Predictive models for health outcomes due to SARS-CoV-2, including the effect of vaccination: a systematic review.

BACKGROUND: The interaction between modelers and policymakers is becoming more common due to the increase in computing speed seen in recent decades. The recent pandemic caused by the SARS-CoV-2 virus was no exception. Thus, this study aims to identify and assess epidemiological mathematical models of SARS-CoV-2 applied to real-world data, including immunization for coronavirus 2019 (COVID-19). METHODOLOGY: PubMed, JSTOR, medRxiv, LILACS, EconLit, and other databases were searched for studies employing epidemiological mathematical models of SARS-CoV-2 applied to real-world data. We summarized the information qualitatively, and each article included was assessed for bias risk using the Joanna Briggs Institute (JBI) and PROBAST checklist tool. The PROSPERO registration number is CRD42022344542. FINDINGS: In total, 5646 articles were retrieved, of which 411 were included. Most of the information was published in 2021. The countries with the highest number of studies were the United States, Canada, China, and the United Kingdom; no studies were found in low-income countries. The SEIR model (susceptible, exposed, infectious, and recovered) was the most frequently used approach, followed by agent-based modeling. Moreover, the most commonly used software were R, Matlab, and Python, with the most recurring health outcomes being death and recovery. According to the JBI assessment, 61.4% of articles were considered to have a low risk of bias. INTERPRETATION: The utilization of mathematical models increased following the onset of the SARS-CoV-2 pandemic. Stakeholders have begun to incorporate these analytical tools more extensively into public policy, enabling the construction of various scenarios for public health. This contribution adds value to informed decision-making. Therefore, understanding their advancements, strengths, and limitations is essential.

Translation, adaptation, and validation of the MeNTS score in colombian population: The MeNTS Col score.

Objective: To evaluate and validate the medically necessary and time sensitive score by testing the variables, in order to create a surgical preoperative score for procedure prioritization in COVID-19 pandemic in Colombia. Methods: A multicenter retrospective cross-sectional study of instrument validation with a cultural adaptation and translation into the Spanish language was carried out in Bogota, Colombia. Patients over 18 years of age who had undergone elective procedures of general surgery and subspecialties were included. The translation of the medically necessary and time sensitive score into Spanish was performed independently by two bilingual surgeons fluent in both English and Spanish. A final version of the Spanish questionnaire (MeNTS Col) for testing was then produced by an expert committee. After translation and cultural adaptation, it was submitted to evaluate the psychometric properties of the medically necessary and time sensitive score. Cronbach's α was used to represent and evaluate the internal consistency and assess reliability. Results: A total of 172 patients were included, with a median age of 54 years; of which 96 (55.8%) patients were females. The vast majority of patients were treated for general surgery (n = 60) and colon and rectal surgery (n = 31). The evaluation of the internal consistency of the scale items in Spanish version was measured, and values of 0.5 for 0.8 were obtained. In the reliability and validation process, Cronbach's α values in all items remained higher than 0.7. The new MeNTS Col model was analyzed, and a result of 0.91 was obtained. Conclusions: The Spanish version of the medically necessary and time sensitive, the MeNTS Col score, and its respective Spanish translation perform similarly to the original version. Therefore, they can be useful and reproducible in Latin American countries.

Guía de práctica clínica para el manejo de la neumonía adquirida en la comunidad / Clinical Practice Guideline for the management of community-acquired pneumonia

Resumen La neumonía sigue siendo una de las principales causas de consulta y de hospitalización a la que, además de su un alto impacto en términos de morbilidad y mortalidad, se suma la actual problemática de resistencia a los antimicrobianos, por lo que establecer directrices que permitan su adecuado diagnóstico y tratamiento es de gran importancia para obtener mejores desenlaces clínicos y promover un uso racional de antibióticos en estos pacientes. La presente guía de práctica clínica (GPC) contiene recomendaciones basadas en la evidencia para el diagnóstico y tratamiento de la neumonía adquirida en la comunidad en adultos, las cuales fueron realizadas mediante el proceso de adaptación de GPC basadas en la evidencia para el contexto colombiano.

Abstract Pneumonia continues to be one of the main causes of consultation and hospitalization to which, besides its high impact on morbidity and mortality, the current problem of antimicrobial resistance is added; thus, establishing guidelines that allow its adequate diagnosis and treatment is of great importance to obtain better clinical outcomes and promote a rational use of antibiotics in these patients. This clinical practice guideline (CPG) contains evidence-based recommendations for the diagnosis and treatment of community-acquired pneumonia in adult population; these recommendations were made by means of the process of adaptation of evidence-based CPGs for the Colombian context.

Microstrip sensor and methodology for the determination of complex anisotropic permittivity using perturbation techniques.

In this work, a sensor in microstrip technology and a methodology for measuring the real part and the imaginary part of the complex uniaxial permittivity of solid anisotropic samples are presented. The sensor is based on a pair of parallel lines coupled resonators and a cleft arranged in the coupling region which allows to hold the samples under test (SUTs). The proposed methodology relates the change in the even/odd resonance frequency with the real part of the permittivity in the vertical/horizontal direction, and the change in the Q factor of the even/odd mode with the imaginary part of the permittivity in the vertical/horizontal direction. The methodology was successfully verified with the characterization, at 2.43 GHz of anisotropic samples of printed PLA, Diclad 880, and RO4350B using the knowns materials: RT5870, PTFE and RO4003.

Prevalencia de síndrome de burnout en postulantes al examen de residencia médica / Prevalence of Burnout syndrome among Medical Residency applicants

Introducción: Los médicos que se preparan para rendir el examen de residencia médica, están expuestos a estrés laboral, debido a que adicionalmente tienen que trabajar para poder solventar sus estudios. Objetivos: Determinar la prevalencia del síndrome de burnout en médicos generales que se preparan para el examen de residencia médica. Métodos: Se realizó un estudio descriptivo y transversal, se aplicó el cuestionario Maslach Burnout Inventory (MBI) a médicos generales que trabajaban y que se preparaban para rendir el examen de residencia médica, que voluntariamente aceptaron participar en el estudio. Se realizó estadística univariada y bivariada; los cálculos fueron realizados con un nivel de confianza del 95 por ciento. Resultados: Se incluyó a un total de 306 médicos. El 56,9 por ciento fueron de sexo femenino y el promedio de edad fue de 28,5 ± 4,3 años. El 2,3 por ciento (7) de los médicos presentaron síndrome de burnout; las subescalas de despersonalización (42,2 por ciento) y agotamiento emocional (32 por ciento) tuvieron mayores porcentajes de índices altos. Conclusiones: La prevalencia de síndrome de burnout fue baja en los médicos generales que se preparan para el examen de residencia médica. Las subescalas con mayores índices fueron despersonalización y agotamiento emocional(AU)

Introduction: Doctors who are preparing to take the medical residency exam are exposed to work stress, because they have to work to pay their studies. Objectives: To determine the prevalence of Burnout syndrome in general practitioners preparing for the residency exam. Methods: A descriptive and cross-sectional study was carried out, the Maslach Burnout Inventory (MBI) was applied in general practitioners who worked and were preparing to take the medical residency exam were included, who voluntarily agreed to participate in the study. Univariate and bivariate statistics were performed, the calculations were performed with a confidence level of 95 percent. Results: A total of 306 general practitioners were included. 56,9 percent were female and the average age was 28,5 ± 4,3 years. 2,3 percent (7) of the doctors had Burnout syndrome, the subscales of depersonalization (42,2 percent) and emotional exhaustion (32 percent) had higher percentages of high indexes. Conclusions: The prevalence of Burnout syndrome was low in general practitioners preparing for the medical residency examination. The subscales with the highest indices were depersonalization and emotional exhaustion(AU)

Clinical practice guideline for screening of patients at risk of colonization by carbapenemase-producing Enterobacterales and the treatment of infections caused by these bacteria / Guía de práctica clínica para la tamización de pacientes con riesgo de colonización por Enterobacterales productores de carbapenemasasy el manejo de infecciones causadas por estas bacterias

Abstract Carbapenemase-producing Enterobacterales (CPE) infections have increased in recent years. Colombia has become an endemic country for this group of microorganisms, and the infections they cause have a serious impact in terms of morbidity and mortality. The early identification of CPE carriers who are admitted to health care centers as patients is necessary to implement adequate isolation and infection control measures to limit the spread of this type of microorganisms in hospitals. Furthermore, treating these infections is a challenging task due to the limited therapeutic alternatives available and the fact that there are only a few studies proving their effectiveness in this setting. Therefore, the objective of the present work is to develop a clinical practice guideline (CPG) for the screening of patients at risk of CPE colonization and the treatment of inpatients with suspected or confirmed infections caused by this type of bacteria through a CPG adaptation process based on the ADAPTE methodology. With this purpose in mind, evidence-informed recommendations for the screening and timely identification of CPE carriers admitted to hospitals are made, as well as for the adequate pharmacological treatment of CPE infections in this context.

Resumen Las infecciones por Enterobacterales productores de carbapenemasas (EPC) han aumentado en los últimos años. Colombia se ha convertido en un país endémico para este grupo de microorganismos y las infecciones que causan tienen un impacto importante en términos de morbimortalidad. La identificación temprana de los portadores de EPC que ingresan como pacientes a las instituciones de salud es necesaria para implementar medidas de aislamiento y control de infecciones adecuadas que limiten la diseminación de este tipo de microorganismos en los hospitales. Además, el tratamiento de estas infecciones es difícil debido a las limitadas alternativas terapéuticas disponibles y la escasez de estudios que demuestren su efectividad en este escenario. Por lo anterior, el objetivo del presente trabajo es desarrollar una guía de práctica clínica (GPC) para la tamización de pacientes con riesgo de colonización por EPC y para el manejo de pacientes con infecciones, ya sea sospechadas o confirmadas, causadas por este tipo de bacterias, mediante un proceso de adaptación de GPC basado en la metodología ADAPTE. Con este propósito en mente, se hacen recomendaciones informadas en evidencia para realizar la tamización y oportuna identificación de portadores de EPC admitidos en instituciones hospitalarias, así como para el adecuado manejo farmacológico de las infecciones por CPE en este escenario.

Detection of Leishmania RNA Virus in Clinical Samples from Cutaneous Leishmaniasis Patients Varies according to the Type of Sample.

Leishmania RNA virus (LRV) is a double-stranded RNA virus belonging to the Totiviridae family detected as cytoplasmic inclusions in some strains of the human parasite Leishmania spp. Experimental evidence supports the hypothesis that human coinfection with Leishmania spp.-LRV triggers an exacerbated immune response in the host that can be responsible for the observed complicated outcomes in cutaneous leishmaniasis (CL), such as mucosal leishmaniasis (ML) and treatment failure of CL. However, the reported frequencies of LRV associated with complicated outcomes in patient's series are highly variable, diminishing the relevance on the virus presence in the pathogenesis of the disease. To assess whether or not the inconsistent information about the frequency of LRV associated with CL complicated outcomes could be related to the virus detection approach, the present study evaluated the LRV presence in clinical samples using a diagnostic algorithm according to the type of the sample. In 36 samples with diagnosis of complicated forms of CL (15 of ML and 21 of CL antimony treatment failure) and six samples with non-Leishmania spp. infection, the LRV presence was assessed by RT-PCR, RT-qPCR, and nested RT-PCR. Viral load was estimated in parasite clinical isolates. By combining the methods, LRV1 presence was confirmed in 45% (9/20) of isolates and 37.5% (6/16) of the incisional biopsies. Remarkably, in some cases (4/8), LRV1 was undetectable in the isolates but present in their respective biopsies, and less frequently, the opposite was observed (1/8), suggesting the possibility of loss of parasites harboring LRV1 during the in vitro growth.

Colombian consensus on the diagnosis, treatment, and prevention of Candida Spp. disease in children and adults, / Consenso Colombiano Para el Diagnóstico, Tratamiento y Prevención de la Enfermedad por Candida Spp. en Niños y Adultos

Invasive Candidiasis (IC) and candidemia (as its most frequent manifestation) have become the main cause of opportunistic mycosis at hospital settings. This study, made by members of the Colombian Association of Infectious Diseases (ACIN), was aimed at providing a set of recommendations for the management, follow-up and prevention of IC / candidemia and mucous membrane candida infection in adult, pediatric and neonatal patients in a hospital setting, including the hemato-oncological and critical care units. All the data obtained through an exhaustive search were reviewed and analyzed in a comprehensive manner by all the members of the group, and the recommendations issued are being made after a careful review of the scientific literature available and the consensus of all specialists involved; the emergence of Candida Spp. problem is highlighted and a correct orientation to health professionals regarding the management of patients with candidiasis is provided in a rational and practical way, emphasizing patient evaluation, diagnostic strategies, prophylaxis, empirical treatment, directed treatment and preventative therapy.

La Candidiasis Invasora (CI) y la candidemia, como su manifestación más frecuente, se ha convertido en la principal causa de micosis oportunista a nivel hospitalario. Este manuscrito realizado por miembros de la Asociación Colombiana de Infectología (ACIN), tuvo como objetivo proporcionar un conjunto de recomendaciones para manejo, seguimiento y prevención de la CI/candidemia y de la infección candidiásica de mucosas, en población adulta, pediátrica y neonatal, en un entorno hospitalario, incluyendo las unidades hemato-oncológicas y unidades de cuidado crítico. Todos los datos obtenidos mediante una búsqueda exhaustiva, fueron revisados y analizados de manera amplia por todos los miembros del grupo, y las recomendaciones emitidas se elaboraron luego de la evaluación de la literatura científica disponible, y el consenso de todos los especialistas involucrados, reconociendo el problema de la emergencia de las infecciones por Candida Spp. y brindando una correcta orientación a los profesionales de la salud sobre el manejo de pacientes con enfermedad candidiásica, de una forma racional y práctica, enfatizando en la evaluación del paciente, estrategias de diagnóstico, profilaxis, tratamiento empírico, tratamiento dirigido y terapia preventiva.

Reconstrucción endovascular de aneurisma intracraneal mediante dispositivo diversor de flujo Pipeline®. Reporte de 2 casos y revisión de la literatura / Endovascular reconstruction of intracranial aneurysm using a Pipeline® flow diversifier device

Resumen Introducción: Los aneurismas intracraneales son anomalías vasculares cerebrales con una prevalencia aproximada a nivel mundial del 2-3%. Son la principal causa de hemorragia subaracnoidea no traumática, el diagnóstico y tratamiento preventivo de esta entidad puede reducir considerablemente la morbimortalidad que de ella deviene. Con la aparición de nuevos dispositivos de terapia endovascular cerebral como los diversores de flujo se ha logrado ofrecer al paciente un procedimiento menos invasivo que no requiere cirugía convencional, y una importante reducción en el número de días de estancia intrahospitalaria y de recuperación, con alto grado de seguridad. El tratamiento endovascular para aneurismas intracraneales ha evolucionado sustancialmente en las últimas dos décadas, convirtiéndose en el tratamiento de elección en diversas situaciones clínicas. Reporte de caso: Caso 1: Varón de 62 años edad que ingresa a unidad hospitalaria después de sufrir un traumatismo craneoencefálico moderado con pérdida transitoria del estado de alerta y cefalea holocraneana. Se realizó una tomografía de cráneo simple y con contraste ante la sospecha de hemorragia subaracnoidea. Se evidenció la presencia de un aneurisma intracraneal en la arteria carótida interna izquierda, segmento comunicante posterior de 4 x 3 mm con cuello de 3 mm. Se realizó tratamiento mediante la colocación de dispositivo diversor de flujo Pipeline®, así como control angiográfico a los 3 meses post-tratamiento con una evolución satisfactoria. Caso 2: Mujer de 59 años de edad que acudió por presentar hemiparesia facial y brazo ipsilateral, con incremento gradual de la intensidad y duración. Se inició protocolo de estudio con resonancia magnética. Se evidenció la presencia de aneurisma intracraneal de 15 mm de diámetro en el segmento comunicante de la arteria carótida interna derecha y otro de 8 mm contralateral. Fue programada para colocación de dispositivo diversor de flujo Pipeline® con adecuada evolución. Conclusión: El uso de dispositivos diversores de flujo es una excelente alternativa para el tratamiento de aneurismas intracraneales incidentales, con importantes ventajas de costo-efectividad, reduciendo tiempos quirúrgicos, de estancia hospitalaria y de recuperación. Además de tener un porcentaje de curación superior al 95% a 5 años.

Abstract Introduction: Intracranial aneurysms are cerebral vascular anomalies with an approximate global prevalence of 2 to 3% and are the main cause of non-traumatic subarachnoid hemorrhage. Diagnosis and preventive treatment of this entity can considerably reduce morbidity and mortality. With the advent of new devices for cerebral endovascular therapy such as flow diverters, the patient now has the option of choosing a less invasive procedure, which does not require conventional surgery. This represents a significant reduction in the number of days of in hospital stay and recovery. The procedure has showed a high degree of security. The endovascular treatment for intracranial aneurysms has evolved substantially in the last two decades, and has become the treatment of choice. Case report: Case 1: A 62-year-old male was admitted in the hospital after a moderate cranioencephalic trauma with transient loss of conscious and a holocranial headache. A cerebral angiography was performed to rule out subarachnoid hemorrhage. The angiography showed an intracranial aneurysm. It was localized in left internal carotid-posterior communicating artery. The measures were of 4mm X 3mm with a 3mm neck. The treatment was performed with a pipeline flow-diverting device, as well as an angiographic control 3 months after the treatment with a satisfactory evolution. Case 2: A 59-year-old female patient with facial hemiparesis and ipsilateral arm, that showed a gradual increase in intensity and duration. A magnetic resonance study protocol was initiated and an intracranial aneurysm was observed in the communicating segment of the right internal carotid artery. The diameter of the aneurysmal sac was of 15 mm and also, a contralateral of 8 mm. Placement of a flow-diverting device was programmed. Conclusion: The use of flow-diverting devices is an excellent alternative for the treatment of incidental intracranial aneurysms, with important cost-effectiveness advantages, surgical time, hospital stay and recovery reduction. In addition to having a recovery percentage of 95% in 5 years.

Prevalencia de factores de riesgo para infección por Klebsiella pneumoniae resistente a carbapenémicos en adultos en un hospital de cuarto nivel, Bogotá / Prevalence of risk factor for Klebsiella pneumoniae carbapenemic-resistant infection in adults in a fourth level hospital, Bogota

Introducción: Las infecciones por gram negativos adquiridas en el hospital son una causa importante de muerte, Klebsiella pneumoniae es una de las bacterias más significativas, está además relacionada con la aparición de nuevos mecanismos de resistencia antibiótica. Los carbapenémicos han permitido combatir ciertas de estas cepas resistentes, sin embargo, la aparición de algunas con resistencia a estos antibióticos representa un reto terapéutico. A partir de este contexto clínico se planteó establecer la prevalencia de factores de riesgo en pacientes adultos con aislamientos de Klebsiella pneumoniae resistente a carbapenémicos. Material y métodos: Se realizó un estudio descriptivo retrospectivo en el Hospital Universitario Clínica San Rafael de Bogotá (Colombia). Selección de pacientes: A partir de 295 historias clínicas revisadas de pacientes hospitalizados con aislamiento positivo para Klebsiella pneumoniae con perfil de resistencia a carbapenémicos confirmada en el periodo enero 2013 a diciembre 2015, se obtuvieron 84 pacientes que cumplían todos los criterios de inclusión. Mediciones: Se tuvieron en cuenta variables demográficas como sexo y edad, así como las diferentes condiciones probablemente asociadas a la condición infecciosa. Métodos analíticos: A las variables cualitativas se les calcularon frecuencias absolutas y relativas, y a las variables cuantitativas medidas de tendencia central y de dispersión. Resultados: De 84 pacientes, el 55% correspondía a sexo femenino, tenían una edad media de 66 años. El aislamiento microbiológico en orina fue del 30.4%, en sangre 24.3%, liquido peritoneal 20.7% y secreción traqueal 12.1%. El 91,6% de la población tenía hospitalización en los últimos 3 meses, 86.5% recibió tratamiento antibiótico durante la hospitalización, de estos el 59.1% fue Meropenem, el 26,2% fue Ampicilina Sulbactam, el 23,9% fue Vancomicina, el 18,3% fue Piperacilina Tazobactam. El 54,7%se sometió a algún procedimiento quirúrgico 3 meses antes del aislamiento, de los cuales el 47.8% correspondía a cirugías abdominales y el 13,1% a cirugía de tórax, luego aparecían cirugía ortopédica, en sistema nervioso central y ginecológica. El 70% de los casos tenían antecedente de implante de dispositivos intravasculares, 45,2% exposición a ventilación mecánica, 24% uso de nutrición parenteral. Conclusiones: Este estudio establece las bases para proponer nuevos estudios que planteen estrategias de prevención con el objetivo de lograr disminuir las probabilidades de adquirir esta infección multirresistente.

Introduction: Gram-negative infections acquired in the hospital are an important cause of death, Klebsiella pneumoniae is one of the most significant bacteria, it is also related to the appearance of new mechanisms of antibiotic resistance. The carbapenems have allowed to fight certain of these resistant strains, however, the appearance of some with resistance to these antibiotics represents a therapeutic challenge. From this clinical context, it was proposed this research, to establish the prevalence of risk factors in adult patients with isolates of Klebsiella pneumoniae resistant to carbapenems. Material and methods: A retrospective descriptive study was carried out in the San Rafael Clinical University Hospital of Bogotá (Colombia). Selection of patients: From 295 reviewed clinical records of patients hospitalized with positive isolation for Klebsiella pneumoniae with carbapenemic resistance profile confirmed, in the period January 2013 to December 2015, 84 patients were obtained who fulfilled all the inclusion criteria. Measurements: Demographic variables such as sex and age were taken into account, as well as the different conditions probably associated with the infectious condition. Analytical methods: Qualitative variables were calculated absolute and relative frequencies, and quantitative variables measures of central tendency and dispersion were calculated. Results: Of 84 patients, 55% corresponded to females, had a mean age of 66 years. The microbiological isolation in urine was 30.4%, in blood 24.3%, peritoneal fluid 20.7% and tracheal secretion 12.1%. 91.6% of the population had hospitalization in the last 3 months, 86.5% received antibiotic treatment during hospitalization, of these 59.1% was Meropenem, 26.2% was Ampicillin Sulbactam, 23.9% was Vancomycin, 18.3% was Piperacillin Tazobactam. 54.7% underwent some surgical procedure 3 months before the isolation, of which 47.8% corresponded to abdominal surgeries and 13.1% to thoracic surgery, then they appeared orthopedic surgery, in central nervous system and gynecological. 70% of the cases had antecedents of implantation of intravascular devices, 45.2% exposure to mechanical ventilation, 24% use of parenteral nutrition. Conclusions: This research establishes the bases to propose new researches that propose prevention strategies with the objective of reducing the chances of acquiring this multiresistant infection.

Infrared light field imaging system free of fixed-pattern noise.

Digital photonic sensors have greatly evolved to maximize sensitivity and spatial, spectral, and temporal imaging resolution. For low-energy photons, new designs have generated new types of noise that degrade the formed-image signal-to-noise ratio to values lower than 1. Fixed-pattern noise (FPN), which is produced by the non-uniform focal-plane-array optoelectronics response, is an ill-posed problem in infrared and hyperspectral imaging science. Here, we experimentally show that the FPN behaves as an object at a depth of infinity when a light field is captured by an imaging system. The proposed method is based on the capture of the light field of a scene and digital refocusing to any nearby objects in the scene. Unlike standard techniques for FPN reduction, our method does not require knowledge of the physical parameters of the optoelectronic transducer, the motion scene, or the presence of off-line blackbody sources. The ability of the proposed method to reduce FPN is measured by evaluating the structural similarity (SSIM) index employing a blackbody-based FPN reduction technique as a reference. This new interpretation of the FPN opens avenues to create new cameras for low-energy photons with the ability to perform denoising by digital refocusing.

Clinical and Parasitological Features of Patients with American Cutaneous Leishmaniasis that Did Not Respond to Treatment with Meglumine Antimoniate.

BACKGROUND: American cutaneous leishmaniasis (ACL) is a complicated disease producing about 67.000 new cases per year. The severity of the disease depends on the parasite species; however in the vast majority of cases species confirmation is not feasible. WHO suggestion for ACL produced by Leishmania braziliensis, as first line treatment, are pentavalent antimonial derivatives (Glucantime or Sodium Stibogluconate) under systemic administration. According to different authors, pentavalent antimonial derivatives as treatment for ACL show a healing rate of about 75% and reasons for treatment failure are not well known. METHODS: In order to characterise the clinical and parasitological features of patients with ACL that did not respond to Glucantime, a cross-sectional observational study was carried out in a cohort of 43 patients recruited in three of the Colombian Army National reference centers for complicated ACL. Clinical and paraclinical examination, and epidemiological and geographic information were recorded for each patient. Parasitological, histopathological and PCR infection confirmation were performed. Glucantime IC50 and in vitro infectivity for the isolated parasites were estimated. RESULTS: Predominant infecting Leishmania species corresponds to L. braziliensis (95.4%) and 35% of the parasites isolated showed a significant decrease in in vitro Glucanatime susceptibility associated with previous administration of the medicament. Lesion size and in vitro infectivity of the parasite are negatively correlated with decline in Glucantime susceptibility (Spearman: r = (-)0,548 and r = (-)0,726; respectively). CONCLUSION: A negative correlation between lesion size and parasite resistance is documented. L. braziliensis was found as the main parasite species associated to lesion of patients that underwent treatment failure or relapse. The indication of a second round of treatment in therapeutic failure of ACL, produced by L. braziliensis, with pentavalent antimonial derivatives is discussable.

Small clonal B-cell population in the bone marrow as a possible tool in the diagnosis of occult primary parotid lymphoma.

CASE DESCRIPTION: An 82-years old Hispanic woman with a past medical history significant for pulmonary thromboembolism on oral anticoagulation, rheumatoid arthritis, and hypertension developed a new onset thrombocytopenia. CLINICAL FINDINGS: Small clonal B-cells populations (SCBP) also known as monoclonal B-cell lymphocytosis was found as part of the workup for an idiopathic thrombocytopenia and lead ultimately to the diagnosis of parotid primary follicular lymphoma coexisting with Warthin tumor involving the bone marrow in a small extent and oncocytic papilloma located in the maxillary sinus. TREATMENT AND OUTCOME: Patient was treated with Rituximab monotherapy with improvement on her platelet count. CLINICAL RELEVANCE: Although it is unclear the role of this clonal cells, they may work as a possible diagnostic tool for occult lymphomas. Further prospective studies are needed to confirm this possible association.

DESCRIPCIÓN DE CASO: Mujer hispana de 82 años con una historia médica significativa de tromboembolismo pulmonar en anticoagulación, artritis reumatoide e hipertensión, la cual desarrolló recientemente una trombocitopenia. HALLAZGOS CLÍNICOS: Una pequeña población de células B monoclonales también conocida como linfocitosis monoclonal de células B fue encontrado dentro del estudio de una trombocitopenia idiopática que conllevó al diagnóstico de un linfoma folicular primario de parótida coexistiendo con un tumor de Warthin y un papiloma oncocítico localizado en el seno maxilar. TRATAMIENTO Y RESULTADO: La paciente fue tratada con monoterapia de Rituximab con una mejoría en su conteo de plaquetas. RELEVANCIA CLÍNICA: Aunque el rol de las pequeñas poblaciones B monoclonales no está completamente dilucidado, podrían tener una aplicación como herramienta diagnóstica. Futuros estudios prospectivos son necesarios para confirmar esta posible asociación.

Small clonal B-cell population in the bone marrow as a possible tool in the diagnosis of occult primary parotid lymphoma / Pequeña población de células B monoclonales en medula ósea como posible herramienta diagnóstica en el linfoma oculto primario de parótida

Case Description: An 82-years old Hispanic woman with a past medical history significant for pulmonary thromboembolism on oral anticoagulation, rheumatoid arthritis, and hypertension developed a new onset thrombocytopenia. Clinical Findings: Small clonal B-cells populations (SCBP) also known as monoclonal B-cell lymphocytosis was found as part of the workup for an idiopathic thrombocytopenia and lead ultimately to the diagnosis of parotid primary follicular lymphoma coexisting with Warthin tumor involving the bone marrow in a small extent and oncocytic papilloma located in the maxillary sinus. Treatment and Outcome: Patient was treated with Rituximab monotherapy with improvement on her platelet count. Clinical relevance: Although it is unclear the role of this clonal cells, they may work as a possible diagnostic tool for occult lymphomas. Further prospective studies are needed to confirm this possible association.

Descripción de caso: Mujer hispana de 82 años con una historia médica significativa de tromboembolismo pulmonar en anticoagulación, artritis reumatoide e hipertensión, la cual desarrolló recientemente una trombocitopenia. Hallazgos clínicos: Una pequeña población de células B monoclonales también conocida como linfocitosis monoclonal de células B fue encontrado dentro del estudio de una trombocitopenia idiopática que conllevó al diagnóstico de un linfoma folicular primario de parótida coexistiendo con un tumor de Warthin y un papiloma oncocítico localizado en el seno maxilar. Tratamiento y resultado: La paciente fue tratada con monoterapia de Rituximab con una mejoría en su conteo de plaquetas. Relevancia clínica: Aunque el rol de las pequeñas poblaciones B monoclonales no está completamente dilucidado, podrían tener una aplicación como herramienta diagnóstica. Futuros estudios prospectivos son necesarios para confirmar esta posible asociación.

[Resistance exercise improves serum lipids in adult women]. / Reducción del riesgo cardiovascular en mujeres adultas mediante ejercicio físico de sobrecarga.

BACKGROUND: Sedentariness is one of the main cardiovascular risk factors. Aerobic exercise can reduce the risk; however, resistance training seems to be more effective in reducing cardiovascular risk. AIM: To determine the metabolic effects of a 12 weeks resistance training program of high intensity and low volume in two groups of sedentary adult women. MATERIAL AND METHODS: Forty women aged between 30 and 60 years were randomly assigned to an experimental group and a control group. Four kinds of strength exercises, using their own body weight were chosen. Plasma lipid profile and body composition were measured at baseline and at the end of the intervention. RESULTS: A reduction in total cholesterol and triacylglycerol and an increase in HDL cholesterol was observed in the experimental group after the training program. CONCLUSIONS: The high intensity and low volume training improved plasma lipid profile in this group of women.

[Nosocomial infections impact in a hospital in Bogota, Colombia: effects on mortality and hospital costs]. / Impacto de la infección nosocomial en un hospital de Bogotá, Colombia: efectos en mortalidad y costos.

BACKGROUND: Nosocomial infections (NI) are events associated with high impact on hospital costs and mortality. AIM: To evaluate from the health provider's perspective the costs and mortality attributable to NI. METHODS: We selected a sample of patients with and without NI matched by age and diagnosis at admission. Costs were calculated and converted from Colombian pesos to US dollars using the average exchange rate of 2008. We evaluated the mortality rate in both groups. RESULTS: We collected data on 187 patients with NI and 276 without NI. Median total hospitalization cost was US$ 6,329 (95% CI US$5,527-7,934) in NI patients, while in non-infected patients this median was US$1,207 (95% CI US$ 974-1,495). Mortality was higher in the NI group (31.6% versus 5.1%). Patients with NI had longer hospital stays (median 21 days, 95% CI 18-24 days) than non-infected patients (median 5 days, 95% CI 5-6 days). Mortality was also markedly higher in the NI group than in the non-infected group (31.6% versus 5.1%). CONCLUSION: NI are adverse and costly events related to patient attention that affect adversely the quality of attention.

Reducción del riesgo cardiovascular en mujeres adultas mediante ejercicio físico de sobrecarga / Resistance exercise improves serum lipids in adult women

Background: Sedentariness is one of the main cardiovascular risk factors. Aerobic exercise can reduce the risk; however, resistance training seems to be more effective in reducing cardiovascular risk. Aim: To determine the metabolic effects of a 12 weeks resistance training program of high intensity and low volume in two groups of sedentary adult women. Material and methods: Forty women aged between 30 and 60 years were randomly assigned to an experimental group and a control group. Four kinds of strength exercises, using their own body weight were chosen. Plasma lipid profile and body composition were measured at baseline and at the end of the intervention. Results: A reduction in total cholesterol and triacylglycerol and an increase in HDL cholesterol was observed in the experimental group after the training program. Conclusions: The high intensity and low volume training improved plasma lipid profile in this group of women.

Impacto de la infección nosocomial en un hospital de Bogotá (Colombia): efectos en mortalidad y costos / Nosocomial infections impact in a hospital in Bogota (Colombia): effects on mortality and hospital costs

Background: Nosocomial infections (NI) are events associated with high impact on hospital costs and mortality. Aim: To evaluate from the health provider's perspective the costs and mortality attributable to NI. Methods: We selected a sample of patients with and without NI matched by age and diagnosis at admission. Costs were calculated and converted from Colombian pesos to US dollars using the average exchange rate of 2008. We evaluated the mortality rate in both groups. Results: We collected data on 187 patients with NI and 276 without NI. Median total hospitalization cost was US$ 6,329 (95% CI US$5,527-7,934) in NI patients, while in non-infected patients this median was US$1,207 (95% CI US$ 974-1,495). Mortality was higher in the NI group (31.6% versus 5.1%). Patients with NI had longer hospital stays (median 21 days, 95% CI 18-24 days) than non-infected patients (median 5 days, 95% CI 5-6 days). Mortality was also markedly higher in the NI group than in the non-infected group (31.6% versus 5.1%). Conclusion: NI are adverse and costly events related to patient attention that affect adversely the quality of attention.

Introducción: Las infecciones asociadas a la atención en salud (IAAS) están relacionadas con un incremento en los costos de hospitalización y un mayor riesgo de mortalidad. Objetivo: Establecer los costos y la mortalidad asociados a la presentación IAAS en una institución de cuarto nivel. Métodos: Se hizo una selección pareada de pacientes con IAAS y sin IAAS para calcular el costo por medio de costeo directo y emparejamiento. Los costos fueron calculados en pesos colombianos y convertidos a dólares estadounidenses según la tasa de cambio de 2008. Resultados: Se incluyeron 187 pacientes con IAAS y 276 pacientes sin IAAS. La tasa de IAAS fue de 1,8% La mediana del costo de hospitalización en los pacientes con IAAS fue US$ 6.329 (95% CI US$ 5.527-7.934) y en los no infectados de US$1,207 (95% CI US$ 974-1.495). Los pacientes con IAAS presentaron mayor tiempo de estancia hospitalaria, con una diferencia de 16 días respecto a los no infectados (21 días (IC 95% 18-24) vs 5 días (IC 95% 5-6)). Se encontró una mortalidad atribuible de 26,4%. Conclusiones: Las IAAS son eventos adversos a la atención, que se asocian con mayor mortalidad y generación de costos extra.