiempo promedio en el que se realizó la prueba fue de 2:27 min. Conclusiones: PGALS es una herramienta de aplicación rápida y fácil, bien tolerada por los pacientes y que permite identificar trastornos del SME en la población pediátrica.

ABSTRACT Introduction: The early identification of disorders of the musculoskeletal system in paediatrics should be of use in their approach and treatment. pGALS (paediatric Gait, Arms, Legs and Spine) is a tool used for evaluation of children with previous musculoskeletal disease. No studies were found in the literature reviewed that used pGALS as a screening test in pGALS Colombia. Objective: To identify the usefulness of pGALS as a screening test in children and adolescents in Colombia. Materials and methods: Descriptive, cross-sectional study, which included children and adolescents, aged 6 to 16 years without a previous diagnosis of inflammatory or autoimmune skeletomuscular disease, who were evaluated with pGALS in their homes and in their schools during September and October 2018. Results: The study included 169 patients, with a mean age of 9.43years. Changes in pGALS were observed in 66.85% of the participants. The positive response to the first question in the examination had a sensitivity of 91.3%, a specificity of 53%, a positive likelihood ratio of 1.9, and negative likelihood ratio of 0.16 to identify changes in the musculoskeletal system. The positive response to any of the three questions had a statistically significant association to find altered pGALS (P = .001), sensitivity 58%, specificity 94%, positive likelihood ratio of 9.3, and negative likelihood ratio of 0.44. The acceptance by pGALS patients was 95.3%. The mean time to perform the test was 2:27 minutes. Conclusions: PGALS is a quick and easy tool that is well tolerated by patients, and helps in the identification of musculoskeletal system disorders in the paediatric population.

Microplastics integrating the zooplanktonic fraction in a saline lake of Argentina: influence of water management.

This study address for the first time in Argentina and the South American continent the effect of water management on the presence of microplastics (MPs) in a shallow lake, assessing their contribution to the zooplankton fraction. Water samples were collected in the lake and its principal affluent, an irrigation channel, from winter 2018 to summer 2019 with a zooplankton net (47 µm). MPs were present in all analyzed samples, with a dominance of fibers, black color, and ≤ 1000 µm range size. MPs concentration was maximum during summer at the lake (180 MPs m-3) while during spring (140 MPs m-3) at the channel. Rotifers and cyclopoids dominated the zooplanktonic fraction at both sites which range sizes (< 200 to 600 µm) included most of the size range found for MPs (50-950 µm). According to our results, the MPs found represents a potential risk for the first levels of the food web. In the lake, the concentration of MPs concerning total zooplankton abundance was higher when the channel was closed. Nevertheless, when the channel was open, the higher concentration in summer matches with the increase of tourism and an extraordinary rainfall. Our results suggest that while the runoff of agro-industrial waste regulates the MPs concentration in the channel, its water management, the touristic activities, and the runoff of MPs from nearby urban settlements regulate the concentration of MPs in the lake. These findings emphasize the need for better treatment of urban and agro-industrial waste that develops near continental aquatic systems, mainly in those where tourism activities are frequent and treatment facilities scarce.

Efectividad y seguridad del uso de micronutrientes en polvo para tratamiento de niños con anemia: revisión sistemática / Effectiveness and safety of the use of micronutrients in powder for treatment of children with Anemia: A systematic review / Efetividade e segurança do uso de micronutrientes em pó no tratamento de crianças com anemia: revisão sistemática

Resumen Objetivo: Estimar la efectividad del uso de micronutrientes en polvo, comparado con otras intervenciones para tratamiento de niños con anemia. Metodología: Se realizó revisión sistemática, en las siguientes bases de datos: Medline, EMBASE, CENTRAL, LILACS, Psycinfo, Clinicaltrials.gov, Google scholar; open gray y resúmenes de congresos. No restricción de idioma, se incluyeron ensayos clínicos controlados, hasta enero de 2017. Resultados: Se identificaron 14.735 artículos; 3 estudios cumplieron con los criterios de inclusión: Kounnavong, 2011, Lemaire, 2011 y Hirve, 2007. Kounnavong concluyó que la suplementación con MMP tuvo efectos positivos en la reducción de la prevalencia de la anemia y en el mejoramiento de la concentración de hemoglobina; Hirve evidenció un aumento significativo de la Hemoglobina a las 3 y a las 8 semanas en todos los grupos sin diferencias significativas entre ellos. En el estudio de Lemaire, la hemoglobina fue mayor para los sujetos asignados al azar en el grupo que recibe MNP a 2 meses. Conclusiones: No es posible estimar la efectividad del uso de micronutrientes en polvo, comparado con otras intervenciones para tratamiento de niños con anemia, debido a la insuficiencia y heterogeneidad clínica de los estudios incluidos.

Abstract Objective: To estimate the effectiveness of micronutrient powder use compared to other interventions for the treatment of children with anemia. Methodology: A systematic review was carried out in the following databases: Medline, EMBASE, CENTRAL, LILACS, Psycinfo, Clinicaltrials.gov, Google scholar, open gray and conference abstracts. There was no language restriction, only controlled clinical trials were considered, until January 2017. Results: A total of 14,735 articles were identified, of which three studies met the inclusion criteria: Kounnavong, 2011, Lemaire, 2011 and Hirve, 2007. The Kounnavong study concluded that MMP supplementation had positive effects in reducing the prevalence of anemia and in improving hemoglobin concentration; in the Hirve study there was a significant increase in hemoglobin at 3 and 8 weeks at all groups with no significant differences between them. Finally in the Lemaire study hemoglobin was higher for subjects randomized in the group receiving MNP at 2 months. Conclusions: It is not possible to estimate the effectiveness of micronutrient powder use compared to other interventions for the treatment of children with anemia, due to the insufficiency and clinical heterogeneity of the included studies.

Resumo Objetivo: Estimar a eficácia do uso de micronutrientes em pó em comparação com outras intervenções no tratamento de crianças com anemia. Metodologia: Foi realizada uma revisão sistemática nos seguintes bancos de dados: Medline, EMBASE, CENTRAL, LILACS, Psycinfo, Clinicaltrials.gov, Google scholar, cinza aberto e anais de conferências. Sem restrição de idioma, foram incluídos ensaios clínicos controlados até janeiro de 2017. Resultados: foram identificados 14.735 artigos; 3 estudos preencheram os critérios de inclusão: Kounnavong, 2011, Lemaire, 2011 e Hirve, 2007. Kounnavong concluiu que a suplementação de MNP teve efeitos positivos na redução da prevalência de anemia e na melhoria da concentração de hemoglobina; Hirve mostrou um aumento significativo na hemoglobina em 3 e 8 semanas em todos os grupos, sem diferenças significativas entre eles. No estudo de Lemaire, a hemoglobina foi maior em indivíduos randomizados no grupo que recebeu MNP aos 2 meses. Conclusões: Não é possível estimar a eficácia do uso de micronutrientes em pó em comparação com outras intervenções para o tratamento de crianças com anemia, devido à insuficiência e heterogeneidade clínica dos estudos incluídos.

Beneficial effects of murtilla extract and madecassic acid on insulin sensitivity and endothelial function in a model of diet-induced obesity.

Infusions of murtilla leaves exhibit antioxidant, analgesic, and anti-inflammatory properties. Several compounds that are structurally similar to madecassic acid (MA), a component of murtilla leaf extract (ethyl acetate extract, EAE), have been shown to inhibit protein tyrosine phosphatase 1B (PTP1P). The aim of this study was to evaluate if EAE and two compounds identified in EAE (MA and myricetin [MYR]) could have a beneficial effect on systemic and vascular insulin sensitivity and endothelial function in a model of diet-induced obesity. Experiments were performed in 5-week-old male C57BL6J mice fed with a standard (LF) or a very high-fat diet (HF) for 4 weeks and treated with EAE, MA, MYR, or the vehicle as control (C). EAE significantly inhibited PTP1B. EAE and MA, but not MYR, significantly improved systemic insulin sensitivity in HF mice and vascular relaxation to Ach in aorta segments, due to a significant increase of eNOS phosphorylation and enhanced nitric oxide availability. EAE, MA, and MYR also accounted for increased relaxant responses to insulin in HF mice, thus evidencing that the treatments significantly improved aortic insulin sensitivity. This study shows for the first time that EAE and MA could constitute interesting candidates for treating insulin resistance and endothelial dysfunction associated with obesity.

Soporte comunitario a la autogestión del aborto en Argentina / Community support for abortion self-management in Argentina

La disponibilidad de misoprostol para producir la interrupción del embarazo en contextos donde el acceso al aborto está restringido ha transformado las prácticas y permite que las propias mujeres y/o sus organizaciones comunitarias ayuden a otras mujeres a abortar interactuando, o no, con el sistema de salud. Este estudio se propone caracterizar la experiencia estas organizaciones, evaluar los impactos en términos simbólicos, sanitarios y económicos y describir las interacciones con el sistema de salud. La metodología combina métodos cualitativos y cuantitativos. Se aplicaron entrevistas en profundidad a líderes históricas de las organizaciones, entrevistas semiestructuradas a militantes actuales y una encuesta autoadministrada a proveedores de salud. Se realizó un estudio del impacto presupuestario de este accionar sobre el sistema de salud

Sociocultural dynamics that influence Chagas disease health care in Colombia.

Chagas disease (CD) is a Latin America endemic and neglected tropical disease that affects primarily poor people living in rural areas. Its current low profile leads to many diagnostic, treatment, and control challenges. This study aimed to identify and characterize the sociocultural dynamics that influence CD health care in Colombia. Data for our ethnographic study was collected in 2013 and included participant observation in two main endemic areas in Colombia. In addition, 81 people belonging to four groups (patients and family members; health care workers; researchers; and officers) were recruited through snowball sampling technique and participated in informal and semi-structured interviews. People from the first two groups also participated in social cartography excercises. Data analysis resulted in the identification of three main sociocultural dynamics. Local Understandings: Patients reported confusions around disease transmission, treatment effectiveness and development of future complications. Providers' Knowledge and Training: Failures in professional's knowledge and training mostly affect the primary level of care in rural areas. Professionals undergo minimal training during medical school and lack access to continuous education. In contrast, clinicians working at tertiary university hospitals or at the CD unit of the Colombian National Institute of Health (NIH) exhibited great knowledge and competency. Health Care System Barriers: The Colombian market-based health care reform augmented access barriers, which impacted CD care greatly. We identified geographic and bureaucratic itineraries that depended on type of insurance plan, insurance contracts with service providing institutions, and levels of care. This study shows that people's experience of these sociocultural dynamics vary depending on their mobility from rural to urban contexts. It unveils the importance of analyzing the structure of the health care system. In the Colombian case, its for-profit orientation has become one of the most important obstacles for comprehensive, integrated, and timely health care responses.

Horacio Ferrer Díaz, médico, combatiente y escritor matancero / Horacio Ferrer Díaz, physician, fighter and writer from Matanzas

El estudio descriptivo de personalidades de la provincia debe formar parte de un proyecto para enriquecer el conocimiento de todos los profesionales matanceros vinculados con las ciencias médicas y la historia, que a su vez serán los que preparen a los estudiantes de las ciencias médicas para su formación integral. Esta es la razón fundamental por la que seleccionamos al eminente médico Horacio Ferrer Díaz, que en el siglo xix prestigió el terruño. Fue un notable galeno, especializado en oftalmología, quien combinó su desempeño profesional con las actividades revolucionarias en defensa de la independencia de Cuba. Fue inventor de un aparato para estudiar la retina y otro para extraer la catarata al vacío y de una mesa giratoria de reconocimiento única en el mundo. Publicó "La Fonometría antes y después de la operación de catarata", y fue el primero que operó un paciente con desprendimiento de retina en Cuba. Hijo de la tierra unionense, Ferrer Díaz debe ser recordado por siempre por sus aportes médicos y su gran activismo político en las filas mambisas, donde adquiere grados militares, y en contra del gobierno de Machado y la dictadura de Batista después. El recuento de la historia en las guerras independentistas queda plasmado para todos los cubanos en su obra Con el rifle al hombro, escrita en su ancianidad (AU).

The descriptive study of the province's personalities should be a part of a project to enhance the knowledge of all Matanzasan professional related with the medical sciences and the history, who are in their turn the ones who are going to train the medical sciences students for their comprehensive education. That is the main reason of choosing the personality of the eminent doctor Horacio Ferrer Díaz, who gave prestige to our native province. He was a notable physician, specialized in Ophthalmology, who combined his professional performance with the revolutionary activities in defense of the Cuban independence. He was the inventor of a device to study the retina and another to vacuum extract the cataract, and a rotating table of examination that was unique in the world. He published "Photometry before and after the cataract surgery" and was the first one who operated a patient with retinal detachment in Cuba. A son of the region of Union, Ferrer Díaz should be recollected forever because of his medical contributions and his great political activism at the service of the independence fighters against the Spanish colonialism, where he obtained military ranks, and against the government of Gerardo Machado and Batista's dictatorship later. The recount of independent wars was reflected in his work With the rifle on the shoulder, written in his old age (AU).

Horacio Ferrer Díaz, médico, combatiente y escritor matancero / Horacio Ferrer Díaz, physician, fighter and writer from Matanzas

El estudio descriptivo de personalidades de la provincia debe formar parte de un proyecto para enriquecer el conocimiento de todos los profesionales matanceros vinculados con las ciencias médicas y la historia, que a su vez serán los que preparen a los estudiantes de las ciencias médicas para su formación integral. Esta es la razón fundamental por la que seleccionamos al eminente médico Horacio Ferrer Díaz, que en el siglo xix prestigió el terruño. Fue un notable galeno, especializado en oftalmología, quien combinó su desempeño profesional con las actividades revolucionarias en defensa de la independencia de Cuba. Fue inventor de un aparato para estudiar la retina y otro para extraer la catarata al vacío y de una mesa giratoria de reconocimiento única en el mundo. Publicó "La Fonometría antes y después de la operación de catarata", y fue el primero que operó un paciente con desprendimiento de retina en Cuba. Hijo de la tierra unionense, Ferrer Díaz debe ser recordado por siempre por sus aportes médicos y su gran activismo político en las filas mambisas, donde adquiere grados militares, y en contra del gobierno de Machado y la dictadura de Batista después. El recuento de la historia en las guerras independentistas queda plasmado para todos los cubanos en su obra Con el rifle al hombro, escrita en su ancianidad (AU).

The descriptive study of the province's personalities should be a part of a project to enhance the knowledge of all Matanzasan professional related with the medical sciences and the history, who are in their turn the ones who are going to train the medical sciences students for their comprehensive education. That is the main reason of choosing the personality of the eminent doctor Horacio Ferrer Díaz, who gave prestige to our native province. He was a notable physician, specialized in Ophthalmology, who combined his professional performance with the revolutionary activities in defense of the Cuban independence. He was the inventor of a device to study the retina and another to vacuum extract the cataract, and a rotating table of examination that was unique in the world. He published "Photometry before and after the cataract surgery" and was the first one who operated a patient with retinal detachment in Cuba. A son of the region of Union, Ferrer Díaz should be recollected forever because of his medical contributions and his great political activism at the service of the independence fighters against the Spanish colonialism, where he obtained military ranks, and against the government of Gerardo Machado and Batista's dictatorship later. The recount of independent wars was reflected in his work With the rifle on the shoulder, written in his old age (AU).

Incidencia de la diabetes mellitus en Cuba, según tipo, en menores de 18 años de edad / Incidence of diabetes mellitus in Cuba in children under 18 years by type

Introducción: la diabetes mellitus tipo 2 en niños y adolescentes está alcanzando proporciones alarmantes. Desde la década de los 90, se asiste a la aparición, cada vez más frecuente, de este fenómeno, el cual parece ser una consecuencia del preocupante aumento de la obesidad en la población, proceso que va acompañado también de insulinorresistencia. Objetivo: describir el comportamiento del incremento de la incidencia de la diabetes mellitus tipo 2 con respecto a la tipo 1, en individuos hasta 18 años de edad, Cuba, 2013-2015. Métodos: se realizó un estudio observacional descriptivo. La población de estudio fue la diagnosticada como diabética de 1 a 18 años, tipo 1 y tipo 2. Los datos estadísticos se tomaron del Registro Nacional de Dispensarización de Diabetes Mellitus correspondiente a los años 2013, 2014 y 2015. Resultados: el comportamiento global de la Razón de Tasas de Incidencia, en los años estudiados, fue fluctuante en la diabetes mellitus tipo 2; mientras que, en la diabetes mellitus tipo 1, se elevó en el periodo 2013-2014 y durante el 2014-2015 existió un notable descenso. La Razón de Tasas de Incidencia (diabetes mellitus tipo 2/diabetes mellitus tipo 1) es mayor que 1, solo en el grupo de edad de 15 a 18 años, correspondientes a los años 2013 y 2014. A medida que incrementa la edad, se eleva esta Razón de Tasas de Incidencia. Conclusiones: la incidencia de diabetes mellitus tipo 2 en los grupos de edades estudiados, se incrementa a medida que incrementa la edad, mientras que la incidencia de la DM 1 disminuye con el incremento de esta(AU)

Introduction: type 2 diabetes mellitus in children and adolescents is reaching alarming proportions. Since the 1990s, we are witnessing the increasingly frequent appearance of this phenomenon, which seems to be a consequence of the worrying increase in obesity in the population, a process that is also accompanied by insulin resistance. Objective: to describe the behavior of the increase in the incidence of type 2 diabetes mellitus with respect to type 1 in individuals up to 18 years old in Cuba from 2013 to 2015. Methods: a descriptive observational study was carried out. The study population was the one diagnosed as diabetic from 1 to 18 years old, type 1 and type 2. The statistical data were taken from the National Registry of Classification of Diabetes Mellitus corresponding to the years 2013, 2014 and 2015. Results: the overall behavior of the Incidence´s Rate Ratio in the years studied was fluctuating in type 2 diabetes mellitus; while in type 1 diabetes mellitus, it increased in the period 2013-2014, and during 2014-2015 there was a notable decrease. The Incidence´s Rate Ratio (diabetes mellitus type 2/diabetes mellitus type 1) is higher than 1 only in the age group of 15 to 18 years, corresponding to the years 2013 and 2014. As the age increases, it raises this Incidence´s Rate Ratio. Conclusions: the incidence of type 2 diabetes mellitus in the age groups studied increases as age increases, while the incidence of type 1 decreases with the increase of age(AU)

Incidencia de la diabetes mellitus en Cuba, según tipo, en menores de 18 años de edad / Incidence of diabetes mellitus in Cuba in children under 18 years by type

Introducción: la diabetes mellitus tipo 2 en niños y adolescentes está alcanzando proporciones alarmantes. Desde la década de los 90, se asiste a la aparición, cada vez más frecuente, de este fenómeno, el cual parece ser una consecuencia del preocupante aumento de la obesidad en la población, proceso que va acompañado también de insulinorresistencia. Objetivo: describir el comportamiento del incremento de la incidencia de la diabetes mellitus tipo 2 con respecto a la tipo 1, en individuos hasta 18 años de edad, Cuba, 2013-2015. Métodos: se realizó un estudio observacional descriptivo. La población de estudio fue la diagnosticada como diabética de 1 a 18 años, tipo 1 y tipo 2. Los datos estadísticos se tomaron del Registro Nacional de Dispensarización de Diabetes Mellitus correspondiente a los años 2013, 2014 y 2015. Resultados: el comportamiento global de la Razón de Tasas de Incidencia, en los años estudiados, fue fluctuante en la diabetes mellitus tipo 2; mientras que, en la diabetes mellitus tipo 1, se elevó en el periodo 2013-2014 y durante el 2014-2015 existió un notable descenso. La Razón de Tasas de Incidencia (diabetes mellitus tipo 2/diabetes mellitus tipo 1) es mayor que 1, solo en el grupo de edad de 15 a 18 años, correspondientes a los años 2013 y 2014. A medida que incrementa la edad, se eleva esta Razón de Tasas de Incidencia. Conclusiones: la incidencia de diabetes mellitus tipo 2 en los grupos de edades estudiados, se incrementa a medida que incrementa la edad, mientras que la incidencia de la DM 1 disminuye con el incremento de esta(AU)

Introduction: type 2 diabetes mellitus in children and adolescents is reaching alarming proportions. Since the 1990s, we are witnessing the increasingly frequent appearance of this phenomenon, which seems to be a consequence of the worrying increase in obesity in the population, a process that is also accompanied by insulin resistance. Objective: to describe the behavior of the increase in the incidence of type 2 diabetes mellitus with respect to type 1 in individuals up to 18 years old in Cuba from 2013 to 2015. Methods: a descriptive observational study was carried out. The study population was the one diagnosed as diabetic from 1 to 18 years old, type 1 and type 2. The statistical data were taken from the National Registry of Classification of Diabetes Mellitus corresponding to the years 2013, 2014 and 2015. Results: the overall behavior of the Incidence´s Rate Ratio in the years studied was fluctuating in type 2 diabetes mellitus; while in type 1 diabetes mellitus, it increased in the period 2013-2014, and during 2014-2015 there was a notable decrease. The Incidence´s Rate Ratio (diabetes mellitus type 2/diabetes mellitus type 1) is higher than 1 only in the age group of 15 to 18 years, corresponding to the years 2013 and 2014. As the age increases, it raises this Incidence´s Rate Ratio. Conclusions: the incidence of type 2 diabetes mellitus in the age groups studied increases as age increases, while the incidence of type 1 decreases with the increase of age(AU)

Impacto bio-psico-social del uso indiscriminado de dispositivos de audio / Bio-Psycho-social impact of the indiscriminate use of audio devices

La sociedad del siglo XXI se caracteriza por un gran desarrollo de la ciencia y las tecnologías y, esto entre otras causas, ha generado un uso indiscriminado de dispositivos de audio que a su vez traen consigo contaminación sonora y repercusiones negativas en la salud del hombre. El objetivo general de esta investigación fue determinar la discapacidad auditiva producida por el uso de dispositivos de audio, entre jóvenes y adolescentes. Se realizó estudio observacional, descriptivo y prospectivo de los pacientes con sintomatología audiológica, que asistieron a las consultas de Otocirugía y Audiología del Hospital Faustino Pérez de Matanzas, entre enero del 2014 a febrero del 2015, y que cumplieron los criterios de inclusión, exclusión y salida, además de ajustarse a las consideraciones éticas sobre el tipo de estudio. Se midieron las variables: clínico epidemiológicas, tiempo de uso del dispositivo, grado de lesión, síntomas audiológicos y subjetivos asociados. El grupo más afectado fue el de 20 a 24 años. Los audífonos pequeños generaron mayor daño auditivo, así como la exposición al ruido durante más de 60 min de forma continua y a altas intensidades. Síntomas de la esfera psicoafectiva como la irritabilidad y el insomnio se expresaron con elevada incidencia. Después de ser diagnosticados y tratados, las secuelas audiológicas persistieron necesitando, en algunos casos, la rehabilitación protésica. La educación otoaudiológica es un pilar indispensable en la prevención del trauma acústico inducido por ruidos. Se ofertaron plegables educativos para generalizar los resultados en el nivel primario de atención.

The XXI century society is characterized by a great development of sciences and technologies and this, among other things, has generated an indiscriminate use of audio devices bringing with them a sound contamination and negative repercussion on people´s health. The general aim of this research was determining the hearing disability due to the use of audio devices by young people and teenagers. We carried out a prospective, descriptive, observational study of the patients with audiological symptomatology who assisted the Otosurgery and Audiology consultations of the Hospital Faustino Perez of Matanzas, in the period from january 2014 to february 2015 and fulfilled the inclusion, exclusion and exit criteria, and also adjusted to ethical considerations on the kind of study. The easured variables were: the clinical-epidemiological ones, time of device use, lesion level, associated audiological and subjective symptoms. The most affected age group was the 20-24 years one. The small audiphones are the ones generating more auditory damage, and also the exposition to noise during more than 60 minutes, in a continuous form and at high intensities. There they were appreciated symptoms of the psycho-affective sphere like irritability and insomnia expressed with a high incidence. After being diagnosed and treated, audiological sequels persisted, needing, in some cases, prosthetic rehabilitation. Oto-audiological education is an unavoidable pillar in preventing the noise-induced acoustical trauma. Educative leaflets were given to generalize the outcomes at the primary health care level.

Papilomatosis laríngea recurrente con seguimiento multidisciplinario: a propósito de un caso / Recurrent laryngeal papilomatosis with multidiscipline follow-up: A propos of a case

La papilomatosis laríngea es una enfermedad producida por el virus del papiloma humano, que frecuentemente afecta las cuerdas vocales, la epiglotis, así como las bandas ventriculares, pudiendo extenderse a todo el órgano. La enfermedad tiene un curso impredecible y ha sido reportada la extensión pulmonar y la transformación maligna. En la práctica clínico quirúrgica otorrinolaringológica constituye un reto lograr un manejo adecuado del paciente cuando la evolución tiende a las recidivas. Se presentó el caso de una paciente de 53 años, sin historia conocida de enfermedad anterior, a la que se le diagnosticó papilomatosis laríngea, recibiendo tratamiento con Interferón82b humano recombinante y microcirugías laríngeas. En un período de 4 meses presentó 6 recidivas: las 5 primeras mediando entre ellas de 10 a 15 días, y la sexta se presentó a 1 mes de la anterior. Se enunció la secuencia utilizada para su estudio, incluyendo dosificación de anticuerpos antiinterferón, estudios serológicos buscando concomitancia con otros virus, tipificación viral, dosificación de inmunoglobulinas y complementos. Se realizó, además, una propuesta de seguimiento clínico teniendo en cuenta el grado y estadio de las lesiones. Se evidenció la importancia del manejo multidisciplinario del paciente por inmunólogos, infectólogos, otorrinolaringólogos y foniatras, para una total recuperación(AU)

Laryngeal papillomatosis is a disease produced by the human papillomavirus, frequently affecting the vocal cords, epiglottis, and also the ventricular bands, that may extend to the entire organ. The disease has an unpredictable course and the pulmonary extension and malignant transformation has been reported. In the clinic-surgical otorhinolaryngological practice it is a challenge to achieve an adequate manage of the patient when the evolution tends to recidivisms. The case of a female patient aged 53 years was presented; she had no record of previous disease, and was diagnosed of laryngeal papillomatosis, being treated with human recombinant Interferon82b and laryngeal microsurgeries. In a period of 4 months, she presented 6 recidivisms: the first five of them mediated by 10-15 days, and the 6ths one a month after the precedent. The sequence used for the study was enounced, including the dosage of interferon antibodies, serologic studies searching for concomitance with other viruses, viral typing, dosage of immunoglobulins and complements. Besides that, it was carried out a proposal of clinical follow-up taking into account the lesions status and level. It was evidenced the importance of the multidiscipline management of the patient by immunologists, infection diseases specialists, otolaryngologists and phoniatrists for his/her total recuperation(AU)