Anomalía congénita en miembro superior derecho: reporte de un caso de Sindrome de Roberts Focomelia en La Paz, Bolivia / Congenital anomaly in the right upper limb: a case report of Roberts Focomelia syndrome in La Paz, Bolivia

El síndrome de Roberts es una alteración de origen genético, donde sus principales características clínicas son el acortamiento severo de las extremidades (focomelia) de predominio en miembros superiores, mismo que conlleva todo un grupo de diferentes entidades clínicas que engloban el síndrome. La importancia de los controles prenatales, antecedentes de relevancia por parte de la madre y el control ecográfico obstétrico, son clave para un diagnóstico oportuno de la focomelia. Se reporta un caso de un neonato, producto de la tercera gestación, madre sin antecedentes de relevancia, nace vigoroso, con llanto activo, donde al examen físico se evidencia hipoplasia de radio, cubito, mano y dedos en extremidad superior derecha, mismo que se confirma con placa de rayos K con evidencia de focomelia en los segmentos ya mencionados, manteniendo un seguimiento del cuadro.

Patterns of morphological variation and ecological correlates in the skull of vipers (Serpentes: Viperidae)

The skull of vipers is a highly kinetic anatomical structure involved in envenomating and consuming of prey. Morphological knowledge about the viperid skull is based on studies on some groups of species, but information on its variation within the whole family and its functional morphology is still scarce. In this study, we aimed to explore variation in skull morphology among species of the three subfamilies of Viperidae, and test whether that variation correlates with macrohabitat and diet. We performed quantitative analyses of the viperid skull based on broad taxonomic sampling and two methodological approaches: linear and geometric morphometrics. The results of both approaches showed that much of the variation lies in differences of shape and relative size of the premaxilla, the nasals, the frontals, and the parietals. The results indicated that phylogeny and size influence the shape of the skull, but we also found evidence of morphological differentiation between arboreal and terrestrial species and in species with mammal specialist diet. Our findings imply that, besides evolutionary allometry and phylogenetic signal, demands of particular diets coupled with use of certain habitats have in part shaped morphological evolution of the viperid skull.

Total-evidence phylogeny and evolutionary morphology of New World pitvipers (Serpentes: Viperidae: Crotalinae)

Crotalines (pitvipers) in the Americas are distributed from southern Canada to southern Argentina, and are represented by 13 genera and 163 species that constitute a monophyletic group. Their phylogenetic relationships have been assessed mostly based on DNA sequences, while morphological data have scarcely been used for phylogenetic inquiry. We present a total-evidence phylogeny of New World pitvipers, the most taxon/character comprehensive phylogeny to date. Our analysis includes all genera, morphological data from external morphology, cranial osteology and hemipenial morphology, and DNA sequences from mitochondrial and nuclear genes. We performed analyses with parsimony as an optimality criterion, using different schemes for character weighting. We evaluated the contribution of the different sources of characters to the phylogeny through analyses of reduced datasets and calculation of weighted homoplasy and retention indexes. We performed a morphological character analysis to identify synapomorphies for the main clades. In terms of biogeography, our results support a single colonization event of the Americas by pitvipers, and a cladogenetic event into a Neotropical clade and a North American/Neotropical clade. The results also shed light on the previously unstable position of some taxa, although they could not sufficiently resolve the position of Bothrops lojanus, which may lead to the paraphyly of either Bothrops or Bothrocophias. The morphological character analyses demonstrated that an important phylogenetic signal is contained in characters related to head scalation, the jaws and the dorsum of the skull, and allowed us to detect morphological convergences in external morphology associated with arboreality.

Perfil de competencias del tutor clínico de enfermería desde la perspectiva del personal de enfermería experto / Competencies of clinical nursing preceptors from the perspective of expert nurses

INTRODUCCIÓN: La figura del tutor clínico es esencial en la formación de los estudiantes de enfermería, dado que es modelo y guía en los procesos de aproximación al quehacer profesional y se transforma en facilitador del aprendizaje y en un nexo entre la teoría y la práctica. Pese a ello, en Chile no se han establecido las competencias del tutor clínico de enferme-ría para estudiantes de pregrado, por lo que el objetivo del manuscrito es describir sus competencias para la formación de estudiantes de pregrado de enfermería chilenos desde la perspectiva del personal de enfermería experto. Sujetos y métodos. Es un estudio de diseño cualitativo. Para la construcción del perfil de competencias se realizó un Del-phi electrónico con 22 enfermeros expertos y luego se realizó la validación de contenido con la participación de jueces. RESULTADOS: Participaron 12-14 enfermeros expertos y 11 jueces. Se construyó el perfil de competencias para el tutor clínico de enfermería, compuesto de cinco dimensiones: profesional, docencia clínica, pensamiento crítico, habilidades interpersonales y trabajo en equipo. CONCLUSIÓN: El perfil brinda orientación y estándares que aseguran la calidad de la docencia y de la formación de futuros enfermeros en un marco que profesionaliza la labor de los tutores clínicos

INTRODUCTION: The clinical preceptor is essential in the training of nursing students. They are a model and guide in the approach to professional work, facilitate learning and link theory and practice. In Chile, the competencies of the nursing clinical preceptor for undergraduate students have not been established. So the purpose of the manuscript is to describe the competencies of the clinical nursing preceptor for the training of Chilean nursing undergraduate students from the perspective of expert nurses. Subjects and methods. Qualitative design study. For the construction of the competency profi le, an electronic Delphi was conducted with 22 expert nurses, then the content was validated with the participation of judges. RESULTS: 12-14 nurses and 11 judges participated. The Profi le of competencies for the clinical nursing preceptor composed of fi ve dimensions: professional, clinical teaching, critical thinking, interpersonal skills and teamwork. CONCLUSION: The profile provides guidance and standards that ensure the quality of teaching and the training of future nurses in a framework that professionalizes the work of clinical preceptor

A new species of Bothrops (Serpentes: Viperidae: Crotalinae) from Pampas del Heath, southeastern Peru, with comments on the systematics of the Bothrops neuwiedi species group

We describe a new species of pitviper of the genus Bothrops from the Peruvian Pampas del Heath, in the Bahuaja-Sonene National Park. Pampas del Heath is an area of seasonally flooded savannas and a northwestern extension of the Gran Chaco Boliviano-Paraguayo. The new species is easily distinguished from its congeners by the exclusive combination of dorsal color pattern of body consisting of small C-shaped blotches, postocular stripe originating posteriorly to the eye, covering posterior supralabials, dorsum of the head with paired markings arranged symmetrically, venter cream heavily speckled with brown, prelacunal scale discrete in contact with second supralabial, three to five prefoveals, subfoveal single usually present, postfoveals absent to two, canthals two, seven intersupraoculars, one or two suboculars, two or three postoculars, seven or eight supralabials, nine to eleven infralabials, 26-27 interrictals, 23-25 middorsal scales, 172 ventrals in the female and 169-173 in males, 45 subcaudals in the female and 50 in males. We performed separate and combined phylogenetic analyses based on morphology and five mitochondrial genes and recovered the new species as a member of the Bothrops neuwiedi species group. All lineages of this clade inhabit the South American dry diagonal. This novel species of pitviper increases the known diversity of the genus Bothrops and adds to the number of described taxa from the unique and scarcely known ecosystem of Pampas del Heath.

A new species of Bothrops (Serpentes: Viperidae: Crotalinae) from Pampas del Heath, southeastern Peru, with comments on the systematics of the Bothrops neuwiedi species group

We describe a new species of pitviper of the genus Bothrops from the Peruvian Pampas del Heath, in the Bahuaja-Sonene National Park. Pampas del Heath is an area of seasonally flooded savannas and a northwestern extension of the Gran Chaco Boliviano-Paraguayo. The new species is easily distinguished from its congeners by the exclusive combination of dorsal color pattern of body consisting of small C-shaped blotches, postocular stripe originating posteriorly to the eye, covering posterior supralabials, dorsum of the head with paired markings arranged symmetrically, venter cream heavily speckled with brown, prelacunal scale discrete in contact with second supralabial, three to five prefoveals, subfoveal single usually present, postfoveals absent to two, canthals two, seven intersupraoculars, one or two suboculars, two or three postoculars, seven or eight supralabials, nine to eleven infralabials, 26-27 interrictals, 23-25 middorsal scales, 172 ventrals in the female and 169-173 in males, 45 subcaudals in the female and 50 in males. We performed separate and combined phylogenetic analyses based on morphology and five mitochondrial genes and recovered the new species as a member of the Bothrops neuwiedi species group. All lineages of this clade inhabit the South American dry diagonal. This novel species of pitviper increases the known diversity of the genus Bothrops and adds to the number of described taxa from the unique and scarcely known ecosystem of Pampas del Heath.

Menopausia, el inicio del envejecimiento de las mujeres chilenas. Un estudio cualitativo / Menopausa, o inicio do envelhecimento das mulheres chilenas. Um estudo qualitativo / Menopause, the beginning of aging for Chilean women. A qualitative study

Objective. To develop the meaning of menopause of a group of post-menopausal women and their relationship with aging. Methods. Qualitative descriptive study on 15 Chilean women that completed a taped face-to-face in depth interview that were interpreted according to Krippendorff. Results. A qualitative content analysis revealed the presence of two themes: (a) Cessation of women´s reproductive stage and (b) a life transition to aging. Conclusion. Women perceived their menopause as the beginning of aging focusing on the end of fertility and the social connotation that this new role implies. Feeling old 10 years before the customary beginning of old age is an important starting point to be incorporated in women's health education.

Objetivo. Desarrollar el significado de manopausia de un grupo de mujeres posmenopáusicas y su relación con el envejecimiento. Métodos. Estudio cualitativo descriptivo de las grabaciones de 15 mujeres chilenas que completaron una entrevista a profundidad, cara a cara. Los relatos se interpretaron de acuerdo con Krippendorff. Resultados. Un análisis de contenido cualitativo reveló la presencia de dos temas: (a) Cesación de la etapa reproductiva de las mujeres y (b) transición de la vida adulta al envejecimiento. Conclusión. Las mujeres percibieron la menopausia como el principio del envejecimiento que se centraba en el fin de la fertilidad y la connotación social que implicaba este nuevo papel. Sentirse viejo 10 años antes del comienzo habitual de la vejez es un punto de partida importante para ser incorporado en la educación para la salud de la mujer.

Objetivo. Desenvolver o significado de menopausa de um grupo de mulheres pós-menopáusicas e sua relação com o envelhecimento. Métodos. Estudo qualitativo descritivo das gravações de 15 mulheres chilenas que completaram uma entrevista a profundidade, cara a cara; os relatos se interpretaram de acordo com Krippendorff. Resultados. Uma análise de conteúdo qualitativo revelou a presença de dois assuntos: (a) Cessação da etapa reprodutiva das mulheres e (b) transição da vida ao envelhecimento. Conclusão. As mulheres perceberam sua menopausa como o princípio do envelhecimento que se centrava no fim da fertilidade e a conotação social que implicava este novo papel. Sentir-se velho 10 anos antes do começo habitual da velhice é um ponto de partida importante para ser incorporado na educação para a saúde da mulher.

Acceso oportuno al test de Elisa en el nivel primario de salud: una mirada desde los profesionales de salud / Timely access to ELISA test in the primary health level: a health professionals' view

Introdución: el Sindrome de Inmunodeficiencia Adquirida (VIH) sigue siendo un importante problema de salud pública a nivel mundial, ya que ha causado más de 34 millones de muertes hasta la fecha. Objetivo: conocer las barreras y facilitadores de un grupo personas que solicitan el test Elisa para el diagnóstico del Virus de Inmunodeficiencia Adquirida (VIH) en la atención primaria de salud, desde la perspectiva de los profesionales de la salud que trabajan en estos lugares. Métodos: estudio cualitativo descriptivo basado en el enfoque de análisis de contenido descrito por Krippendorff. Se realizaron entrevistas en profundidad a 30 profesionales de la salud que trabajan en dos Centros de Salud Familiar (CESFAM) de la comuna de La Pintana, Santiago de Chile. Para mantener el rigor metodológico se utilizaron los criterios de Guba & Lincoln. Resultados: se identificaron factores asociados al acceso oportuno al test de Elisa percibidas por los profesionales, entre ellos algunos que dificultan y otros que facilitan (Estigma social del VIH, burocracia en el proceso de toma del test de Elisa y falta de privacidad en la solicitud del test, relación de confianza entre usuario y profesional, y centralización del examen en los CESFAM). Conclusiones: el conocimiento de los factores tanto que facilitan como que dificultan mencionado por los profesionales que trabajan en centros donde se realiza la toma del test de Elisa debe ser considerada en el diseño e implementación de nuevas estrategias y en la modificación de las existentes, con la finalidad de aumentar el número de personas que accedan al test y con esto mejorar la calidad del cuidado y la satisfacción usuaria(AU)

Introduction: The Acquired Immunodeficiency Syndrome (HIV) continues to be a critic health concern for the worldwide public health, since it has caused up to date more than 34 million deaths. Objective: Know the obstacles and facilitators of a group of people who request the ELISA test for diagnosing the acquired immunodeficiency virus (VIH) in primary health care, from the perspective of the health professional who works in this sites. Methods: Qualitative descriptive study based on the content analysis approach described by Krippendorff. In-deep interviews were conducted on 30 health professionals who work in two Family Health Centers (CESFAM) of La Pintana Town, Santiago de Chile. The Guba & Lincoln criteria were used, in order to maintain the methodologic rigor. Results: We identified factors associated with the timely access to ELISA tests as perceived by the professionals, among then some that make difficult and others that facilitate (HIV social stigma, bureaucracy in taking the ELISA test and the lack of privacy in requesting the test, confidence relationship between the user and the professional, and centralization of the test in the CESFAM's). Conclusions: Knowing both the facilitating and hindering factors mentioned by the professionals who work in centers where the ELISA tests are made should be considered in the design and implementation of new strategies and in the modification of the existing ones, with the aim to increase the number of people who can access the tests and thus to improve the quality of care and the users' satisfaction(AU)

Acceso oportuno al test de Elisa en el nivel primario de salud: una mirada desde los profesionales de salud / Timely access to ELISA test in the primary health level: a health professionals' view

Introdución: el Sindrome de Inmunodeficiencia Adquirida (VIH) sigue siendo un importante problema de salud pública a nivel mundial, ya que ha causado más de 34 millones de muertes hasta la fecha. Objetivo: conocer las barreras y facilitadores de un grupo personas que solicitan el test Elisa para el diagnóstico del Virus de Inmunodeficiencia Adquirida (VIH) en la atención primaria de salud, desde la perspectiva de los profesionales de la salud que trabajan en estos lugares. Métodos: estudio cualitativo descriptivo basado en el enfoque de análisis de contenido descrito por Krippendorff. Se realizaron entrevistas en profundidad a 30 profesionales de la salud que trabajan en dos Centros de Salud Familiar (CESFAM) de la comuna de La Pintana, Santiago de Chile. Para mantener el rigor metodológico se utilizaron los criterios de Guba & Lincoln. Resultados: se identificaron factores asociados al acceso oportuno al test de Elisa percibidas por los profesionales, entre ellos algunos que dificultan y otros que facilitan (Estigma social del VIH, burocracia en el proceso de toma del test de Elisa y falta de privacidad en la solicitud del test, relación de confianza entre usuario y profesional, y centralización del examen en los CESFAM). Conclusiones: el conocimiento de los factores tanto que facilitan como que dificultan mencionado por los profesionales que trabajan en centros donde se realiza la toma del test de Elisa debe ser considerada en el diseño e implementación de nuevas estrategias y en la modificación de las existentes, con la finalidad de aumentar el número de personas que accedan al test y con esto mejorar la calidad del cuidado y la satisfacción usuaria(AU)

Introduction: The Acquired Immunodeficiency Syndrome (HIV) continues to be a critic health concern for the worldwide public health, since it has caused up to date more than 34 million deaths. Objective: Know the obstacles and facilitators of a group of people who request the ELISA test for diagnosing the acquired immunodeficiency virus (VIH) in primary health care, from the perspective of the health professional who works in this sites. Methods: Qualitative descriptive study based on the content analysis approach described by Krippendorff. In-deep interviews were conducted on 30 health professionals who work in two Family Health Centers (CESFAM) of La Pintana Town, Santiago de Chile. The Guba & Lincoln criteria were used, in order to maintain the methodologic rigor. Results: We identified factors associated with the timely access to ELISA tests as perceived by the professionals, among then some that make difficult and others that facilitate (HIV social stigma, bureaucracy in taking the ELISA test and the lack of privacy in requesting the test, confidence relationship between the user and the professional, and centralization of the test in the CESFAM's). Conclusions: Knowing both the facilitating and hindering factors mentioned by the professionals who work in centers where the ELISA tests are made should be considered in the design and implementation of new strategies and in the modification of the existing ones, with the aim to increase the number of people who can access the tests and thus to improve the quality of care and the users' satisfaction(AU)

Optimizando el acceso oportuno al test de ELISA para el diagnóstico del VIH: Recomendaciones desde los usuarios y profesionales de la Atención Primaria de Salud / Recommendations of health care users and professionals to achieve a timely access to HIV diagnosis

Background: Early HIV (human immunodeficiency virus) diagnosis optimizes therapies aimed at reducing viral load, increasing survival, lowering health costs and reducing the number of people infected with the virus. In Chile, despite widespread and readily available HIV testing, infected people continue to get tested in a late fashion and are usually diagnosed in advanced stages of the disease. Aim: To determine the elements that facilitate or impede a timely HIV testing and to evaluate how to improve the access to HIV testing. Material and Methods: Descriptive, in-depth interviews to 30 participants with unknown serology, 15 participants diagnosed at AIDS stage and 15 health care professionals working at a primary healthcare settings. Results: Users and professionals formulated three suggestions to improve timely access to ELISA test for HIV diagnosis. Namely, to inform users and professionals about the characteristics of the disease and diagnostic test, to offer fast and easy access to HIV testing, and to train the whole healthcare team about obtaining informed consent for testing. Conclusions: These recommendations should be implemented at healthcare centers to attain a timely HIV diagnosis.

Facilitadores y barreras que enfrentan las personas al tomarse el test de ELISA para el diagnóstico del VIH: revisión de la literatura / Facilitators and barriersto HIV testing: A literature review

Background: Late diagnosis of HIV is a problem of international and national relevance. Despite the availability of HIV testing in primary health care, it is often performed too late. Aim: To identify facilitators and barriers to early HIV testing in primary health care. Methods: Four databases of nursing, psychological, biomedical, and health related professions areas were examined with a review protocol. Results were grouped into two main subjects: facilitators and barriers occurring among the population, among health care workers, and within primary health care centers. Results: Perception of risk behaviors, self-care, social support, trust, confidentiality of the examination, the offer of the examination, and the knowledge of early treatment have been recognized as facilitators for taking the exam. The lack of information about the test and the disease are recognized as the main barrier to access the test. This information is a cornerstone to design and implement strategies to increase the number of people taking voluntarily HIV testing.

Introducción: El diagnóstico tardío de la infección por VIH es un problema universal. A pesar de la disponibilidad del test de ELISA para el diagnóstico de esta infección en la atención primaria de salud, las personas continúan tomándoselo tardíamente. Objetivo: Conocer los factores que facilitan o dificultan que las personas accedan oportunamente al examen en la atención primaria de salud. Métodos: Cuatro bases de datos del área de la enfermería, psicológica, salud biomédica y profesiones afines (años 2001-2012) fueron examinadas con un protocolo de revisión. Resultados: De 195 artículos detectados, 15 cumplieron con los criterios de inclusión y fueron agrupados en dos grandes temas: elementos facilitadores y elementos obstaculizadores de la persona, de los profesionales y de los centros de atención primaria de salud. Percepción de conductas de riesgo, autocuidado, apoyo social, la confianza, confidencialidad del examen, el ofrecimiento del examen y el conocimiento de un tratamiento oportuno han sido reconocidos como uno de los elementos facilitadores para la toma del examen. La falta de información sobre el test y la enfermedad son reconocidas como los principales obstaculizadores para acceder al test. Discusión: La información obtenida es un pilar fundamental para diseñar e implementar estrategias destinadas a aumentar el número de personas que solicitan voluntariamente al examen.

Efecto terapéutico en el tratamiento del Acné Vulgar usando principios activos de MELISSA OFFICINALIS L. y PLANTAGO LANCEOLATA / Therapeutic effect in the treatment of Acne Vulgaris using active principies MELISSA OFFICINALIS L. and PLANTAGO LANCEOLATA

El acné es una inflamación crónica de la unidad pilosebácea que compromete regiones del cuerpo como el rostro, cuello, hombros y parte del tronco superior y es una causa de consulta que afecta comúnmente a personas entre los 15 a 25 años de edad. El siguiente estudio pretende medir los efectos terapéuticos que existen en el tratamiento del acné vulgar usando los principios activos de las plantas MEUSSA OFFICINALIS L y PLANTAGO LANCEOLATA. Es un ensayo clínico a doble ciego controlado paralelo con una muestra de 20 pacientes voluntarios, el tipo de muestreo fue por conveniencia. Los escenarios del estudio fueron: el laboratorio de la Facultad de Medicina de la Universidad Mayor de San Simón donde se realizó el procedimiento de extracción de los principios activos y hogares de los participantes donde se les entregó el tratamiento y se realizaron los controles. Fueron 20 pacientes voluntarios de los cuales 4 abandonaron el tratamiento y se continuó con 11 pacientes mujeres y 5 varones. Los resultados muestran que el grupo tratado con principios activos tuvo un promedio de 5 a 8 días siendo más breve en comparación del grupo control, ningún paciente presentó reacciones adversas al tratamiento y el sexo que tuvo mejores resultados con el tratamiento fue el masculino. Podemos concluir que el uso de los principios activos de plantas naturales para tratar el acné vulgar presenta diferentes grados de eficacia, siendo relevante el tiempo y las concentraciones de los principios activos.

Acne is a chronic inflammation of the pilosebaceous unit that engages regions of the body like the face, neck, shoulders and upper trunk and is a cause of consultation that commonly affects people between 15 to 25 years old. The next study aims to measure the therapeutic effects that exist in the treatment of acne vulgaris using the active ingredients of plants MELISSA OFFICINAUS L y PLANTAGO LANCEOLATA It's a clinical trial double blind parallel controlled with a sample of 20 patient volunteers, the type of sampling was convenience.The stages of the study were: the laboratory of the Faculty of Medicine of the Universidad Mayor of San Simón where took place the procedure for extraction of active principies and homes of participants where they were handed treatment and carried out the checks.They were 20 volunteer patients, of whom 4 abandoned treatment and continued with 5 men and 11 women patients. The results show that the group treated with active ingredients had an average of 5 to 8 days still shorter compared to the control group, no patient presented adverse reactions to treatment and sex that had better results with treatment was the male.We can conclude that the use of the active principies of natural plants to treat acné vulgaris has different degrees of effectiveness, still relevant time and the concentrations of the active ingredients.

Posición prono como tratamiento del Síndrome de Distress Respiratorio agudo: perspectiva desde la atención de enfermería / Prone position as treatment of Acute Respiratory Distress Syndrome: perspective from the nursing care

El Síndrome de Distress Respiratorio (ARDS) ha sido objeto de controversia por más de 30 años, tanto por los mecanismos fisiopatológicos implicados, como por las estrategias empleadas en su tratamiento. Una posible intervención terapéutica, propuesta desde hace algunos años, es la posición prono la cual ha mostrado resultados favorables, a un bajo costo y con escasos efectos adversos. El personal de enfermería juega un rol clave en el desarrollo de esta maniobra, ya que es el encargado de llevarla a cabo de forma correcta, previniendo la mayor parte de las complicaciones, es por esto que es objetivo de la presente revisión de la literatura identificar la efectividad de la posición prono en el tratamiento del ARDS desde la perspectiva de la atención de enfermería.

The Acute Respiratory Distress Syndrome (ARDS) has been a controversial subject for more than thirty years, because of the physiopathologycal mechanisms implicated in it and because of the strategies used in its treatment. One possible therapeutically intervention proposed some years ago is the prone position; it has shown good results with low costs and few adverse effects. The nursery staffs play a key rol in the development of this manover because they are the ones charged of getting it along in a good way, preventing most of the complications. This is why; it is the objective of the present literature revision to identify the effectiveness of the prone position in the ARDS treatment from the nurse attention perspective.