Seroprevalence and coprological prevalence of liver fluke Fasciola hepatica in cattle and sheep from Santander department, Colombia.

Fasciola hepatica is a parasite with a worldwide distribution that affects several mammals, including humans, and is considered a public health problem. Therefore, the aim of this study was to determine the prevalence of Fasciola hepatica in humans, cattle and sheep, as well as to evaluate factors associated with the prevalence. A total of 185 serum samples from sheep, 290 from cattle, and 114 from humans were collected and processed using an in-house developed ELISA to detect IgG antibodies against F. hepatica. Additionally, 185 stool samples from sheep and 290 from cattle were examined using a Dennis sedimentation technique. Risk factors were analyzed using epidemiological surveys. The overall seroprevalence was 46.5% (86/185) in sheep, 32.5% (94/289) in cattle, and no humans tested positive for the infection. The coprological prevalence was 47.7% (86/180) in sheep and 33.7% (98/290) in cattle. Female gender and cattle living with alternate grazing management showed 2.5 and 6.5 times higher probability of infection, respectively. Bovines coexisting with sheep exhibited a higher risk of infection (odds ratio [OR]=4.3) compared to those without sheep. We concluded that F. hepatica in cattle and sheep has an endemic behavior, and therefore represents a problem of public health for rural communities.

The Characterization of Cardiac Explants Reveals Unique Fibrosis Patterns and a Predominance of CD8+ T Cell Subpopulations in Patients with Chronic Chagas Cardiomyopathy.

AIM: The present study aimed to characterize the histopathological findings and the phenotype of inflammatory cells in the myocardial tissue of patients with end-stage heart failure (ESHF) secondary to CCC in comparison with ESHF secondary to non-Chagas cardiomyopathies (NCC). METHODS: A total of 32 explanted hearts were collected from transplanted patients between 2014 and 2017. Of these, 21 were classified as CCC and 11 as other NCC. A macroscopic analysis followed by a microscopic analysis were performed. Finally, the phenotypes of the inflammatory infiltrates were characterized using flow cytometry. RESULTS: Microscopic analysis revealed more extensive fibrotic involvement in patients with CCC, with more frequent foci of fibrosis, collagen deposits, and degeneration of myocardial fibers, in addition to identifying foci of inflammatory infiltrate of greater magnitude. Finally, cell phenotyping identified more memory T cells, mainly CD8+CD45RO+ T cells, and fewer transitioning T cells (CD45RA+/CD45RO+) in patients with CCC compared with the NCC group. CONCLUSIONS: CCC represents a unique form of myocardial involvement characterized by abundant inflammatory infiltrates, severe interstitial fibrosis, extensive collagen deposits, and marked cardiomyocyte degeneration. The structural myocardial changes observed in late-stage Chagas cardiomyopathy appear to be closely related to the presence of cardiac fibrosis and the colocalization of collagen fibers and inflammatory cells, a finding that serves as a basis for the generation of new hypotheses aimed at better understanding the role of inflammation and fibrogenesis in the progression of CCC. Finally, the predominance of memory T cells in CCC compared with NCC hearts highlights the critical role of the parasite-specific lymphocytic response in the course of the infection.

Tendencias de investigaciones sobre la familia en Colombia. Una perspectiva educativa / Trends in family research in Colombia. An educational perspective / Tendências nas pesquisas sobre a família na Colômbia. Uma perspectiva educacional

Una revisión a las investigaciones culminadas sobre la familia en Colombia (1990-2014), seleccionadas bajo el criterio de posibilidades para el campo educativo, es lo que presento en este artículo. Mi propósito es analizar las tendencias en tales estudios y dejar algunas líneas de posibilidad en materia de propuestas para el trabajo con familias. El artículo surge de la investigación cualitativa "La familia rural y sus formas de diálogo en la construcción de paz", que tuvo un enfoque fenomenológico-hermenéutico. Dentro de los resultados encontré que tales estudios coinciden en: concebir a la familia como agrupación cambiante, diversa, permeable a los contextos, perdurable en medio de los cambios; emplear unas metodologías descriptivas y disciplinares que han determinado sus niveles de impacto sobre la población estudiada; y plantear propuestas para la familia, muchas veces indirectas (académicas), pocas veces directas (no académicas).

A review of the investigations culminated on the family in Colombia (1990-2014), selected at the discretion of possibilities for education, is presented in this article. Its purpose is to analyze trends in such studies and leave some lines of possibility regarding proposals for work with families. The article comes from qualitative research "Rural family and forms of dialogue in building peace" held a phenomenological-hermeneutical approach. Within the results it was found that such studies coincide in conceiving the family as a changing group, diverse, permeable to contexts, enduring in the midst of changes; employ descriptive and disciplinary methodologies that have determined their levels of impact on the population studied; and propose proposals for the family, often indirect (academic), rarely direct (non-academic).

Uma revisão das pesquisas sobre a família,na Colômbia (1990-2014), selecionadas pelo critério de possibilidades para a Educação, é apresentada neste artigo. Sua finalidade é analisar tendências em tais estudos e deixar algumas linhas de possibilidades em propostas de trabalho com as famílias. O artigo vem da pesquisa qualitativa "Família rural e formas de diálogo na construção da paz", realizada a partir de uma abordagem fenomenológicohermenêutica. Entre os resultados, descobrimos que tais estudos concordam em conceber a família como agrupamentos cambiantes, diversos, de contextos permeáveis, e permanentes frente aos meios de mudanças; usar uma metodologia descritiva e disciplinare que determinaram seus níveis de impacto sobre a população estudada; e apresentar propostas para as famílias, muitas vezes indiretas (acadêmico), raramente diretas (não-acadêmico).

Intrasite vancomycin powder as a prophylactic adjuvant in lumbar fusion / Vancomicina transtisular en polvo como adyuvante en profilaxis antibiótica en fusión lumbar / Vancomicina em pó no sítio cirúrgico como adjuvante na profilaxia antibiótica de fusão lombar

ABSTRACT Objective: To identify whether the use of prophylactic intrasite vancomycin as an adjuvant is a protective factor against deep tissue infection of the surgical site. Methods: Retrospective, descriptive, case-control study evaluating 210 patients, of whom 70 received intrasite vancomycin (case group) and 140 were controls. It was made a follow up for at least one year, reviewing the physical and electronic records. Data were tabulated in spreadsheets (Excel) including all variables and the statistical analysis was made with Epi InfoTM 7 to calculate the odds ratio. Results: Seven cases of deep infection occurred in the control group and none was found in the case group (odds ratio [95% confidence interval]: 0.1262 [0.007-2.24], P = 0.1585). Among the predisposing factors, diabetes and surgical time were the most relevant. Conclusions: Intrasite use of vancomycin has a protective effect against deep infection in patients undergoing lumbar fusion surgery without presenting considerable side effects.

RESUMEN Objetivo: Identificar si el uso de vancomicina transtisular profiláctica como coadyuvante es un factor protector contra la infección de tejidos profundos del sitio quirúrgico. Métodos: Estudio retrospectivo, de carácter descriptivo, con casos y controles que evaluó 210 pacientes, de los cuales a 70 se les aplicó vancomicina (grupo de casos) y 140 controles. Realizado un seguimiento de al menos un año, revisando el expediente físico y electrónico. Los datos fueron tabulados en hojas de cálculo (Excel) incluyendo todas las variables, y aplicamos el análisis estadístico con Epi InfoTM 7, para calcular la razón de momios. Resultados: Se presentaron 7 casos de infección profunda en el grupo control, ninguno en el grupo de casos (razón de momios [intervalo de confianza del 95%]: 0,1262 [0,007 a 2,24], p = 0,1585). Entre los factores predisponentes encontramos que la diabetes y el tiempo quirúrgico fueron de mayor relevancia. Conclusiones: El uso de vancomicina transtisular ejerce un efecto protector contra la infección profunda en pacientes sometidos a cirugía de fusión lumbar sin presentar efectos colaterales de consideración.

RESUMO Objetivo: Identificar se o uso de vancomicina profilática como adjuvante no sítio cirúrgico é um fator de proteção contra a infecção dos tecidos profundos. Métodos: Estudo retrospectivo, descritivo, de caso-controle, que avaliou 210 pacientes, dos quais 70 receberam vancomicina no sítio cirúrgico (grupo caso) e 140 eram controles. Foi feito o acompanhamento por pelo menos um ano, revendo os registros físicos e eletrônicos. Os dados foram tabulados em planilhas (Excel), incluindo todas as variáveis, e a análise estatística foi realizada com o Epi InfoTM 7 para calcular as razões de probabilidade. Resultados: Foram encontradas 7 ocorrências de infecção profunda no grupo controle e nenhum no grupo de casos (razão de probabilidades [intervalo de confiança de 95%]: 0,1262 [0,007-2,24], P = 0,1585). Entre os fatores predisponentes, o diabetes e o tempo cirúrgico foram os mais relevantes. Conclusões: O uso de vancomicina no sítio cirúrgico exerce efeito protetor contra a infecção profunda em pacientes submetidos à cirurgia de fusão lombar sem apresentar efeitos colaterais importantes.

¿Des-víos de la familia en la formación de los hijos e hijas? Nuevos perfiles, funciones constantes / Detours by families in the formation of their children? New roles, same functions / Desvios da família na formação das crianças? Perfis novos, funções constantes

Como campo de estudio, la familia poco ha sido abordada desde la pedagogía, y su función educadora se ha delegado a instancias ajenas a ésta. El propósito del rastreo al concepto familia en diversas disciplinas respondió a la necesidad de comprender su complejidad y posibilidades educativas, y de elaborar unos instrumentos de recolección para la entrevista a ocho grupos focales de familias rurales de distintas regiones de Colombia. Esta investigación cualitativa de enfoque fenomenológico-hermenéutico, permitió hallar que la familia en general ha variado y desviado sus roles de formación a los hijos e hijas por circunstancias externas a ésta y, en consecuencia, funciones antropológicas como la acogida no siempre resultan realizables.

As a field of study, the family has not been extensively studied from the area of pedagogy and its educational role has been delegated to non-pedagogical areas. The purpose of tracking the concept of family in diverse disciplines responds to the need to understand its complexity and educational possibilities. This process also required instruments to collect data for the interviews with eigth focus groups consisting of rural families from four different regions of Colombia. This qualitative study, which used a phenomenological-hermeneutic approach, identified that the concept has generally changed and "detoured" from its role in the formation of its children due to external circumstances and as a result, anthropological functions like support are not always possible.

Como campo de estudo, a família tem sido pouco abordada pela pedagogia e sua função educadora tem sido delegada a instâncias distantes dela. O propósito do rastreamento do conceito de família em diversas disciplinas respondeu à necessidade de entender sua complexidade e possibilidades educacionais, e de elaborar alguns instrumentos de coleta para a entrevista de oito grupos focais de famílias rurais de diferentes regiões da Colômbia. Esta investigação qualitativa de foco fenomenológico-hermenêutico permitiu perceber que a família, em geral, tem variado e divergido seus tipos de formação das crianças para circunstâncias externas a essa e, por conseguinte, funções antropológicas, como o acolhimento, não sempre se resultam realizáveis.

Lectins in human pathogenic fungi.

Lectins are carbohydrate-binding proteins widely distributed in nature. They constitute a highly diverse group of proteins consisting of many different protein families that are, in general, structurally unrelated. In the last few years, mushroom and other fungal lectins have attracted wide attention due to their antitumour, antiproliferative and immunomodulatory activities. The present mini-review provides concise information about recent developments in understanding lectins from human pathogenic fungi. A bibliographic search was performed in the Science Direct and PubMed databases, using the following keywords "lectin", "fungi", "human" and "pathogenic". Lectins present in fungi have been classified; however, the role played by lectins derived from human pathogenic fungi in infectious processes remains uncertain; thus, this is a scientific field requiring more research. This manuscript is part of the series of works presented at the "V International Workshop: Molecular genetic approaches to the study of human pathogenic fungi" (Oaxaca, Mexico, 2012).

Utilidad de la prueba torniquete en el diagnóstico diferencial de Dengue de otros síndromes febriles / Usefulness of the tourniquet test in the differential diagnosis of Dengue of others febrile syndromes

Introducción: El dengue es la infección transmitida por mosquitos más importante en el mundo. Siendo más susceptible a infectarse la población infantil. En la etapa inicial de la enfermedad los síntomas son indiferenciables de otros síndromes febriles agudos, situación que hace complejo, tardío y poco sensible el diagnóstico clínico en la fase aguda de la enfermedad. La prueba torniquete es utilizada como un criterio de clasificación para definir la severidad del dengue hemorrágico por la Organización Mundial de la Salud, podría utilizarse en el diagnóstico diferencial del dengue. Objetivo: Evaluar en población infantil las características operativas de la prueba torniquete en el diagnóstico diferencial del dengue de otros síndromes febriles agudos. Métodos: Entre junio de 2006 y Abril del 2008 se incluyeron del servicio de urgencias pacientes entre dos y 12 años de edad que presentaban un cuadro febril sin origen aparente. Se les realizó un examen físico estandarizado junto con la prueba de torniquete, calculándose la sensibilidad, especificidad, valor predictivo positivo (VPP) y negativo (VPN) a la prueba. Resultados: Se captaron 129 pacientes y se diagnosticaron 66 casos de dengue. La prueba torniquete tuvo sensibilidad de 60.6% (IC95%=48.8-72.4), especificidad 55.9% (IC95%=43.3-68.6), VPP 60.6% (IC95%=48.8-72.4) y un VPN 55.9%. (IC95%=43.3-68.6). El resultado de la prueba estuvo asociado al tiempo de tolerancia del torniquete (p<0.001). Conclusiones: La prueba torniquete por sí sola no es útil como herramienta clínica para diferenciar el dengue de otros síndromes febriles en niños entre los dos y los 12 años de zonas endémicas.

Introduction: Dengue is a mosquito-borne infection most important in the world. The infant population is more susceptible to infection. In the early stage of the disease the symptoms are indistinguishable from others acute febrile syndromes, a situation that makes it complex, slow and little sensitive the clinical diagnosis in the acute phase of illness. The tourniquet test is used as a classification criterion to define the severity of dengue hemorrhagic fever by the World Health Organization and could be used in the differential diagnosis of dengue. Objective: To evaluate in children the operational characteristics of the tourniquet test in the differential diagnosis of dengue from acute febrile other syndromes. Methods: Between June 2006 and April 2008 were included patients between two and 12 years, who had a fever without apparent source in the emergency department. Were evaluated by a standardized physical examination with the tourniquet test. We calculated the sensibility, specificity, positive predictive value (PPV) and negative (NPV) to the test. Results: 129 patients were captured and 66 dengue cases were diagnosed. The tourniquet test had a sensitivity of 60.6% (95% CI = 48.8-72.4), specificity 55.9% (95% CI = 43.3-68.6), PPV 60.6% (95% CI = 48.8-72.4) and NPV 55.9%. (95% CI = 43.3-68.6). The result of the test was associated with tourniquet tolerance time (p <0.001). Conclusions: The tourniquet test by itself is not useful as a clinical tool to differentiate dengue from other febrile syndromes in children between two and 12 years in endemic areas.

Consistency and inconsistency in testing biomarkers in breast cancer. A GRELL study in cut-off variability in the Romance language countries.

PURPOSE: Biological markers are crucial factors in order to differentiate female breast cancers and to determine the right therapy. This study aims at evaluating whether testing for biomarkers for female breast cancer has similar frequency and characteristics across and within countries. METHODS: Population-based cancer registries of the Association for cancer registration and epidemiology in Romance language countries (GRELL) were asked to complete a questionnaire on biomarkers testing. The data collected referred to invasive female breast cancer cases diagnosed between 2004 and 2009. The investigation focused on 1) the overexpression and amplification of the human epidermal growth factor receptor 2 oncogene (HER2); 2) the expression of oestrogen (ER) and progesterone (PgR) receptors; and 3) the proliferation index (PI). Weighted percentages, the heterogeneity among and within countries, and the correlation between responses and calendar years were evaluated. The study was based on 19,644 breast cancers. RESULTS: Overall, 85.9% of the cases were tested for HER2, 91.8% for both ER and PgR, and 74.1% for proliferative markers. For HER2 and ER-PgR, the frequency of testing increased from 2004 to 2009. Testing varied among countries (HER2 from 82.0% to 95.9%, ER-PgR from 89.3% to 98.9%, PI from 10% to 92%) and also within the same country (e.g. HER2 in Italy from 51% to 99%) as well as within single cancer registries. The most relevant differences were in the scores for positive/negative/not clearly defined HER2 (e.g. HER2 was defined positive if IHC 3+ in 21/33 registries), and in the cut-off of positive cells for ER/PgR (from >0% to >30%) and PI positivity (from >0% to >20%). CONCLUSIONS: Biological markers are widely tested in the Romance language countries; however, the parameters defining their positivity may vary, raising concerns about homogeneity in breast cancer classification and treatment.

Chemical, technological and in vitro antioxidant properties of mango, guava, pineapple and passion fruit dietary fibre concentrate.

The aim of this work was to determine the chemical, technological and in vitro antioxidant properties of co-products from the industrialisation of some tropical exotic fruits, such as mango, pineapple, guava and passion fruit, and to evaluate their potential use as dietary fibre sources for food enrichment. Proximate compositions were determined, as well as the total, insoluble and soluble fibre contents. The water holding, oil holding and swelling capacities were also determined. For the antioxidant activity, three different test systems were used (ABTS, DPPH and FRAP). The dietary fibre content of the co-products varied in a range between 69.1 and 81.5g/100g on a dry matter basis with a good balanced ratio between insoluble dietary fibre and soluble dietary fibre. Phenol recovery was dependent on the fruit type and the solvent system used. Methanol:acetone was a more efficient solvent for extracting phenols than ethanol. There was a good correlation between total phenol content and antioxidant capacity of the fruit extracts. All samples analysed had good antioxidant capacity. The results of this study indicate that exotic fruit fibres obtained as co-products in the process to obtain juice may be considered a good source of natural compounds with significant antioxidant activity.

[Optimization of creatinine measurement for laboratory estimation of glomerular filtration rate]. / Optimización de la creatinina al estimar la tasa de filtración glomerular en el laboratorio.

OBJECTIVE: to analyze the optimization of serum creatinine in the laboratory reports of the estimation of glomerular filtration rate (GFR) in groups of patients who were overweight, obese, hypertensive, or had participated in SOHDI diabetes self-help groups. We also looked at how much the patients had learned about their disease, stress control, diet and exercise, as all the problems have increased risk of kidney disease. METHODS: The serum creatinine results in the Family Medicine Unit No. 34, IMSS, at Jalisco, was analyzed in a transverse study, from January to December of 2008. GFR was estimated with the Cockcroft-Gault formulary. Statistical analysis with multivariate logistic regression analyses was performed. RESULTS: the sample was 8331 patients: 23.5 % with GFR < 60 mL/min/1.73 m(2), and 9.1 % with serum creatinine > 1.5 mg/dL. Associated factors were age < 19 years, woman age 19 to 59 years, and SOHDI. CONCLUSIONS: the study suggested that participating in SOHDI groups, and being women are protective factors for dimunution of GFR. The people < 19 years had lesser GFR.

Cuerpo reconocido: formación para la interacción sin violencia en la escuela primaria / Corpo reconhecido: formação para a interação sem violência na escola primária / Recognized body: training for interaction without violence at primary school

Las cuestiones ¿por qué se presentan las interacciones violentas entre las personas menores? ¿cómo se caracterizan? ¿qué mecanismos de reflexión y posibles acciones pueden orientar y abordar los maestros y maestras?, movilizan el desarrollo del presente artículo a lo largo de tres reflexiones analíticas: la primera, en torno a la experiencia de sí mismo y del otro por el cuerpo, como una condición necesaria para el autoconocimiento y el reconocimiento; la segunda, referida a la experiencia del juego en los niños y niñas escolares, como opción de formación en la interacción “no violenta”, en tanto hace posible la inmersión en un mundo nuevo en donde el otro, incluso el extraño, pueda interactuar con sus pares; y se dejan algunas pistas sobre la experiencia del cuerpo del propio maestro o maestra en la formación de los niños y niñas. Todas ellas, como posibilidad y apuesta para la interacción sin violencia en los niños y niñas de primara, gracias al reconocimiento del cuerpo.

As questões Por que se apresentam interações violentas entre os menores? Como se caracterizam? Que mecanismos de reflexão e que ações possíveis podem ser orientadas e abordadas pelos professores e professoras?, mobilizam o desenvolvimento deste artigo ao longo de três reflexões analíticas. A primeira é em torno da experiência do si mesmo e do outro pelo corpo como uma condição necessária para o autoconhecimento e o reconhecimento; a segunda, em torno da experiência do jogo dos meninos e das meninas escolares, como uma opção de formação na interação “não violenta”, em tanto faz possível a imersão num mundo novo, onde o outro, incluso o estranho, possa interatuar com seus pares. Algumas pistas sobre a experiência do corpo do professor ou professora na formação dos meninos e das meninas são também consideradas como possibilidade e aposta para a interação sem violência nas crianças da escola primária; tudo isto devido ao reconhecimento do corpo.

The questions, why do violent interactions among minors take place?, how are they characterized? and, what reflection mechanisms and possible actions may be oriented and approached by teachers?, are the main focus of this article, by means of three analytical reflections. First, the experience from the self and from others by the body as a necessary condition for self-knowledge and recognition; second, the school children’s play experience as an educational alternative that will result in “non-violent” interaction, as it makes possible the immersion in a new world where the others, including the outsiders, can interact with their peers. The third one consists of some kind of reflection on the teacher’s body when training both boys and girls. All of them are considered a possibility and a bet towards non-violent interaction in primary school boys and girls, thanks to the recognition of their body.

Evolución clínica de pacientes hospitalizados por dengue en una institución de salud de Bucaramanga, Colombia / Clinical evolution of dengue in hospitalized patients

Introducción. El dengue hemorrágico abarca todas las áreas tropicales y subtropicales del planeta, y causa medio millón de hospitalizaciones al año en el mundo. Se ha descrito que esta enfermedad afecta a un grupo cada vez mayor de adolescentes y adultos jóvenes. Objetivo. Describir las características clínicas de la población, tanto adulta como pediátrica, hospitalizada por dengue durante un periodo endémico y determinar los factores de riesgo asociados a mal pronóstico. Materiales y métodos. Cohorte retrospectiva de pacientes hospitalizados por dengue en los años 2006 y 2007 en la Clínica Chicamocha. Resultados. Se evaluaron 328 pacientes, 165 mujeres y 163 hombres, con mediana de edad de 25 años. Se encontraron 116 casos de dengue hemorrágico, de los cuales, 113 eran de grado II. De los 212 pacientes con dengue clásico, 156 presentaron extravasación, sangrado o trombocitopenia. El 82,4 por ciento tuvieron serología positiva. Los pacientes con dengue hemorrágico eran más jóvenes (20,1 contra 25,7 años, p=0,0054). El número mínimo de plaquetas y el valor máximo del hematocrito se alcanzaron alrededor del sexto día de enfermedad. Los menores de 13 años presentaron con menor frecuencia los síntomas típicos de dengue, aunque con un mayor porcentaje de ascitis, derrame y sangrado; además, tuvieron mayor riesgo de desarrollar dificultad respiratoria (riesgo relativo (RR)=3,59, IC95 por ciento 1,3-9,9, p=0,014) e hipotensión (RR=10,77, IC95 porcentaje 5,56-20,86, p<0,001). Conclusiones. La edad continúa siendo el factor predominante en la gravedad intrahospitalaria del dengue. Independientemente de ésta, un grupo de signos, síntomas y hallazgos de laboratorio al ingreso permite predecir la aparición de complicaciones.

Tratamiento del dengue durante su etapa aguda: revisión sistemática de la literatura / Treatment of acute phase of dengue fever: a systematic review

El dengue es la enfermedad ocasionada por un arbovirus de mayor incidencia en el mundo y su impacto económico sobre la productividad de los países afectados es muy importante. Sin embargo, hasta el momento no existe una terapia específica para la enfermedad y hay muy pocos estudios sobre el tema. Esta revisión pretende recopilar los resultados de los trabajos originales que existen en la literatura sobre las intervenciones utilizadas en humanos para el tratamiento del dengue durante la etapa aguda de la enfermedad. Se abordaron los siguientes temas: reemplazo de líquidos, antipiréticos, tratamiento de las hemorragias, tratamiento de la trombocitopenia, uso de corticoides y otras medidas terapéuticas.

[Clinical evolution of dengue in hospitalized patients]. / Evolución clínica de pacientes hospitalizados por dengue en una institución de salud de Bucaramanga, Colombia.

INTRODUCTION: Dengue hemorrhagic fever has extended to every tropical and subtropical area of the world, resulting in a half million hospitalizations every year. This disease appears to affect increasing numbers of adolescents and young adults. OBJECTIVE: The clinical characteristics were described for adult and pediatric dengue inpatients to establish risk factors associated with bad prognosis. MATERIALS AND METHODS: A cohort of dengue inpatients of years 2006 and 2007 was evaluated retrospectively at "Clínica Chicamocha", a high level hospital in Bucaramanga, Colombia. RESULTS: Of 328 patients evaluated, 165 were female and 163 were male with a median age of 25 years. Dengue hemorrhagic fever was diagnosed in 116 patients, of which 113 were classified grade II. Of the 212 patients with dengue fever, 156 developed signs of plasma leakage, bleeding or thrombocytopenia. A positive serology was indicated in 82.4% of the patients. Inpatients with dengue hemorrhagic fever were younger (20.1 vs. 25.7 years, p<0.0054). Both lowest level of platelets and highest hematocrit were reached at the sixth day of illness. Children presented the typical symptoms of dengue less frequently, but demonstrated a greater proportion of ascites, pleural effusion and bleeding, and a higher risk of developing respiratory distress (RR=3.59, 95%CI 1.3-9.9, p<0.014) and hypotension (RR=10.77, 95%CI 5.56-20.86, p<0.001). CONCLUSIONS: Age was the most determinant factor of severity in dengue inpatients. In addition, a combination of particular symptoms and laboratory data at the day of admission may predict the development of complications.

Factores de riesgo en las cactaceae amenazadas de una región semiárida en el sur del desierto Chihuahuense México / Factors for endangered cactaceae in a semi-arid region of the southern Chihuahuan desert, México

El Semidesierto Queretano, en el centro de México, alberga uno de las principales ensambles de cactáceas amenazadas en el Desierto Chihuahuense, la ecoregión con la mayor diversidad de Cactaceae en el mundo. Desde hace algunas décadas se reconoce una aguda y compleja problemática para la supervivencia de estos taxa, debido principalmente a las actividades antrópicas y la extracción ilegal. Las especies amenazadas comúnmente son biológicamente raras, dada sus limitadas áreas de distribución y abundancia. No obstante, se desconoce la influencia de elementos de riesgo potencial en el desarrollo natural de las especies. Por ello se evaluó un conjunto de potenciales factores de perturbación para explorar su efecto en las poblaciones amenazadas. Se encontró que la transformación y destrucción de hábitat derivada de actividades antrópicas, al igual que características demográficas adversas como la baja densidad poblacional y de plántulas, representan los mayores riesgos para el contingente de cactáceas amenazadas. Los resultados sugieren que la modificación y pérdida de hábitat deben ser considerados factores de alto impacto para la supervivencia y vulnerabilidad de las especies amenazadas. La conservación de este ensamble cactológico implica la protección de los matorrales secos como ambiente natural fundamental para su salvaguarda, lo que podría evitar el riesgo de extinción.

Perfil postural en estudiantes de fisioterapia / Postural Profile among Physical Therapy Students

Objetivo: caracterizar el perfil postural de los estudiantes del programa de fisioterapia de la Universidad del Cauca, Colombia. Métodos: se realizó un estudio descriptivo a 44 estudiantes matriculados en el programa de fisioterapia de la Universidad del Cauca. Las características sociodemográficas y antropométricas de la población se consignaron en una ficha diseñada para tal fin, y el análisis postural se realizó por medio del software APIC v2.0. Resultados: el estudio arrojó que el 100 por ciento de los estudiantes analizados presentaron disbalances anatómicos en las diferentes imagenes evaluadas, siendo los más frecuentes las desalineaciones en hombros y pelvis. Conclusiones: es preocupante que los futuros fisioterapeutas presenten disbalances anatómicos antes de iniciar activamente su ejercicio profesional, puesto que si esta situación no es corregida a tiempo los años de vida profesionales potencialmente saludables se verán reducidos probablemente por la presencia de lesiones músculo-esqueléticas; por ello es importante recomendar un programa de control postural sobre esta población relativamente sana.

[Clinical criteria to diagnose dengue in its early stages]. / Criterios clínicos para diagnosticar el dengue en los primeros días de enfermedad.

INTRODUCTION: Clinical differentiation of dengue from other diseases with similar symptoms is difficult. The case definition of the World Health Organization (WHO) has high sensitivity but its specificity is very low. OBJECTIVE: A diagnostic scale was formulated for early clinical diagnosis of dengue that provided greater accuracy than that of the WHO definition. MATERIALS AND METHODS: A cohort of 251 adults (> 12 years of age) with unspecific acute febrile syndrome was selected from clinics located in Bucaramanga, Colombia. They consisted of 125 cases of dengue (serologically and/or virologically confirmed) and 126 with other febrile diseases. Clinical manifestations encountered during the first four days of dengue disease were determined, along with the diverse diagnostic combinations that were presented. RESULTS: : The scale consisted of the following criteria: presence of rash, positive tourniquet test, absence of nasal discharge, arthralgias, absence of diarrhea (1 point for each finding), leukocyte count < 4,000/mm3 (3 points) and platelet count < 180.000/mm3 (2 points). In a receiver-operating-characteristic curve, the predictive area of 81.0% was significantly superior to the one produced with WHO criteria, (70.0%, p < 0.001). Febrile syndrome with at least a 3 point score obtained the following values: sensitivity = 95.2%; specificity = 27.8%; positive predictive value = 56.7%; negative predicative value = 85.4%. With a 6-point score, sensitivity = 70.4%; specificity = 78.6%; positive predictive value = 76.5%; negative predicative value = 72.8%. With at least 8 points: sensitivity = 42.4%; specificity = 96%; positive predictive value = 91.4%; negative predictive value = 62.7%. With 9 or 10 points, specificity and positive predictive value were of 100%. CONCLUSION: The described scale proved useful for early clinical diagnosis of dengue, but requires validation for its application in endemic areas.

Criterios clínicos para diagnosticar el dengue en los primeros días de enfermedad / Clinical criteria to diagnose dengue in its early stages

Introducción. La definición de caso de dengue de la Organización Mundial de la Salud (OMS) tiene alta sensibilidad, pero es muy inespecífica. Objetivo. Formular una escala diagnóstica de mayor exactitud que la definición de la OMS para la identificación clínica temprana del dengue en áreas endémicas. Materiales y métodos. En una cohorte de adultos (>12 años) con síndrome febril agudo sin causa aparente en Bucaramanga, Colombia, compuesta por 125 casos de dengue (confirmados serológica o virológicamente) y 126 de síndrome febril de otra etiología, se determinaron las manifestaciones clínicas tempranas (en los primeros cuatro días de la enfermedad) asociadas al dengue y con ellas se formularon y evaluaron diversas combinaciones diagnósticas. Resultados. La escala compuesta por exantema, prueba de torniquete positiva, ausencia de rinorrea, artralgias, ausencia de diarrea (1 punto por cada hallazgo), recuentos de leucocitos <4.000/mm3 (3 puntos) y plaquetas <180.000/mm3 (2 puntos) exhibió un área bajo la curva de características operador-receptor de 81,04 por ciento, superior a la observada con los criterios de la OMS de 69,96 por ciento (p=0,0003). Con 3 puntos se obtuvo una sensibilidad de 95,2 por ciento; una especificidad de 27,8 por ciento; un valor diagnóstico positivo de 56,7 por ciento; un valor diagnóstico negativo de 85,4 por ciento. Con 6 puntos se obtuvo una sensibilidad de 70,4 por ciento; una especificidad de 78,6 por ciento; un valor diagnóstico positivo de 76,5 por ciento; un valor diagnóstico negativo de 72,8 por ciento. Con 8 puntos se obtuvo una sensibilidad de 42,4 por ciento; una especificidad de 96 por ciento; un valor diagnóstico positivo de 91,4 por ciento; un valor diagnóstico negativo de 62,7 por ciento. Con 9 o 10 puntos, la especificidad y el valor diagnóstico positivo fueron de 100 por ciento. Conclusión. La escala descrita puede ser útil para el diagnóstico clínico temprano del dengue en áreas endémicas.

[Evaluation of the World Health Organization clinical definition of dengue]. / Evaluación de la definición clínica de dengue sugerida por la Organización Mundial de la Salud.

INTRODUCTION: The distinction between dengue and other acute febrile diseases is difficult when based solely on symptoms. OBJECTIVE: An attempt was made to evaluate usefulness of dengue diagnoses in an endemic area (Bucaramanga, Colombia), based on the definitions recommended by the World Health Organization. MATERIALS AND METHODS: In a cohort >12 years of age with indications of acute febrile illness, the sensitivity, the specificity and the predictive values were determined based on the WHO dengue definition. Two or more of the following symptoms were included: headache, retroorbital pain, myalgia, arthralgia, rash, hemorrhagic manifestations, or leucopenia. RESULTS: One hundred-one cases of dengue and 89 patients with acute febrile illness were enrolled in the study. The dengue cases were confirmed by serological or by virus presence. The WHO case definitions showed sensitivity, 99%; specificity, 1%; positive predictive value, 53%, and negative predictive value, 50%. CONCLUSION: This clinical definition demonstrated high sensitivity, but a low specificity. Therefore, the clinical definition was useful for screening, but it did not differentiate between dengue and other febrile diseases.