Cost-utility analysis of a palliative care program in Colombia.

BACKGROUND: The economic assessment of health care models in palliative care promotes their global development. The purpose of the study is to assess the cost-effectiveness of a palliative care program (named Contigo) with that of conventional care from the perspective of a health benefit plan administrator company, Sanitas, in Colombia. METHODS: The incremental cost-utility ratio (ICUR) and the incremental net monetary benefit (INMB) were estimated using micro-costing in a retrospective, analytical cross-sectional study on the care of terminally ill patients enrolled in a palliative care program. A 6-month time horizon prior to death was used. The EQ-5D-3 L questionnaire (EQ-5D-3 L) and the McGill Quality of Life Questionnaire (MQOL) were used to measure the quality of life. RESULTS: The study included 43 patients managed within the program and 16 patients who received conventional medical management. The program was less expensive than the conventional practice (difference of 1,924.35 US dollars (USD), P = 0.18). When compared to the last 15 days, there is a higher perception of quality of life, which yielded 0.25 in the EQ-5D-3 L (p < 0.01) and 1.55 in the MQOL (P < 0.01). The ICUR was negative and the INMB was positive. CONCLUSION: Because the Contigo program reduces costs while improving quality of life, it is considered to be net cost-saving and a model with value in health care. Greater availability of palliative care programs, such as Contigo, in Colombia can help reduce existing gaps in access to universal palliative care health coverage, resulting in more cost-effective care.

Sulfur nanocomposites with insecticidal effect for the control of Bactericera cockerelli.

The purpose of this research was to synthesize nanocomposites consisting of sulfur nanoparticles coated with eucalyptus and rosemary essential oils to determine the insecticidal effect in the control of nymphs of paratrioza (Bactericera cockerelli (Sulc) (Hemiptera: Triozidae)) in potato crops. A solution of thiosulfate was reduced to elemental sulfur, and the sulfur nanoparticles were coated with eucalyptus and rosemary essential oils with the three concentrations of 0.25%, 0.5%, and 0.75%. The samples were characterized by UV-visible spectroscopy, energy-dispersive X-ray spectroscopy, transmission electron microscopy, and scanning electron microscopy. The insecticidal efficacy of the nanocomposites was evaluated in the entomology laboratory 24, 48, and 72 h after application. Furthermore, efficacy was compared to the commercial insecticide thiamethoxam (0.25%) and a control. The results show that eucalyptus nanocomposites with oil concentrations of 0.25%, 0.5%, and 0.75% and rosemary nanocomposites with an oil concentration of 0.5% have an insecticidal efficacy of 100% for the control of insect nymphs 24 h after application. The insecticidal efficacy of rosemary nanocomposites with oil concentrations of 0.25% and 0.75% increases over time and reaches 100% at 24 and 72 h, respectively. The synthesized nanocomposites are more effective in controlling nymphs of paratrioza than the commercial insecticide thiamethoxam; thus, they could be used for the development of new insecticides.

Upper Extremity Trauma in Costa Rica - Evaluating Epidemiology and Identifying Opportunities.

Background: Traffic accidents and musculoskeletal injuries represent a major cause of morbidity and mortality in Costa Rica. To inform capacity building efforts, we conducted a survey study of hand and upper extremity (UE) fellowship-trained surgeons in Costa Rica to evaluate the epidemiology, complications, and challenges in care of UE trauma. Methods: Aiming to capture all hand and UE trained surgeons in Costa Rica, we compiled a list of nine surgeons and sent a survey in Spanish using Qualtrics. Assessment questions were developed to understand the burden, complications, practice patterns, challenges, and capacity associated with care of UE trauma. Questions were designed to focus on opportunities for future investigation. Questions were translated and adapted by two bilingual speakers. Data were reported descriptively and open-ended responses were analyzed using content analysis. Results: Nine (100%) surgeons completed the survey. Distal radius fractures, hand and finger fractures, and tendon injuries are the most frequently noted conditions. Stiffness and infection are the most common complications. About 29% of patients are unable to get necessary therapy and 13% do not return for follow-up care with monetary, distance, and transportation limitations being the greatest challenges. Conclusions: The burden of UE trauma in Costa Rica is high. Identifying common conditions, complications, challenges, and capacity allows for a tailored approach to partnership and capacity building (e.g. directing capacity building and/or research infrastructure toward distal radius fractures). These insights represent opportunities to inform community-driven care improvement and research initiatives, such as Delphi consensus approaches to identify priorities or the development of outcome measurement systems.

Description of a novel technique for ultrasound-based planning for gynaecological 3D brachytherapy and comparison between plans of this technique and 2D with fluoroscopy.

With the purpose of implementing a way to obtain volumes from ultrasound axial images, a novel method for 3D gynaecologic brachytherapy was assessed, with a 3D-printed attachment for a commercial stepper (for prostate brachytherapy). It allowed the acquisition of a transabdominal axial image series by ultrasound; these images were uploaded to a treatment planning system where high-risk clinical tumour volume (HR-CTV) and risk organs were contoured. A dose administration plan was developed with orthogonal X-ray images (0° and 270° incidences), using International Commission on Radiation Units and Measurements (ICRU) 38 points. The same plan was applied in the ultrasound images' sequence and their respective volumes; differences were noted. In the 20 cases analysed, with a given point A dose, its corresponding dose delivered to 90% of HR-CTV percentage was highly variable (mean = 104.2, SD = 26.01). There is a significant variation of this percentage when point A falls outside the HR-CTV than when it falls inside (p < 0.00001). There is a significant correlation in terms of the bladder point dose ICRU 38 and the Maximum dose to 2cc of organ or target volume (D2cc) bladder (p = 0.021); however, there is no such correlation when we relate the rectum point dose ICRU 38 to the D2cc rectum (p = 0.327). There was a negative correlation between HR-CTV and D2cc bladder and D2cc rectum; both were statistically significant. There were significant differences comparing ICRU points and dose to prescription and organ at risk volumes, pointing out that there is room for optimisation of plans using the latter technique. So, it is proposed to further test this image modality and compare it to other imaging techniques that allow the creation of volumes, such as computed tomography or magnetic resonance imaging.

Estimación del gasto energético y tiempo dedicado a la actividad física en escolares costarricenses con sobrepeso u obesidad por medio del acelerómetro Actiheart / Energy expenditure and time spent on physical activity in Costa Rican schoolchildren with overweight or obesity by means of the Actiheart accelerometer

Resumen Objetivo: determinar el gasto energético y el tiempo dedicado a actividad física en condición de vida libre de escolares costarricenses con sobrepeso u obesidad. Metodología: participaron 31 niños y 13 niñas entre 6 y 9 años (7.6 ± 1.03 años) con sobrepeso u obesidad, estado nutricional que se estableció según el IMC. Las variables del estudio fueron la antropometría, el porcentaje de grasa corporal (%GC), el gasto energético total producto de la actividad física a lo largo del día (GEAF total diario), el gasto energético por actividad física (GEAF) y el tiempo dedicado a la actividad física (TAF), las dos últimas se estimaron según condición sedentaria, ligera, moderada o vigorosa, por medio del acelerómetro Actiheart. Resultados: la talla y el %GC fueron significativamente mayores en las niñas (126.8 ± 5.9 cm, 34.0 ± 6.4 %GC) que en los niños (123.0 ± 5.4 cm, 25.2 ± 6.9 %GC). Los niños registraron un GEAF total diario de 824 ± 228.1 kcal/day, GEAF moderada + vigorosa de 285.6 ± 131.7 kcal/day y un TAF moderada + vigorosa de 147.0 ± 66.6 min, valores superiores (p<0.05) a los de las niñas 395 ± 144.4 kcal/day, 139.6 ± 90.1 kcal/day y 75.6 ± 43.2 min, respectivamente. Conclusiones: los escolares cumplen más de los 60 min/día recomendados de TAF de moderada a vigorosa intensidad, sin embargo, el GEAF de moderada a vigorosa intensidad no alcanza el mínimo de 300 kcal/día para la reducción de peso, lo cual podría ser una de las causas del sobrepeso.

Abstract Objective: To determine the energy expenditure and time spent on physical activities in Costa Rican overweight or obese schoolchildren in free-living conditions. Methodology: Participants were 31 boys and 13 girls aged 6 to 9 years old (7.6 ± 1.03 years) with overweight or obesity; nutritional status was established by BMI. The variables of the study were: anthropometric, body fat percentage (%BF), total energy expenditure product of physical activity performed during the day (EEPA daily total), plus the energy expenditure by physical activity (EEPA), and time spent on physical activity (TPA), both variables in sedentary condition, light, moderate and vigorous intensity estimated by the Actiheart accelerometer. Results: Size and %BF were significantly higher in girls (126.8 ± 5.9 cm, 34.0 ± 6.4% BF) than in boys (123.0 ± 5.4 cm, 25.2 ± 6.9% BF). Boys recorded a daily total EEPA of 824 ± 228.1 kcal / day, moderate + vigorous EEPA 285.6 ± 131.7 kcal / day and a moderate + vigorous TPA 147.0 ± 66.6 min; significantly higher (P <0.05) than girls 395 ± 144.4 kcal / day, 139.6 ± 90.1 kcal / day and 75.6 ± 43.2 min respectively . Conclusions: Schoolchildren perform over 60 min/day moderate to vigorous intensity PA recommended, however; the EEPA moderate to vigorous intensity does not meet the minimum recommendation of 300 kcal / day for weight reduction. This could be one of the causes for overweight schoolchildren.

Tiempo dedicado a actividades físicas de diferente intensidad y su relacion con variables antropométricas y grasa corporal en escolares costarricenses / Time dedicated to physical activities of different intensity and its relationship with anthropometic variables and body fat in Costa Rican schoolchildren

Introducción: La realización de actividad física es de relevancia en la prevención del sobrepeso y la obesidad infantil. Objetivo: Determinar la asociación entre el tiempo que dedican escolares costarricenses a actividades físicas de diferentes intensidades con variables antropométricas y con el porcentaje de grasa corporal. Materiales y métodos: Participaron 21 niños y 11 niñas con edades entre los 6 a 9 años. Las mediciones antropométricas fueron: peso, talla, circunferencia de brazo, circunferencia de cintura, pliegue subescapular, pliegue tricipital. Se calculó el IMC, circunferencia muscular del brazo, área del brazo, área muscular del brazo, área grasa del brazo e índice cintura/talla. El análisis del porcentaje de grasa corporalse realizó por el método del deuterio. El tiempo dedicado a la actividad física a diferente intensidad se registró por medio del acelerómetro Actiheart y las variables registradas fueron en condición sedentaria, ligera, moderada, vigorosa y moderada + vigorosa. Resultados: Los niños presentaron valores significativamente mayores (p < 0.05) en la condición moderada, vigorosa y moderada + vigorosa que las niñas. El análisis de correlación de Pearson determinó una asociación negativa entre el tiempo de actividad física moderado y moderado + vigorosa intensidad con el peso, IMC, circunferencia de cintura, pliegue cutáneo tricipital y porcentaje grasa corporal. Conclusiones: Los escolares entre 6 a 9 años que dedican más tiempo a las actividades de moderada intensidad y a las de moderada + vigorosa intensidad disminuyen factores de riesgo relacionados con el desarrollo de enfermedades no transmisibles

Introduction: Physical activity is important in the prevention of childhood overweight and obesity. Objective: To determine the association between the time that Costa Rican schoolchildren dedicate to physical activities of different intensities with anthropometric variables and with the percentage of body fat. Materials and methods: Participants were 21 boys and 11 girls with ages between 6 and 9 years old. Anthropometric measurements were weight, size, arm circumference, waist circumference, sub scapular fold, tricipital fold. BMI, arm muscle circumference, arm area, arm muscle area, fat arm area, and waist/height ratio were calculated. Analysis of the percentage of body fat was carried out by the deuterium method. The time devoted to physical activity at different intensity was recorded using the Actiheart accelerometer and the variables recorded were sedentary, light, moderate, vigorous and moderate + vigorous condition. Results: Boys presented significantly higher values (p <0.05) in the moderate, vigorous and moderate + vigorous condition than girls. Pearson's correlation analysis determined a negative association between moderate physical activity time and moderate + vigorous intensity with weight, BMI, waist circumference, triceps skinfold, and body fat percentage. Conclusions: Schoolchildren between 6 and 9 years of age who dedicate more time to activities of moderate intensity and moderate + vigorous intensity reduce risk factors related to the development of non-communicable diseases

[Primary ciliary dyskinesia in children. Role of electron microscopy in countries with medium economic resources]. / Discinesia ciliar primaria en niños. Rol de la microscopia electrónica en países de medianos recursos económicos.

Primary ciliary dyskinesia (PCD) is a rare genetic disease that produces functional and structural de fects in the cilia. In Peru, no cases of this disease have been reported in the pediatric population. OBJECTIVE: To describe the clinical, radiological and ciliary ultrastructure characteristics in children with PCD, in a country with medium economic resources. CLINICAL CASE: We report 5 patients with PCD treated at the Instituto Nacional de Salud del Niño-Breña (Peru). Age range 1 to 5 years (median 3 years). Three patients were male. The most frequent clinical manifestations were chronic wet cough, rhonchi, coarse crackles, recurrent bronchial obstructive syndrome, and recurrent pneumonia. All patients had atelectasis, three had bronchiectasis, and two had dextrocardia with situs inversus. Two patients had undergone lobectomy. Other causes of recurrent pneumonias were ruled out with im munodeficiency study, chlorine test and pulmonary aspiration The electron microscopy showed ab sence of the inner arm of dynein as the most frequent pattern. All patients received treatment with antibiotics, nebulization with hypertonic saline, and respiratory physiotherapy with good adherence. CONCLUSION: In medium incomes countries, electron microscopy associated with clinical and radio logical characteristics plays an important role in the early diagnosis of this disease. This is the first Peruvian report that contributes to the casuistry and epidemiology of this rare pathology.

[Surfactant protein C dysfunction in pediatric patients: Clinical Case]. / Disfunción de la proteína surfactante C en pacientes pediátricos: Caso Clínico.

Pulmonary surfactant dysfunction disorders are caused by genetic defects that alter pulmonary surfactant metabolism. They are rare disorders and cause significant morbidity and mortality in the neonatal and pediatric populations. OBJECTIVE: To describe the clinical, histopathological, and ultrastructural findings of the lamellar body that suggest surfactant protein C (SP-C) dysfunction, where confirmatory genetic studies are not available. CLINICAL CASE: We report three pediatric cases of pul monary surfactant dysfunction disorders from a pediatric hospital in Peru. Video-assisted lung biop sy was performed in all cases. Ultrastructural studies of the lamellar body were compatible with type- C pulmonary surfactant dysfunction. The treatment used was methylprednisolone pulses monthly for six months, then every two months, varying the duration according to the clinical evolution. They also received daily hydroxychloroquine and azithromycin three times a week. Clinical evaluations, eye fundus, echocardiogram, electrocardiogram, and biochemistry were performed periodically. At follow-up, there was a good response to treatment and no adverse effects were observed. One case died despite the therapies received. CONCLUSIONS: In 3 patients with type-C surfactant dysfunction, treatment with corticosteroids, hydroxychloroquine, and azithromycin was successful in 2 of them. This is one of the first case series reported in Peru that contributes to the study of these diseases, es pecially in low- and medium-income countries.

Thermal stress induces pyknosis in pigeon erythrocytes: digital image analysis.

Pyknosis or hypercondensation of chromatin is informative in the understanding of nucleosomal packing in translationally inactive chromatin and in the compression of cell death. However, mechanisms that result in the formation of avian erythrocytes with variant nuclear morphology are poorly understood.Purpose: In this work, we evaluated pyknosis in pigeon erythrocytes treated with thermal stress using Digital Image Analysis (DIA).Materials and methods: Pigeon erythrocytes were treated at thermal stress (33 °C, 43 °C, and 53 °C), and nuclear modifications were analyzed by DIA.Results: Our results showed that thermal stress induced DNA condensation. Based on DNA fluorescent staining and compaction, four subclasses with progressively more pyknotic nuclei each could be distinguished. Alkaline comet assay showed that the presence of pyknotic nuclei was associated with the DNA fragmentation typical of apoptosis. DIA analysis showed a decrease of nuclear area and a significant increase of fluorescence intensity with respect to non-pyknotic nucleus. Additionally we observed nuclear dissolution events associated with swell and loose membrane integrity.Conclusion: These findings can contribute to the evaluation of health and metabolic status in diagnostic cytology, especially in neoplastic conditions and infection by microorganisms.

Quality of life of children and adults following cardiac surgery for congenital heart disease: A Mexican cohort.

Objective: The real burden of (congenital heart defects [CHD]) and the improvement after surgical correction or palliation is both reflected in the quality of life (QoL). There are few studies in Latin-America that evaluate QoL in the CHD population. The purpose of this study was to measure the QoL after corrective or palliative surgery for CHD. Materials and methods: An observational, cross-sectional, and comparative study was carried out at the Miguel Hidalgo Centennial Hospital. Patients from 8 to 18 years old who underwent surgery for CHD were included during a period of 8 months. A total of 40 patients were included, together with a group of 80 healthy controls. From all participants, a KIDSCREEN-52 questionnaire was taken. A comparative analysis of the results was performed. Results: Overall, patients with cardiac surgery had better QoL indexes than healthy controls (p < 0.0001). The difference was greatest in moods and emotions, autonomy, and parent relations. Conclusions: Self-perception of QoL in post-operative patients for congenital heart disease is similar and in certain dimensions higher than the healthy population, possibly due to socioeconomic differences, parental care, and styles of coping with their disease. Higher complexity studies that include psychosocial variables and parental perception are required, and a better understanding of the QoL determinants will improve the attention provided to the patient and their families. Objetivo: Los efectos de las cardiopatías congénitas en los pacientes, así como la mejoría después de la paliación o la corrección quirúrgica, se reflejan en la calidad de vida (CV). Hay pocos estudios en Latinoamérica que evalúen la CV en esta población. El objetivo de este artículo es notificar la CV posterior a la operación paliativa o correctiva para defectos cardíacos congénitos. Material y métodos: Se llevó a cabo un estudio observacional, transversal y comparativo en el Centenario Hospital Miguel Hidalgo. Durante un período de ocho meses se incluyó a pacientes de 8 a 18 años sometidos a una intervención para cardiopatías congénitas. Se reunió a dos grupos de 40 pacientes y 80 controles sanos, pareados por edad y sexo. A cada participante se le aplicó el cuestionario KIDSCREEN-52 y se realizó un análisis comparativo de los resultados. Resultados: Los pacientes sometidos a operación cardíaca tuvieron mejores índices de CV que los controles sanos (p < 0.0001). La mayor diferencia se obtuvo en los aspectos de estado de ánimo y emociones, autonomía y relación con los padres. Conclusiones: La autopercepción de la CV después de una intervención para cardiopatías congénitas es similar y, en ciertas dimensiones, mejor que la de la población sana, tal vez por diferencias socioeconómicas, atención de los padres y modelos de adaptación a la enfermedad. Se requieren estudios más extensos que incluyan variables psicosociales y percepción parental. Una mayor comprensión de los determinantes de la CV podría mejorar la atención ofrecida al paciente y su familia.

Quality of life of children and adults following cardiac surgery for congenital heart disease: A Mexican cohort / Calidad de vida en niños y adultos después de cirugía para cardiopatías congénitas: primera cohorte mexicana

Abstract Objective: The real burden of (congenital heart defects [CHD]) and the improvement after surgical correction or palliation is both reflected in the quality of life (QoL). There are few studies in Latin-America that evaluate QoL in the CHD population. The purpose of this study was to measure the QoL after corrective or palliative surgery for CHD. Materials and methods: An observational, cross-sectional, and comparative study was carried out at the Miguel Hidalgo Centennial Hospital. Patients from 8 to 18 years old who underwent surgery for CHD were included during a period of 8 months. A total of 40 patients were included, together with a group of 80 healthy controls. From all participants, a KIDSCREEN-52 questionnaire was taken. A comparative analysis of the results was performed. Results: Overall, patients with cardiac surgery had better QoL indexes than healthy controls (p < 0.0001). The difference was greatest in moods and emotions, autonomy, and parent relations. Conclusions: Self-perception of QoL in post-operative patients for congenital heart disease is similar and in certain dimensions higher than the healthy population, possibly due to socioeconomic differences, parental care, and styles of coping with their disease. Higher complexity studies that include psychosocial variables and parental perception are required, and a better understanding of the QoL determinants will improve the attention provided to the patient and their families.

Resumen Objetivo: Los efectos de las cardiopatías congénitas en los pacientes, así como la mejoría después de la paliación o la corrección quirúrgica, se reflejan en la calidad de vida (CV). Hay pocos estudios en Latinoamérica que evalúen la CV en esta población. El objetivo de este artículo es notificar la CV posterior a la operación paliativa o correctiva para defectos cardíacos congénitos. Material y métodos: Se llevó a cabo un estudio observacional, transversal y comparativo en el Centenario Hospital Miguel Hidalgo. Durante un período de ocho meses se incluyó a pacientes de 8 a 18 años sometidos a una intervención para cardiopatías congénitas. Se reunió a dos grupos de 40 pacientes y 80 controles sanos, pareados por edad y sexo. A cada participante se le aplicó el cuestionario KIDSCREEN-52 y se realizó un análisis comparativo de los resultados. Resultados: Los pacientes sometidos a operación cardíaca tuvieron mejores índices de CV que los controles sanos (p < 0.0001). La mayor diferencia se obtuvo en los aspectos de estado de ánimo y emociones, autonomía y relación con los padres. Conclusiones: La autopercepción de la CV después de una intervención para cardiopatías congénitas es similar y, en ciertas dimensiones, mejor que la de la población sana, tal vez por diferencias socioeconómicas, atención de los padres y modelos de adaptación a la enfermedad. Se requieren estudios más extensos que incluyan variables psicosociales y percepción parental. Una mayor comprensión de los determinantes de la CV podría mejorar la atención ofrecida al paciente y su familia.

[Sedentary behaviors and their relation to anthropometric variables and body fat in schoolchildren]. / Conductas sedentarias y su relación con variables antropométricas y grasa corporal en escolares.

OBJECTIVE: To evaluate the association between time spent on sedentary behaviors with anthropome tric variables and the percentage of body fat. SUBJECTS AND METHOD: 43 schoolchildren (72% male) participated, aged between 6 and 9 years. Anthropometric measurements were weight, height, body mass index, arm circumference, waist circumference, subscapular skinfold, tricipital skinfold, arm muscle circumference, arm area, arm muscle area, arm fat area, and waist-to-height ratio. The percen tage of body fat was measured using an isotopic technique considered the gold standard(deuterium). The average time spent on sedentary behaviors recorded by self-report, during three non-consecutive weekdays were school activity, extracurricular work at home, watching television, using electronic devices screens, and sedentary recreational activities. RESULTS: 32% of the subjects were eutrophic considering the percentage of body fat. 52% of daily time is spent on sedentary activities with no significant differences between boys and girls, 12.4 h vs 13.37, respectively. Time spent watching television was significantly associated (p < 0,05) with greater values of the anthropo metric variables [weight, body mass index, waist circumference, waist-to-height ratio, skinfold (subs capular and tricipital)], and body fat percentage. CONCLUSION: The time spent watching television is associated with an increase in body fat. There is an urge to promote recreational activities that involve an increase in moderate and intense physical activity in schoolchildren.

Evaluation of the genotoxic effect of heavy metals in pigeons from urban and rural habitat in Monterrey, Mexico, using the chromatin dispersion assay.

PURPOSE: Evaluate genotoxic effect of heavy metals on Pigeon Erythrocytes (PE) from urban and rural habitat (outside of the city) in Monterrey, Mexico, using the chromatin dispersion assay. MATERIALS AND METHODS: We quantified metals concentrations (Cd, Hg, Cu and Pb) in tail feathers of 22 pigeons from an urban and a rural site in northeastern Mexico. DNA damage in peripheral blood erythrocytes was measured by chromatin dispersion assay in 13 pigeon living in urban habitat and in nine living in rural habitat as the control. MicroNucleus (MN) test was used to confirm levels of DNA damage. RESULTS: Birds in urban habitat had highest concentrations in feathers for all the metallic elements analysed with respect to birds in rural habitat. Concentrations of Cu and Hg showed a significant increase (p < 0.05). Our results showed a significant increase of DNA damage in urban-habitat pigeons compared with that of pigeons in rural area. These results were confirmed by a MN test. CONCLUSIONS: Our preliminary findings demonstrate that PE examination via chromatin dispersion assay is a reliable, precise and inexpensive morphological bioassay for evaluating environmental genotoxicity associated with heavy metals. Further studies for evaluating the individual participation of contaminants in DNA damage are needed.

Uso de gluconato de clorhexidina en la curación de heridas y su potencial formación de tejido de granulación / Use of chlorhexidine in wound healing and granulation tissue formation

Introducción: Las heridas con defectos de coberturas suponen un gran desafío a la hora de elegir un buen tratamiento que reduzca el riesgo de infección e incremente la capacidad de granulación del tejido. El objetivo de este estudio fue demostrar la utilidad del digluconato de clorhexidina para la granulación de tejidos. Materiales y Métodos: Se incluyeron 18 heridas de 16 pacientes que cumplían con los criterios de inclusión. Se realizaron curaciones ambulatorias con gasas embebidas en digluconato de clorhexidina al 20%, cada 48-72 h, hasta lograr la adecuada granulación de tejido y se tomaron fotografías de la evolución clínica de las heridas. Resultados: Se observó una adecuada granulación de las heridas en una media de 9.2 días (rango 4-25), independientemente del tamaño o de las comorbilidades. Ninguna herida presentó signos clínicos de infección durante el período de curación. Conclusiones: El uso de digluconato de clorhexidina es un adecuado método por tener en cuenta para tratar heridas, de forma ambulatoria, y así disminuir los costos hospitalarios del sistema de salud. Nivel de Evidencia: IV

Introduction: Wounds with dressing defects pose a great challenge when choosing a good treatment that may reduce the risk of infection and promote granulation tissue formation. Objective: To demonstrate the usefulness of chlorhexidine digluconate (CHG) for granulation tissue formation. Materials and Methods: Eighteen wounds (16 patients) that met the inclusion criteria were included. Wound cleansing was performed in outpatients with 20% CHG-impregnated cloths every 48-72 h, until the proper tissue granulation was achieved. Photographs of the clinical evolution of the wounds were taken. Results: The adequate wound granulation mean was of 9.2 days (4-25 days) regardless of wound size or presence of comorbidities. There were no clinical signs of infection in any wound during the healing period. Conclusions: CHG treatment is an appropriate method to be considered for outpatient injuries, which reduces the hospital costs borne by the health-care system. Level of Evidence: IV

Relación entre indicadores antropométricos y masa grasa medida por deuterio en escolares costarricenses / Relationship between anthropometric indicators and fat mass measured by deuterium in Costa Rican schoolchildren / Relação entre indicadores antropométricos e massa gordurosa medida por deutério em crianças da escola costarriquenhos

El propósito de este estudio fue identificar la relación entre la masa grasa expresada como porcentaje de grasa corporal (%GC) medida por el método de deuterio (D2O) e indicadores antropométricos en escolares costarricenses. Se trata de un estudio descriptivo transversal en el que participaron 54 niños y 49 niñas de 6 a 9 años. Se realizaron medidas antropométricas: peso, talla, índice de masa corporal, circunferencia de brazo, circunferencia de cintura, circunferencia abdominal, pliegue cutáneo subescapular y pliegue cutáneo tricipital. El análisis del %GC se realizó por medio del método de referencia del D2O. Se realizó una estadística descriptiva y se aplicó un análisis de coeficiente de correlación de Pearson para identificar la relación entre las mediciones antropométricas y el %GC obtenido por D2O. En el grupo de escolares, las niñas presentaron valores mayores de talla y pliegue cutáneo tricipital (p<0,05) y %GC obtenida por D2O (p<0,001). Se observó una fuerte correlación entre el %GC medido por D2O y el índice de masa corporal, la circunferencia de cintura y la circunferencia abdominal tanto en los niños como en las niñas. Se concluye que la circunferencia de cintura y la circunferencia abdominal podrían ser utilizadas conjuntamente con el IMC como herramientas para el diagnóstico de sobrepeso y obesidad en población escolar, cuando no se cuente con metodologías más precisas que determinen el %GC.

The purpose of this study was to identify the relationship between fat mass (FM) expressed as body fat percentage (%BF) measured by the deuterium method (D2O) and anthropometric indicators in Costa Rican schoolchildren. A cross-sectional descriptive study was performed and the participants were 54 boys and 49 girls of ages between six and nine years old. The anthropometric measurements recorded were weight, height, body mass index (BMI), arm circumference (AC), waist circumference (WC), abdominal circumference (AC), subscapular skinfold (SSF), and tricipital skinfold (TSF). The analysis of %BF was performed by means of D2O reference method. Descriptive statistics and the application of Pearson correlation coefficient analysis identified the relationship between anthropometric measurements and %BF obtained by D2O. From the group of schoolchildren, the girls showed greater values for height and tricipital skinfold (p<0.05) and %BF obtained by D2O (p<0.001). This study evidences a strong correlation between %BF measured by D2O and BMI, WC and AC in both girls and boys. It is concluded that WC and AC could be used together with the IMC as tools for the diagnosis of overweight and obesity in schoolchildren, when there are no more precise methodologies that determine the %BF.

O objetivo deste estudo foi identificar a relação entre a massa gordurosa (MG), expressa como percentagem de gordura corporal (%GC) medida pelo método de deutério (D2O) e indicadores antropométricos em escolas da Costa Rica. Trata-se de um estudo descritivo transversal, no qual participaram 54 meninos e 49 meninas com idade entre seis e nove anos. Foram realizadas medidas antropométricas: peso, tamanho, índice de massa corporal (IMC), circunferência do braço (CB), circunferência da cintura (CC), circunferência abdominal (CA), prega cutânea subescapular (PCS) e prega cutânea tricipital (PCT). A análise da %GC foi realizada pelo método de referência D2O, realizou-se uma estatística descritiva e foi aplicada análise coeficiente de correlação de Pearson para identificar a relação entre as medições antropométricas e a %GC obtida por meio do D2O. No grupo de escolares, as meninas apresentaram maiores valores de estatura e PCT (p<0,05) e %GC obtida por D2O (p<0,001). Observou-se uma importante correlação entre %GC medida por D2O e IMC, CC e CA tanto nos meninos quanto nas meninas. Conclui-se que a CC e a CA poderiam ser utilizadas conjuntamente com o IMC como ferramenta para o diagnóstico de sobrepeso e obesidade em população escolar, quando não se conte com metodologias mais precisas que determinem o %GC.

Depredación del borrego Ovis canadensis (Artiodactila: Bovidae) y el venado bura Odocoileus hemionus (Artiodactila: Cervidae) por Puma concolor (Carnivora: Felidae) en Coahuila, México / Predation of bighorn sheep, Ovis canadensis (Artiodactila: Bovidae) and mule deer, Odocoileus hemionus (Artiodactila: Cervidae) by Puma concolor (Carnivora: Felidae) in Coahuila, México

Resumen Pequeñas y aisladas poblaciones de borrego cimarrón (Ovis canadensis; especie sujeta a protección especial) son susceptibles a la depredación en hábitat simpátrico con venado bura. Entender las causas específicas de muerte y supervivencia es importante para el desarrollo de estrategias de conservación para el borrego cimarrón y otros ungulados que comparten el mismo hábitat, tal como el venado bura (Odocoileus hemionus). El objetivo de este estudio fue evaluar la tasa de depredación por puma (Puma concolor) en el borrego cimarrón y compararla con la del venado bura, para conocer la selección de presa del puma entre estas dos especies en un mismo hábitat, así como el impacto que podría tener en las poblaciones. Se plantea la hipótesis de que el puma como depredador oportunista no discrimina entre especies de ungulados simpátricos generando mayor impacto a la especie de menor densidad. Evaluamos la tasa de depredación por puma en 12 borregos cimarrones (10 hembras, 2 machos) y de 10 hembras adultas de venado bura con radio collares a través de micromorts y se comparó por medio una prueba de Wilcoxon, más la estimación de densidades de borrego y venados. Encontramos resultados similares en la causa específica de muerte por puma y supervivencia en ambas especies; 88 % (8/9) muertes debido a depredación por puma en borrego cimarrón con una tasa de supervivencia mensual promedio de 0.79 y una tasa mensual de depredación que va del rango 0.17-0.30. En venado bura la depredación debido a puma fue 83 % (5/6) con una tasa de supervivencia mensual promedio de 0.86 y una tasa de depredación por puma mensual en el rangos 0.10-0.25. Sin embargo, al comparar con la tasa de depredación por puma encontramos una diferencia significativa (Z = 1.826; df = 6; P = 0.05) siendo el borrego cimarrón la presa más selecta. En este estudio se concluye que el puma seleccionó a la presa de menor densidad (borrego cimarrón) y por ende la más impactada en un hábitat simpátrico con venado bura.(AU)

Abstract Small and isolated populations of bighorn sheep are vulnerable to predation by mountain lion in habitat sympatric with mule deer. Understanding the specific causes of death and survival is important for the development of conservation strategies for bighorn sheep and other ungulates that share the same habitat, such as mule deer. We evaluated and compared the rate of predation by puma in 12 bighorn sheep (10 females, two males) and 10 adult females of mule deer with radio collars through measure risk program (micromorts). The impact of predation in both populations of herbivores is evaluated through the estimation of densities of sheep and mule deer. 88 % (8/9) deaths by puma in bighorn sheep with an average monthly survival rate of 0.79 and predation rates due to puma range from 0.17 to 0.30. In mule deer predation due to puma was 83 % (5/6) with an average monthly survival rate of 0.86 and predation rates due to puma range from 0.10 to 0.25, however when comparing the mountain lion depredation rate we found a significant difference between species (Z = 1.826, df = 6, P = 0.05). The density in mule deer was 9x more that bighorn. The bighorn sheep being the prey most selected and the one most affected as the population with the lowest density.(AU)

Evaluación antropométrica y composición corporal por medio de óxido de deuterio en escolares costarricenses / Anthropometric evaluation and body composition by means of deuterium oxide in Costa Rican schoolchildren

El objetivo del estudio fue determinar elestado nutricional de escolares costarricenses de seis a nueve años. Participaron 103 escolares (54 niños y 49 niñas) con un promedio de edad de 7,8 ± 0,9 años. Se evaluó peso, talla, talla sentado, circunferencia de cintura (CC), índice de masa corporal (IMC), índice córmico (IC) y relación cintura-talla (IC/T). Se utilizó el óxido de deuterio (D2O) para evaluar la composición corporal: % agua corporal total (% ACT), masa libre de grasa (MLG), masa grasa (MG) y % de grasa corporal (% GC). El sobrepeso/obesidad se determinó utilizando el IMC y el método de clasificación de McCarthy para % GC de acuerdo a sexo y edad. Los valores medios para niños y niñas fueron: peso (29,1 ± 7,2 vs 31,0 ± 6,7 kg), talla (124.7 ± 6.7 vs 127.5 ± 7.1 cm), talla sentado (64.4 ± 3.7 vs 65.6 ± 3.5 cm), IMC (18.5 ± 3.11 vs 18.9 ± 2.7 kg/m2), CC (62.1 ± 8.6 vs 63.8±7.8 cm), IC (51.6 ± 1.6 vs 51.5 ± 1.6), I.C/T (0.52 ± 0.1 vs 0.51 ± 0.1), % ACT (56.5 ± 5.7 vs 51.9 ± 4.5 %), MLG (21.0 ± 3.5 vs 20.5 ± 3.6 kg), MG (8.1 ± 4.2 vs 10.5 ± 3.6 kg), % GC (26.3 ± 7.3 vs 33.2 ± 5.7 %), respectivamente. La edad, talla, MG, % GC y % ACT fueron significativamente mayores (p<0.05) en las niñas. Los escolares presentan un crecimiento adecuado junto a una alta prevalencia de sobrepeso/obesida(AU)

The aim of the study was to determine the nutritional status of Costa Rican schoolchildren from six to nine years old. Participants were 103 schoolchildren (54 boys and 49 girls) with an average age of 7.8 ± 0.9. Each participant was assessed for weight, height, sitting height, waist circumference (WC), body mass index (BMI), cormic index (CI), and waist-height ratio (WHtR). Deuterium oxide dilution (D2O) was used to assess body composition; total body water % (TBW%), fat-free mass (FFM), fat mass (FM), and body fat % (BF %). Overweight/obesity was determined by the use of BMI and McCarthy's classification scheme for BF % in terms of sex and age. Mean values for boys and girls were: age (7.6 ± 0.9 vs 8.0 ± 1.0 years), weight (29.1 ± 7.2 vs 31.0 ± 6.7 kg), height (124.7 ± 6.7 vs 127.5 ± 7.1 cm), sitting height (64.4 ± 3.7 vs 65.6 ± 3.5 cm), BMI (18.5 ± 3.11 vs 18.9 ± 2.7 kg/m2), WC (62.1 ± 8.6 vs 63.8 ± 7.8 cm), CI (51.6 ± 1.6 vs 51.5 ± 1.6), WHtR (0.52 ± 0.1 vs 0.51 ± 0.1), TBW % (56.5 ± 5.7 vs 51.9 ± 4.5 %), FFM (21.0 ± 3.5 vs 20.5 ± 3.6 kg), FM (8.1 ± 4.2 vs 10.5 ± 3.6 kg), BF% (26.3 ± 7.3 vs 33.2 ± 5.7 %), respectively. Age, height, FM, BF %, and TBW % were significantly higher (p<0.05) in girls. Schoolchildren show adequate growth along with high prevalence of overweight/ obesity(AU)

Validez del porcentaje de grasa corporal por pliegues cutáneos comparado con la dilución de óxido de deuterio en escolares costarricenses / Validity of percent body fat by skinfold thickness comparated with deuterium oxide dilution in Costa Rican school children

El objetivo del estudio fue determinar la validez del porcentaje de grasa corporal (% GC) estimado por la ecuación de Slaughter en escolares costarricenses. Participaron 54 niños y 49 niñas con una edad promedio 7.8 ± 1.0 años. El óxido de deuterio (D2O) fue el método de referencia para determinar la masa grasa (FM) expresada como % GC. Se utilizó un análisis de regresión lineal y prueba t para determinar la asociación y las diferencias entre el %GC por la ecuación de Slaughter y D2O. La concordancia entre métodos se determinó por el coeficiente de correlación de concordancia (CCC) de Lin. La medición de acuerdo entre los métodos se analizó mediante el procedimiento de Bland-Altman. El % GC entre métodos fue significativamente diferente en niños (26.3 ± 7.4% vs 22.4 ± 7.0%) y niñas (33.2 ± 5.7% vs 26.1 ± 5.7%). La asociación entre métodos no fue significativa en niños (R2 = 0.76, p <0.0001) y niñas (R2 = 0.24, p <0.0001). Los gráficos de Bland-Altman mostraron que la ecuación de Slaughter subestimó el % GC en 6,0% en niños y 3,5% en niñas, en comparación con D2O. El CCC de Lin identificó una fuerza de concordancia pobre entre métodos, niños ρc= 0.87 y niñas ρc= 0.56. Con los resultados se concluye que la ecuación de Slaughter registró baja concordancia del % GC en comparación con el D2O en escolares costarricenses(AU)

The aim of the study was to determine the validity of the body fat percentage (% GC) estimated by the Slaughter equation in Costa Rican school children. The sample consisted of 54 male and 49 female, mean age 7.8 ± 1.0 years. Deuterium oxide dilution (D2O) was the reference method to determine the fat mass (FM) expressed as BF%. Linear regression analyses and paired sample t-tests were used to test association and mean differences between Slaughter equation and D2O BF%. Concordance between Slaughter equation and D2O BF% was determined by Lin's concordance correlation coefficient (CCC). Measurement of agreement between the two methods was analyzed using the Bland-Altman procedure. Measurements of BF% by Slaughter equation and D2O were significantly different for boys (26.3 ± 7.4% vs 22.4 ± 7.0%) and for girls (33.2 ± 5.7% vs 26.1 ± 5.7%). Non-significant association between methods was found in males (R2 = 0.76, p <0.0001) and females (R2 = 0.24, p <0.0001). Bland-Altman plots showed that Slaughter equation underestimated the %BF in a 6.0% for boys and in a 3.5% for girls compared with D2O. Lin's CCC identified poor strength of concordance between the two methods, for boys ρc= 0.87 and for girls ρc= 0.56. With the results we conclude that the Slaughter equation registered low agreement of BF% compared against the one obtained by D2O in Costa Rican school children(AU)

Índice C en médicos de dos centros hospitalarios chilenos según el test de competencia moral de Lind / Assessment of moral competence of physicians

Background: Moral competence (MC) in physicians is fundamental, given the increasing complexity of medicine. The "Moral Competence Test" (MCT © Lind) evaluates this feature and its indicator is the C Index (CI). Aim: To explore moral competence and its associated factors among physicians working in Chile. Material and Methods: The MCT was answered by 236 physicians from two medical centers who voluntarily participated in the study. Besides the test, participants completed an encrypted form giving information about gender, years in practice and post-graduate studies. Results: The average CI value of the participants was 20,9. Post-graduate studies had a significant positive influence on CI. There was a significant decrease in CI, between 16 and 20 years of professional exercise. Gender and the area of post-graduate studies did not have a significant influence. Conclusions: The studied physicians showed a wide range of CI which was positively affected by the postgraduate studies performed. The years of professional practice had a negative influence. Expanding training opportunities during professional practice could have a positive effect on CM as measured by CI.

WHO body mass index for age charts overestimate thinness and overweight compared to international and US charts applied to indigenous and non-indigenous Mexican children

Assessments of whether children are thin (low body mass index for age) or overweight are based on body mass index (BMI for age and sex) charts published by the World Health Organization (WHO), the International Obesity Task Force (IOTF), and the US Centers for Disease Control and Prevention (CDC). We aimed to determine whether these charts indicated different prevalence of thinness and overweight (obesity included) in indigenous and non-indigenous school aged children from different regions and ethnic groups in Mexico. A probability proportional to size, cluster sampling method was employed in four regions of the country. We recruited 1,731 children aged 7.0-9.9 (507 indigenous from six ethnic groups and 1,224 non-indigenous). BMI was calculated according to age, and thinness and overweight classifications were compared according to cutoff values in the WHO, IOTF, and CDC references. The WHO reference generated the highest rates for thinness (12.5%) and overweight (30%) in children across regions and ethnic groups. The CDC reference estimated the lowest rates of thinness in children (5.5%), and the IOTF reference estimated the lowest rates of overweight (24.7%). Estimates of both thinness (8.3%) and overweight (13.4%) rates were lower in indigenous than non-indigenous groups (14.3% and 37.5%, respectively). The WHO BMI for age chart estimated higher rates of thinness and overweight in children compared to the CDC and IOTF charts. Because thinness as indicator of undernutrition status is relatively new, differences in body composition among indigenous and non-indigenous children may justify the need for more appropriate screening criteria to compare the growth status(AU)

La clasificación del estado nutricio de los niños con delgadez o con sobrepeso se realiza empleando el índice de masa corporal (IMC para la edad y el sexo) con las tablas de la OMS, IOTF y CDC. El objetivo de esta investigación fue determinar si estas referencias resultan en diferentes prevalencias de delgadez y sobrepeso (obesidad incluida) en niños escolares indígenas y no indígenas de diferentes regiones de México. Se empleó un muestreo por conglomerados en cuatro regiones del país. Se reclutaron 1,731 niños con edades entre 7,0-9,9 (507 indígenas de cinco grupos étnicos y 1,224 no indigenas) durante 2006 y 2008. El IMC se calculó y se clasificó como delgadez y sobrepeso con los puntos de corte sugeridos por las referencias internacionales. Cuando se compararon las clasificaciones, la referencia de OMS generó la prevalencia más alta de delgadez (12,5%) y sobrepeso (30%) en niños de todas las regiones y grupos étnicos. La referencia de los CDC estimó las prevalencias más bajas de delgadez (5,5%) y la referencia IOTF produjo las proporciones más bajas de sobrepeso (24,7%). Las proporciones de delgadez (8,3%) y sobrepeso (13,4%) fueron más bajas en niños indígenas que en los no indígenas (14.3% y 37.5%, respectivamente). La referencia de la OMS del IMC para la edad produjo las prevalencias más altas de delgadez y sobrepeso en comparación con los estándares de CDC y IOTF. Dado que la delgadez como indicador de desnutrición en niños es de uso reciente, las diferencias encontradas entre indígenas y mestizos pueden justificar el contar con mejores herramientas de tamizaje en estudios de crecimiento(AU)