Clinical inertia in newly diagnosed type 2 diabetes mellitus among patients attending selected healthcare institutions in Colombia.

BACKGROUND: The burden of disease of diabetes in Colombia have increased in the last decades. Secondary prevention is crucial for diabetes control. Many patients already treated remain with poor glycemic control and without timely and appropriate treatment intensification. This has been called in the literature as Clinical Inertia. Updated information regarding clinical inertia based on the Colombian diabetes treatment guidelines is needed. OBJECTIVE: To measure the prevalence of clinical inertia in newly diagnosed Type 2 Diabetes Mellitus (T2DM) patients in healthcare institutions in Colombia, based on the recommendations of the current official guidelines. METHODS: An observational and retrospective cohort study based on databases of two Health Medical Organizations (HMOs) in Colombia (one from subsidized regimen and one from contributory regimen) was conducted. Descriptive analysis was performed to summarize demographic and clinical information. Chi-square tests were used to assess associations between variables of interest. RESULTS: A total of 616 patients with T2DM (308 for each regimen) were included. Median age was 61 years. Overall clinical inertia was 93.5% (87.0% in contributory regimen and 100% in subsidized regimen). Patients with Hb1Ac ≥ 8% in the subsidized regimen were more likely to receive monotherapy than patients in the contributory regimen (OR 2.33; 95% CI 1.41-3.86). CONCLUSIONS: In this study, the prevalence of overall clinical inertia was higher in the subsidized regime than in the contributory regime (100% vs 87%). Great efforts have been made to equalize the coverage between the two systems, but this finding is worrisome with respect to the difference in quality of the health care provided to these two populations. This information may help payers and clinicians to streamline strategies for reducing clinical inertia and improve patient outcomes.

Serological evidence for potential yellow fever virus infection in non-human primates, southeastern Mexico.

BACKGROUND: Arthropod-borne flaviviruses like dengue virus (DENV) and yellow fever virus (YFV) are major human pathogens. In Latin America, YFV is maintained in sylvatic cycles involving non-human primates (NHP) and forest-dwelling mosquitos. YFV supposedly does not circulate north of Panama. METHODS: We conducted a serologic study for flaviviruses and other emerging viruses in NHP from southeastern Mexico. A total of thirty sera of black-handed spider monkeys (Ateles geoffroyi, n = 25), black howler monkeys (Alouatta pigra, n = 3), and mantled howler monkeys (Al. palliata, n = 2) sampled in 2012 and 2018 were screened by an indirect immunofluorescence assay (IFA) to detected IgG antibodies against DENV, YFV, Zika virus (ZIKV), West Nile virus (WNV), Rift Valley fever virus, Crimean-Congo hemorrhagic fever virus, Middle East respiratory syndrome coronavirus, and Zaire Ebola virus, and confirmed by plaque reduction neutralization tests (PRNT90) representing all mosquito-borne flavivirus serocomplexes circulating in the Americas. RESULTS: A total of 16 sera (53.3%; 95% CI, 34.3-71.7) showed IFA reactivity to at least one tested flavivirus with end-point titers ranging from 1:100 to 1:1000. No serum reacted with other viruses. Monotypic and high mean PRNT90 endpoint YFV titers of 1:246 were found in 3 black-handed spider monkey sera (10.0%; 95% CI, 2.1-26.5) sampled in 2018 in Tabasco, compared to all other flaviviruses tested. Monotypic endpoint PRNT90 titers of 1:28 for Ilheus virus and 1:22 for WNV in serum of black howler monkeys sampled in 2018 in Tabasco suggested additional flavivirus exposure. CONCLUSIONS: Our findings may suggest unnoticed YFV circulation. Intensification of YFV surveillance in NHP and vectors is warranted in Mexico and potentially other areas considered free of yellow fever.

Experimental infection of Artibeus lituratus bats and no detection of Zika virus in neotropical bats from French Guiana, Peru, and Costa Rica suggests a limited role of bats in Zika transmission.

Bats are important natural reservoir hosts of a diverse range of viruses that can be transmitted to humans and have been suggested to play an important role in the Zika virus (ZIKV) transmission cycle. However, the exact role of these animals as reservoirs for flaviviruses is still controversial. To further expand our understanding of the role of bats in the ZIKV transmission cycle in Latin America, we carried out an experimental infection in wild-caught Artibeus lituratus bats and sampled several free-living neotropical bats across three countries of the region. Experimental ZIKV infection was performed in wild-caught adult bats (4 females and 5 males). The most relevant findings were hemorrhages in the bladder, stomach and patagium. Significant histological findings included inflammatory infiltrate consisting of a predominance of neutrophils and lymphocytes, in addition to degeneration in the reproductive tract of males and females. This suggests that bat reproduction might be at some level affected by ZIKV. Leukopenia was also observed in some inoculated animals. Hemorrhages, genital alterations, and leukopenia are suggested to be caused by ZIKV; however, since these were wild-caught bats, we cannot exclude other agents. Detection of ZIKV by qPCR was observed at low concentrations in only two urine samples in two inoculated animals. All other animals and tissues tested were negative. Finally, no virus-neutralizing antibodies were found in any animal. To determine ZIKV infection in nature, the blood of a total of 2056 bats was sampled for ZIKV detection by qPCR. Most of the sampled individuals belonged to the genus Pteronotus sp. (23%), followed by the species Carollia sp. (17%), Anoura sp. (14%), and Molossus sp. (13.7%). No sample of any tested species was positive for ZIKV by qPCR. These results together suggest that bats are not efficient amplifiers or reservoirs of ZIKV and may not have an important role in ZIKV transmission dynamics.

The atypical CDK activator RingoA/Spy1 regulates exit from quiescence in neural stem cells.

In the adult mammalian brain, most neural stem cells (NSCs) are held in a reversible state of quiescence, which is essential to avoid NSC exhaustion and determine the appropriate neurogenesis rate. NSCs of the mouse adult subependymal niche provide neurons for olfactory circuits and can be found at different depths of quiescence, but very little is known on how their quiescence-to-activation transition is controlled. Here, we identify the atypical cyclin-dependent kinase (CDK) activator RingoA as a regulator of this process. We show that the expression of RingoA increases the levels of CDK activity and facilitates cell cycle entry of a subset of NSCs that divide slowly. Accordingly, RingoA-deficient mice exhibit reduced olfactory neurogenesis with an accumulation of quiescent NSCs. Our results indicate that RingoA plays an important role in setting the threshold of CDK activity required for adult NSCs to exit quiescence and may represent a dormancy regulator in adult mammalian tissues.

Synthesis and Biological Activity of a VHL-Based PROTAC Specific for p38α.

We report a series of small molecule proteolysis-targeting chimeras (PROTACs) that target the protein kinase p38α for degradation. These PROTACs are based on a ligand of the VHL E3 ubiquitin ligase, which is linked to an ATP competitive inhibitor of p38α. We provide evidence that these compounds can induce the specific degradation of p38α, but not p38ß and other related kinases, at nanomolar concentrations in several mammalian cell lines. We also show that the p38α-specific PROTACs are soluble in aqueous solutions and therefore suitable for their administration to mice. Systemic administration of the PROTACs induces p38α degradation only in the liver, probably due to the PROTAC becoming inactivated in that organ, but upon local administration the PROTACs induce p38α degradation in mammary tumors. Our compounds provide an alternative to traditional chemical inhibitors for targeting p38α signaling in cultured cells and in vivo.

Perfil audiológico y grados de discapacidad en las personas con alteraciones vestibulares pertenecientes a la consulta del Centro Equilibra, Vértigo y Equilibrio, San José, Costa Rica / Audiological profile and handicap levels in people with vestibular disorders at Centro Equilibra, Vértigo and Equilibrio, San José, Costa Rica

Antecedentes y objetivo: Las alteraciones vestibulares se encuentran ligadas a un grupo de patologías que pueden afectar estructuras vestibulares, auditivas, o ambas partes del oído interno del ser humano. El problema abordado en este estudio responde a una escasez de información sobre el perfil audiológico de las personas que cursan con alteraciones vestibulares en Costa Rica. Existen investigaciones internacionales que abordan este tema, pero no hay registros de estudios realizados en la población costarricense. Es por este motivo que surge el interés de desarrollar esta investigación, cuyo objetivo es caracterizar el perfil audiológico y los grados de discapacidad en las personas con alteraciones vestibulares pertenecientes a la consulta del Centro Equilibra, durante los meses de septiembre a noviembre de 2019.Pacientes y métodosSe realizó un estudio descriptivo, transversal, cuantitativo y observacional-analítico con pacientes mayores de 18años que acudieron al Centro Equilibra. Las principales variables analizadas fueron el sexo, la edad, los antecedentes patológicos personales, el diagnóstico médico, los síntomas vestibulares primarios, las manifestaciones auditivas y los grados de discapacidad.ResultadosSe obtuvieron datos de 177 personas, donde las alteraciones vestibulares se presentaron más en el sexo femenino (razón 2,6:1). La media de edad fue de 56años. El 53,7% presentó pérdida auditiva, de tipo neurosensorial, ligera, gradualmente descendente. El 33,9% de la población presentó acúfeno, en su mayoría en frecuencias agudas. En la población adulta el 52% presentó algún grado de percepción de discapacidad auditiva; contrariamente, en los adultos mayores la mayoría (77%) no presentó ningún grado de discapacidad. El 87% de las personas percibieron discapacidad vestibular debido a su alteración vestibular. (AU)

Background and objective: Vestibular disorders are linked to a group of pathologies that can affect the vestibular part, the auditory part, or both parts of the inner ear. The problem in this study is the little information that exists about the audiological profile of people suffering from vestibular disorders in Costa Rica. There are international research studies on this topic, but there are no records of studies conducted in the Costa Rican population. This is why there is interest in developing this research which aims to characterize the audiological profile and the levels of handicap in people with vestibular disorders under Centro Equilibra, Vertigo and Equilibrio consultation during the months of September to November 2019.Patients and methodsA descriptive, cross-sectional, quantitative, and observational analytical study with patients over 18years old who attended Centro Equilibra. The main variables analysed were sex, age, personal pathological history, medical diagnosis, main vestibular symptoms, auditory manifestations, and levels of handicap.ResultsThe data was obtained from 177 people; vestibular disorders occurred more in the female sex (ratio 2.6:1). The mean age was 56years. Fifty-three point seven percent presented slight sensorineural hearing loss, gradually decreasing. Of the population, 33.9% presented tinnitus, mostly at high frequencies. In the adult population, 52% presented some level of hearing handicap, unlike older adults, where the majority (77%) did not present any level of handicap. People with vestibular disorders perceive greater physical handicap (83%).ConclusionsHearing loss was the most common hearing manifestation and although statistical analysis shows that it is not directly related to vestibular disorders, it is related to concomitant metabolic diseases. For this reason, it is necessary to promote the prevention of metabolic diseases as one of the measures to improve hearing health, even from an early age. (AU)

Audiological profile and handicap levels in people with vestibular disorders at Centro Equilibra, Vértigo and Equilibrio, San José, Costa Rica.

BACKGROUND AND OBJECTIVE: Vestibular disorders are linked to a group of pathologies that can affect the vestibular part, the auditory part, or both parts of the inner ear. The problem in this study is the little information that exists about the audiological profile of people suffering from vestibular disorders in Costa Rica. There are international research studies on this topic, but there are no records of studies conducted in the Costa Rican population. This is why there is interest in developing this research which aims to characterize the audiological profile and the levels of handicap in people with vestibular disorders under Centro Equilibra, Vertigo and Equilibrio consultation during the months of September to November 2019. PATIENTS AND METHODS: A descriptive, cross-sectional, quantitative, and observational analytical study with patients over 18 years old who attended Centro Equilibra. The main variables analysed were sex, age, personal pathological history, medical diagnosis, main vestibular symptoms, auditory manifestations, and levels of handicap. RESULTS: The data was obtained from 177 people; vestibular disorders occurred more in the female sex (ratio 2.6:1). The mean age was 56 years. Fifty-three point seven percent presented slight sensorineural hearing loss, gradually decreasing. Of the population, 33.9% presented tinnitus, mostly at high frequencies. In the adult population, 52% presented some level of hearing handicap, unlike older adults, where the majority (77%) did not present any level of handicap. People with vestibular disorders perceive greater physical handicap (83%). CONCLUSIONS: Hearing loss was the most common hearing manifestation and although statistical analysis shows that it is not directly related to vestibular disorders, it is related to concomitant metabolic diseases. For this reason, it is necessary to promote the prevention of metabolic diseases as one of the measures to improve hearing health, even from an early age.

Invasive Pneumococcal Disease Characterization in Adults and Subgroups aged < 60 years and ≥ 60 years in Bogota, Colombia.

Background: There is scarce information on the burden of invasive pneumococcal disease (IPD) among adults in low- and middle-income countries. This study aimed to describe the clinical outcomes and microbiological characteristics associated with IPD in adults and subgroups aged 18-59 years and ≥60 years in Colombia. Methods: A retrospective chart review study was conducted in five institutions of Bogotá from January 2011 to December 2017. Analyses were carried out for overall population and stratified by age group (18-59; ≥ 60 years). Results: There were 169 IPD cases; median age was 58 years, 51.5% were male, and 80.5% had at least one comorbidity. Bacteremic pneumonia was the most common presentation (63.9%). The median length of hospital stay was 12 days with high healthcare resource utilization (HCRU): 58.6% required ICU and 53.3% inotropic support. Overall case-fatality rate (CFR) was 41.4%. Clinical outcomes were worse in patients ≥60 years old with significantly higher CFR and HCRU (ICU admission, mechanical ventilation, and inotropic support) compared to those aged 18-59 years. The most frequent serotypes were 3, 6 A/C, 14, and 19A. The sensitivity to penicillin in meningitis and non-meningitis isolates were 75% and 89.1% respectively. Conclusions: IPD was associated with a substantial burden in adults and worse clinical outcomes and HCRU in older adults in Colombia. Surveillance data combined with clinical outcomes have the potential to inform age-based pneumococcal vaccination policies.

Sea urchins: an update on their pharmacological properties.

Sea urchins are a group of benthic invertebrates characterized by having rigid globose bodies, covered in spines, and have an innate immune system that has allowed them to survive in the environment and defend against many pathogens that affect them. They are consumed for their unique flavor, but also for possessing a rich source of bioactive compounds which make them a source for a wide array of medicinal properties. Thus, these may be used to discover and develop new drugs such as anti-bacterials, anti-carcinogenics and anti-virals. Precisely for those reasons, this revision is centered on the known biological activities in various sea urchin species. Recently, the potential pharmacological benefits of nine sea urchin species [Diadema antillarum (Philippi 1845), Echinometra mathaei (de Blainville), Evechinus chloroticus (Valenciennes), Mesocentrotus nudus (Agassiz, 1863), Paracentrotus lividus (Lamarck, 1816), Scaphechinus mirabilis (Agazzis, 1863), Stomopneustes variolaris (Lamarck, 1816), Tripneustes depressus (Agassiz, 1863), and Tripneustes ventricosus (Lamarck, 1816)] have been evaluated. Our work includes a comprehensive review of the anti-fungal, anti-parasitic, anti-inflammatory, hepatoprotective, anti-viral, anti-diabetic, anti-lipidemic, gastro-protective and anti-cardiotoxic effects. Furthermore, we revised the compounds responsible of these pharmacological effects. This work was intended for a broad readership in the fields of pharmacology, drugs and devices, marine biology and aquaculture, fisheries and fish science. Our results suggest that organic extracts, as well as pure compounds obtained from several parts of sea urchin bodies are effective in vitro and in vivo pharmacological models. As such, these properties manifest the potential use of sea urchins to develop emergent active ingredients.

Cardiovascular risk factors and comorbidities in people living with HIV: A cross-sectional multicenter study from Colombia comorbidities in a Colombian PLWHIV population.

INTRODUCTION: HIV is an independent risk factor for cardiovascular diseases (CVD). There is insufficient information regarding comorbidities and cardiovascular risk factors in the Colombian HIV population. The aim of this study is to describe the prevalence of cardiovascular risk factors and comorbidities in patients from the HIV Colombian Group VIHCOL. METHODS: This is a multicenter, cross-sectional study conducted in the VIHCOL network in Colombia. Patients 18 years or older who had at least 6 months of follow-up were included. A stratified random sampling was performed to estimate the adjusted prevalence of cardiovascular risk factors and comorbidities. RESULTS: A total of 1616 patients were included. 83.2% were men, and the median age was 34 years. The adjusted prevalence for dyslipidemia, active tobacco use, hypothyroidism, and arterial hypertension was 51.2% (99% CI: 48.0%-54.4%), 7.6% (99% CI: 5.9%-9.3%), 7.4% (99% CI: 5.7%-9.1%), and 6.3% (99% CI: 4.8%-7.9%), respectively. CONCLUSIONS: In this Colombian HIV cohort, there is a high prevalence of modifiable CVD risk factors such as dyslipidemia and active smoking. Non-pharmacological and pharmacological measures for the prevention and management of these risk factors should be reinforced.

Natural co-infection of divergent hepatitis B and C virus homologues in carnivores.

In humans, co-infection of hepatitis B and C viruses (HBV, HCV) is common and aggravates disease outcome. Infection-mediated disease aggravation is poorly understood, partly due to lack of suitable animal models. Carnivores are understudied for hepatitis virus homologues. We investigated Mexican carnivores (ringtails, Bassariscus astutus) for HBV and HCV homologues. Three out of eight animals were infected with a divergent HBV termed ringtail HBV (RtHBV) at high viral loads of 5 × 109 -1.4 × 1010 copies/ml serum. Two of the RtHBV-infected animals were co-infected with a divergent hepacivirus termed ringtail hepacivirus (RtHV) at 4 × 106 -7.5 × 107 copies/ml in strain-specific qRT-PCR assays. Immunofluorescence assays relying on HBV core and RtHV NS3/4a proteins indicated that none of the animals had detectable hepadnavirus core-specific antibodies, whereas one RtHV-infected animal had concomitant RtHV-specific antibodies at 1:800 end-point titre. RtHBV and RtHV complete genomes showed typical HBV and HCV structure and length. All RtHBV genomes were identical, whereas RtHV genomes showed four amino acid substitutions located predominantly in the E1/E2-encoding genomic regions. Both RtHBV (>28% genomic nucleotide sequence distance) and RtHV (>30% partial NS3/NS5B amino acid sequence distance) formed new species within their virus families. Evolutionary analyses showed that RtHBV grouped with HBV homologues from different laurasiatherian hosts (carnivores, bats, and ungulates), whereas RtHV grouped predominantly with rodent-borne viruses. Ancestral state reconstructions showed that RtHV, but not RtHBV, likely emerged via a non-recent host switch involving rodent-borne hepacivirus ancestors. Conserved hepatitis virus infection patterns in naturally infected ringtails indicate that carnivores may be promising animal models to understand HBV/HCV co-infection.

Audiological profile and handicap levels in people with vestibular disorders at Centro Equilibra, Vértigo and Equilibrio, San José, Costa Rica. / Perfil audiológico y grados de discapacidad en las personas con alteraciones vestibulares pertenecientes a la consulta del Centro Equilibra, Vértigo y Equilibrio, San José, Costa Rica.

BACKGROUND AND OBJECTIVE: Vestibular disorders are linked to a group of pathologies that can affect the vestibular part, the auditory part, or both parts of the inner ear. The problem in this study is the little information that exists about the audiological profile of people suffering from vestibular disorders in Costa Rica. There are international research studies on this topic, but there are no records of studies conducted in the Costa Rican population. This is why there is interest in developing this research which aims to characterize the audiological profile and the levels of handicap in people with vestibular disorders under Centro Equilibra, Vertigo and Equilibrio consultation during the months of September to November 2019. PATIENTS AND METHODS: A descriptive, cross-sectional, quantitative, and observational analytical study with patients over 18years old who attended Centro Equilibra. The main variables analysed were sex, age, personal pathological history, medical diagnosis, main vestibular symptoms, auditory manifestations, and levels of handicap. RESULTS: The data was obtained from 177 people; vestibular disorders occurred more in the female sex (ratio 2.6:1). The mean age was 56years. Fifty-three point seven percent presented slight sensorineural hearing loss, gradually decreasing. Of the population, 33.9% presented tinnitus, mostly at high frequencies. In the adult population, 52% presented some level of hearing handicap, unlike older adults, where the majority (77%) did not present any level of handicap. People with vestibular disorders perceive greater physical handicap (83%). CONCLUSIONS: Hearing loss was the most common hearing manifestation and although statistical analysis shows that it is not directly related to vestibular disorders, it is related to concomitant metabolic diseases. For this reason, it is necessary to promote the prevention of metabolic diseases as one of the measures to improve hearing health, even from an early age.

MK2 degradation as a sensor of signal intensity that controls stress-induced cell fate.

Cell survival in response to stress is determined by the coordination of various signaling pathways. The kinase p38α is activated by many stresses, but the intensity and duration of the signal depends on the stimuli. How different p38α-activation dynamics may impact cell life/death decisions is unclear. Here, we show that the p38α-signaling output in response to stress is modulated by the expression levels of the downstream kinase MK2. We demonstrate that p38α forms a complex with MK2 in nonstimulated mammalian cells. Upon pathway activation, p38α phosphorylates MK2, the complex dissociates, and MK2 is degraded. Interestingly, transient p38α activation allows MK2 reexpression, reassembly of the p38α-MK2 complex, and cell survival. In contrast, sustained p38α activation induced by severe stress interferes with p38α-MK2 interaction, resulting in irreversible MK2 loss and cell death. MK2 degradation is mediated by the E3 ubiquitin ligase MDM2, and we identify four lysine residues in MK2 that are directly ubiquitinated by MDM2. Expression of an MK2 mutant that cannot be ubiquitinated by MDM2 enhances the survival of stressed cells. Our results indicate that MK2 reexpression and binding to p38α is critical for cell viability in response to stress and illustrate how particular p38α-activation patterns induced by different signals shape the stress-induced cell fate.

Cultural psychiatry: beyond DSM-5.

BACKGROUND: Cultural psychiatry evaluates manifestations, symptoms of emotional distress and mental disorders in diverse cultural contexts; it also addresses social problems such as poverty, violence, inequalities between groups or social classes. OBJECTIVE: To present a narrative review of the most relevant cultural aspects in the context of clinical practice in psychiatry and to suggest some alternatives to improve the cultural competence of health care professionals. METHOD: A narrative review was carried out of the most relevant articles in the area. RESULTS: Usually, the cultural argument is used to explain differences in observed prevalences in some mental disorders according to gender and geographical location. Cultural differences modify the expression of emotional distress and this can reduce the accuracy and affect the reliability and validity of the current diagnostic classification used in psychiatry. The American Psychiatric Association, in the most recent classification, revised cultural syndromes but only included a limited number of situations. Consequently, medical education and psychiatry must respond to diverse populations and provide quality care through the development of trans-cultural competence in the curriculum. CONCLUSIONS: It should be considered that cultural differences modify the expression of distress and thereby undermine the validity and reliability for diagnoses in distinct cultural contexts. In an increasingly globalised world, future classifications may completely omit 'cultural syndromes'.

Psiquiatría cultural: más allá del DSM-5 / Cultural psychiatry: beyond DSM-5

RESUMEN Introducción: La psiquiatría cultural evalúa las manifestaciones, los síntomas de sufrimiento emocional o los trastornos mentales en los distintos contextos culturales; asimismo, aborda problemas sociales como la pobreza, la violencia y las desigualdades entre grupos o clases sociales. Objetivo: Presentar una revisión narrativa de los aspectos culturales más relevantes en el contexto de la práctica clínica en psiquiatría y proponer algunas alternativas para mejorar la competencia cultural de los profesionales de la salud. Métodos: Se llevó a cabo una revisión narrativa de los artículos más relevantes en el área. Resultados: Habitualmente se utiliza la perspectiva cultural para explicar diferencias en las prevalencias que se observan en algunos trastornos mentales según el sexo y la localización geográfica. Las diferencias culturales modifican la expresión de distress o sufrimiento emocional, y esto puede reducir la precisión y afectar a la confiabilidad de las clasificaciones y la validez de los diagnósticos actuales usados en psiquiatría. La Asociación Psiquiátrica Americana, en la clasificación más reciente, revisó los trastornos asociados con la cultura pero solo incluyó un reducido número de situaciones. La formación médica y la psiquiatría deben responder a las necesidades de comunidades diversas y proporcionar un cuidado de calidad mediante el desarrollo de competencias transculturales en los currículos. Conclusiones: Se debe considerar que las diferencias culturales modifican la expresión de distress y con ello se menoscaba la validez y la confiabilidad de los diagnósticos hegemónicos en distintos contextos culturales. En un mundo cada vez más globalizado, es posible que futuras clasificaciones diagnósticas omitan los «síndromes culturales¼.

ABSTRACT Background: Cultural psychiatry evaluates manifestations, symptoms of emotional distress and mental disorders in diverse cultural contexts; it also addresses social problems such as poverty, violence, inequalities between groups or social classes. Objective: To present a narrative review of the most relevant cultural aspects in the context of clinical practice in psychiatry and to suggest some alternatives to improve the cultural competence of health care professionals. Method: A narrative review was carried out of the most relevant articles in the area. Results: Usually, the cultural argument is used to explain differences in observed prevalences in some mental disorders according to gender and geographical location. Cultural differences modify the expression of emotional distress and this can reduce the accuracy and affect the reliability and validity of the current diagnostic classification used in psychiatry. The American Psychiatric Association, in the most recent classification, revised cultural syndromes but only included a limited number of situations. Consequently, medical education and psychiatry must respond to diverse populations and provide quality care through the development of trans-cultural competence in the curriculum. Conclusions: It should be considered that cultural differences modify the expression of distress and thereby undermine the validity and reliability for diagnoses in distinct cultural contexts. In an increasingly globalised world, future classifications may completely omit 'cultural syndromes'.

Factores de resiliencia y bienestar en familias colombianas / Resilience factors and familiar well-being in Colombian families

Resumen Las familias, en la actualidad, enfrentan nuevos retos y cambios que comprometen su capacidad de adaptación y su bienestar. Este estudio tuvo como objetivo describir y comparar indicadores de resiliencia familiar y bienestar familiar de 442 familias colombianas ubicadas geográficamente en Bogotá (n = 196), Santa Marta (n = 81) y Cali-Palmira (n = 145). El diseño fue analítico transversal. Las familias diligenciaron el Índice Familiar de Regeneración y Adaptación (FIRA-G) para valorar la resiliencia y el Índice de Bienestar de los miembros de la Familia (FMWB). Los resultados demostraron relaciones significativas y positivas entre bienestar familiar y resiliencia familiar al igual que una relación inversa y significativa entre indicadores de resiliencia negativos como tensión, distrés y tensión familiar con indicadores positivos de resiliencia familiar tales como coherencia, fortaleza y apoyo social. La comparación entre ciudades evidenció divergencias entre las familias de Bogotá y Cali-Palmira, en los niveles de bienestar familiar, estresores familiares y apoyo de parientes y amigos. En el caso de la ciudad de Santa Marta se encuentran diferencias en los estresores familiares con Cali-Palmira y en apoyo social comunitario con Bogotá. La discusión se orienta a mostrar que la resiliencia familiar es resultado de la participación de varios elementos: los recursos familiares adaptativos positivos que le permiten a las familias reducir el estrés y enfrentar las demandas del ambiente, la presencia de los dos padres en familias sin indicadores clínicos que hace que la carga de estrés sea compartida -lo cual abona el terreno para la resiliencia familiar-, y el apoyo social manifestado en ayudas externas al núcleo familiar por parte de la comunidad, los parientes y los amigos.

Abstract Currently, modern families are coping with different stressful situations. The family studies are focused on the conceptual perspective, political perspective and methodological topic and they leave aside the familiar dynamics and functioning. This paper was interested in describing and comparing indicators of family resilience and family welfare of 442 Colombian families. This study had three hypotheses: The first one is focused on differences in well-being family dimension per location; the second hypothesis was focused on significant differences in family resilience per location, and the third one was interested in significant relations in family resilience and family well-being. The theoretical support to this research is the McCubbin and Patterson's resilience model called Double ABCX and Family Adaptation and Adjust Response Model by Patterson. The family well-being is considered a result of internal family functioning and is measured by the family member perception about the concern about health problems, fears, anger and sadness. Family resilience is understood as the capacity to recover from adversity. This capacity strengthens families and improves their resources. In this theoretic resilience approach the resilience is a dynamic result to the adaptation phase and the family well-being is the final adjustment. The design was cross-sectional analytical with a convenience sample. The families were interviewed in their homes, from each family both parents and a child between 9 and 17 years old participated. They are located geographically in Bogotá (n = 196), Santa Marta (n = 81) and Cali-Palmira (n = 145). Families completed the Family Member Well-being Index (FMWB) and the Family Regeneration and Adaptation Index (FIRA-G) to assess resilience. Families residing in Bogotá showed significant differences with those of Cali-Palmira in the dimension of family well-being, family stress and support from friends and family. While families located in Santa Marta showed differences with respect to the families located in Cali-Palmira in family stress and in community and social support. The father correlations between the family resilience index and the well-being family index is strong and inverse with the family stress and the family well-being summarized. The mother well-being family perception is significant associated with family resilience, and these correlations was strongest with family well-being summarized. The family stress index, strains and distress exposed moderate and inverse relations with the positive resilience family summarized. The discussion deals with family resilience as a product of the dynamic interaction in the hole family system and is oriented to the fact that the presence of support from family and friends reduces the burden of family stress, promotes support in the face of crisis and, in general, improves the well-being and family adaptation. In general, the differences reflect varied resilience trajectories that depend on the challenges posed by the close context of the city where they live. An approach to this result leads us to think as a hypothesis not yet widely explored, in the mobility factor of cities, which limits contact with close family networks. In big cities like Bogotá, its internal mobility compromises the times and spaces of daily life, and thus allows or prevents families from organizing their relationships in the different areas of their social life. Resilience occurs through positive adaptive family resources that included social support and family coherence and allow families to reduce stress and meet the demands of the environment. On the other hand, the presence of the two parents in families without clinical indicators shows that the burden of shared stress helps family resilience, which is also fed by the presence of external aids to the family nucleus, such as the support of the community, family and friends.

Identificación de clústeres de casos de COVID-19 en la provincia Santiago de Cuba / Identification of clusters in COVID-19 cases in the Santiago de Cuba province

Introducción: A partir de la aparición de la epidemia COVID-19 se conforma un equipo multidisciplinario en Santiago de Cuba con participación de varias instituciones y activado por el Consejo de defensa provincial. El análisis integrado epidemiológico, la gestión gubernamental y la respuesta social resultarían determinantes en el control de la enfermedad. Objetivos: Identificar posibles grupos de casos con COVID-19 en la provincia Santiago de Cuba y caracterizar su transmisión según variables epidemiológicas. Métodos: Se desarrolló un estudio ecológico, comparándose los clústeres de transmisión de COVID-19. Se resumieron variables de interés y se realizó análisis de redes sociales desde el punto de vista de las relaciones entre casos y contactos, así como análisis espacial. Resultados: Se identificaron cinco grupos espaciales de transmisión en los municipios, uno en Palma Soriano, uno en Contramaestre y tres en Santiago de Cuba. Los antecedentes patológicos personales (hipertensión y procesos respiratorios), el sexo femenino, los casos sintomáticos y el promedio de 22 a 27 contactos por cada confirmado fueron las variables más relevantes. Se identificó fuente de infección introducida en 51 por ciento (25/49). Además, se identificaron redes sociales complejas en la transmisión de la enfermedad. Conclusiones: La transmisión de COVID-19 en la provincia Santiago de Cuba mostró grupos de casos y contactos con redes sociales epidemiológicas características para cada municipio, así como el modo de transmisión de acuerdo a la fuente de infección, relaciones de familiaridad o cercanía social y la relación de distancia espacial entre contactos, aspectos que influyeron en las bajas tasas de incidencia de la enfermedad, con predominio en su forma sintomática, edades jóvenes y en mujeres(AU)

Introduction: From the onset of COVID-19 epidemic, a multidisciplinary team is formed in Santiago de Cuba with the participation of several institutions and activated by the Provincial Defense Council. Integrated epidemiological analysis, government management and social response would be decisive in controlling the disease. Objectives: To identify possible groups of COVID-19 cases in the Santiago de Cuba province and to describe the transmission according to epidemiological variables. Methods: An ecological study was carried out, comparing COVID-19 transmission clusters. Variables of interest were summarized and analysis of social contact networks was carried out from the point of view of the relationships between cases and contacts, as well as spatial analysis. Results: Five spatial transmission groups were identified in the municipalities, one in Palma Soriano, one in Contramaestre and three in Santiago de Cuba. The personal pathological antecedents (hypertension and respiratory processes), female sex, symptomatic cases and the average of 22 to 27 contacts for each confirmed were the most relevant variables. A source of introduced infection was identified in 51 percent (25/49). In addition, complex social networks were identified in the transmission of the disease. Conclusions: The transmission of COVID-19 in Santiago de Cuba province showed groups of cases and contacts with characteristic epidemiological social networks for each municipality, as well as the mode of transmission according to the source of infection, relationships of familiarity or social closeness and the relationship of spatial distance between contacts, which influenced on the low incidence rates of the disease, with predominance of symptomatic form, young ages and in women(AU)

Quinacrine, an Antimalarial Drug with Strong Activity Inhibiting SARS-CoV-2 Viral Replication In Vitro.

Quinacrine (Qx), a molecule used as an antimalarial, has shown anticancer, antiprion, and antiviral activity. The most relevant antiviral activities of Qx are related to its ability to raise pH in acidic organelles, diminishing viral enzymatic activity for viral cell entry, and its ability to bind to viral DNA and RNA. Moreover, Qx has been used as an immunomodulator in cutaneous lupus erythematosus and various rheumatological diseases, by inhibiting phospholipase A2 modulating the Th1/Th2 response. The aim of this study was to evaluate the potential antiviral effect of Qx against denominated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Vero E6 cells. The cytotoxicity of Qx in Vero E6 cells was determined by the MTT assay. Afterwards, Vero E6 cells were infected with SARS-CoV-2 at different multiplicities of infections (MOIs) of 0.1 and 0.01 in the presence of Qx (0-30 µM) to determinate the half maximal effective concentration (EC50). After 48 h, the effect of Qx against SARS-CoV-2 was assessed by viral cytotoxicity and viral copy numbers, the last were determined by digital real-time RT-PCR (ddRT-PCR). Additionally, electron and confocal microscopy of Vero E6 cells infected and treated with Qx was studied. Our data show that Qx reduces SARS-CoV-2 virus replication and virus cytotoxicity, apparently by inhibition of viral ensemble, as observed by ultrastructural images, suggesting that Qx could be a potential drug for further clinical studies against coronavirus disease 2019 (COVID-19) infection.