Changes in Televisit Modalities Due to the COVID Pandemic in Chile: A Comparison of Patient Satisfaction.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has impacted healthcare guidelines and modalities of patient consultation worldwide. The frequent cycles of quarantine confinement in Chile have caused mobility restrictions for patients and physicians, forcing the Hospital Las Higueras de Talcahuano (HHT) to replace the assisted televisit modality with a more classic televisit program. Here we have described if this change in televisit modality and type of outpatient may have impacted patients' satisfaction. METHODS: The patient's perception of satisfaction was evaluated through self-administered survey questionnaires previously validated in Spanish. Cohorts were grouped according to the following two relational models: (i) assisted televisit, 503 neurology patients from 2018 to 2019, and (ii) televisit, 831 patients from different specialties treated during 2020. Perception of satisfaction was compared by gender, age, and type of televisit, and internal consistency (Cronbach alpha) and reliability (factorial analysis of principal components) were assessed. Finally, we compared the patient satisfaction of both modalities. RESULTS: Questionnaires showed excellent internal consistency; all items showed point biserial correlations greater than 0.30. Assisted televisit and televisit cohorts comprised 64.2% and 67.6% females, respectively, and patients under the age of 65 years were 62.2% and 75%, respectively. Assisted televisit patients showed very high 94.4% (n=475) and high 5.2% (n=26) satisfaction levels, while televisit patients showed very high 22.3% (n=185), high 63.9% (n=531), and moderate 13.1% (n=109) satisfaction levels; this difference was statistically significant at p<0.001. CONCLUSION: Lower perception of satisfaction due to the change in televisit relational modality underscores the importance of primary care professionals who support the specialist in the assisted televisit model. However, the televisit modality showed high patient satisfaction and suggested that this modality can be a plausible alternative according to each location's reality. The results of this study indicate that both assisted televisit and televisit contribute to delivering an integrative solution that helps to alleviate the system's fragmentation.

The burden of intestinal parasitic infections in Antioquia, Colombia: Impact in childhood growth development and nutritional status.

Gastrointestinal protist (GP) and soil-transmitted helminth (STH) infections cause significant morbidity among children in poor-resource settings of tropical and sub-tropical countries including Colombia. Few prospective transversal studies investigating how GP and STH infections affect growth development and nutritional status during childhood have been conducted in this country, none of them in the Antioquia Department. This microscopy-based study estimated the prevalence of GP and helminth (including STH) infections in faecal samples from schoolchildren (n = 384) collected during April-May 2019 in three municipalities of the Antioquia Department. Demographic, epidemiological, and household data were elicited through face-to-face interviews. Parasite detection was carried out by direct microscopic examination of both fresh smears and concentrated faecal material. Children (aged 6-15 years) also had their haemoglobin (Hb) levels, height and weight data collected, and BMI estimated. Data were analysed using bivariate and multivariate logistic regression analysis. Overall, 60.7 % (233/384) of schoolchildren were infected by at least one intestinal parasitic species. Among GPs, Blastocystis sp. was the most common species found (47.7 %, 95 % CI: 42.6-52.8), followed by G. duodenalis (15.9 %, 95 % CI: 12.4-19.9). Cryptosporidium spp. and Cyclospora cayetanensis were sporadically identified (0.3 %, 95 % CI: 0.1-1.4 each). Among helminths, the most prevalent species found were Trichuris trichiura (6.0 %, 95 % CI: 3.8-8.9) and Enterobius vermicularis (1.0 %, 95 % CI: 0.3-2.6). Hookworms, Ascaris lumbricoides, and Strongyloides stercoralis were found at prevalence rates <1 %. Underweight, overweigh, or obese schoolchildren had 1.2 times greater chance of being infected with intestinal parasites than their counterparts with a healthy weight (P-value: 0.015). Variables significantly associated with an increased likelihood of being infected by intestinal parasites include living in a household with unfinished flouring, not wearing shoes, being in close proximity to rodents, and having improper waste disposal. Relatively simple interventional measures directed towards the improvement of household conditions, access to sanitary toilets, and promoting shoe wearing can significantly reduce childhood infections by GP and helminths in the Antioquia Department.

[Evaluation of a rapid weight estimation tool for pediatric emergencies]. / Evaluación de una herramienta de estimación rápida de peso para urgencias pediátricas.

Weight measurement is essential in the treatment of pediatric patients in emergencies, however, in cases of patient instability or limited resources, weight estimation becomes a plausible alternative. There are rapid estimation methods, although with performance discrepancies in different populations. OBJECTIVE: To compare the performance of the "Colombian Pediatric Tape" (CPT) and Broselow Tape (BT) in weight estimation in children. PATIENTS AND METHOD: Descriptive cross-sectional study and concordance analysis. Sample of 42,232 children from the 2010 National Survey of the Nu tritional Situation of Colombia. For the performance evaluation, the prediction of zones and weight of each tool and their concordance using the Kappa coefficient and the Bland-Altman index were considered. RESULTS: Cohen's Kappa index for the BT with respect to the color area agreement was 0.57 and for the CPT it was 0.65. The Bland-Altman index for CPT of the actual weight and the esti mated weight showed a mean difference of 0.005 Kg (CI95; -4.1 to +4.1), and for the BT was 0.13 Kg (CI95; -5.2 to 5.5). The percentage difference analysis of concordance between the two tools showed a statistically significant overall difference in favor of the CPT, 66% Vs 70% (p = 0.00001). CONCLUSIONS: In Colombian children, the BT overestimates or underestimates the weight by up to 21% with respect to the real value, while CPT can be used with better performance to estimate the weight.

Proposal of a guide for the interpretation, simplification of the regulatory process and good tax compliance, case of digital taxpayers, influencers.

Influencers generate opinions in individuals through multiple virtual platforms, this phenomenon implies social influence that induces consumers to buy and direct these activities to the sponsorship of brands, which means monetary income for the influencer. Many of these incomes are not reported to the tax system, which causes evasion due to misinformation or lack of knowledge. Therefore, the need for a correct adaptation and interpretation of the Peruvian tax regulations for the payment of taxes on income received by this segment of taxpayers was observed. The purpose of this research was a guide that interprets, simplifies the processes and provides a regulatory framework for tax compliance for domiciled and non-domiciled influencers. The tax guide was designed thanks to the adaptation of the Scribber methodology and consisted of 4 steps: Familiarization, coding, theme generation, defining themes. The guide was organized in level 01, describing how to achieve the tax obligation in the sector of digital taxpayers influencers, level 02, where the activities described by the regulations are mentioned and level 3, tax procedures carried out by the tax administration to influencers. This guide is an aid to define the category that attributes the taxpayer's tax payment method. By identifying the tax categorization code according to the type of activity. It identifies the key factors to be able to interpret and adapt the law to the influencer's activities.

Identification and validation of novel Blastocystis subtype ST41 in a Colombian patient undergoing colorectal cancer screening.

Blastocystis sp. is among the most frequent intestinal protists identified in humans globally. However, characterization of Blastocystis subtype diversity in humans is ongoing. We report here the identification of novel Blastocystis subtype ST41 in a Colombian patient undergoing colorectal cancer screening involving colonoscopy and fecal testing (microscopy, culture, PCR). The full-length ssu rRNA gene sequence of the protist was generated using MinION long-read sequencing technology. The validity of the novel subtype was confirmed via phylogenetic and pairwise distance analyses of the full-length ST41 sequence and all other valid subtypes. The study provides reference material essential for conducting subsequent experimental studies.

Competency analysis based on accounting career anchors using clustering techniques.

This research work aims to identify the prevalent anchors in the professional accounting career using the Schein scale and to describe the prevalent anchors by defining the values, attitudes, aptitudes, skills, and interests. Career anchors are defined by the competence, motivation, and values a person has to perform a particular job in an organization and are present throughout their working life. When determining the soft and hard competencies of the professional profile, universities must consider the career anchors essential for graduates' work performance. To determine which anchors dominate the competencies of the graduate profile, two universities in Latin America with a degree in accounting were selected. The study was organized in two stages: first, the operationalization of the research was conducted, including the description of the instrument through the application of 40 questions divided into Schein's eight anchors. Samples were selected based on the convenience of the authors: one university in Peru and another in Colombia. The sample includes all students enrolled in the accounting major, and the data were coded and processed. In the second stage, data analysis was performed by grouping parameters, analysis of variance, explanatory analysis using a test for the best clustering algorithm, statistical testing, and discussion of the findings. The predominant anchors in the two universities are creativity, entrepreneurship, and lifestyle. The selected universities placed considerable emphasis on training future accountants with an innovative spirit, integrity, and social commitment without neglecting the professional requirements. This approach allows students to undertake challenges and new businesses in their field of work.

Prevalence of intestinal parasites in a cohort of HIVinfected patients from Antioquia, Colombia. / Prevalencia de parásitos intestinales en una cohorte de pacientes positivos para HIV en Antioquia, Colombia

INTRODUCTION: HIV infection is still a public health problem worldwide and co-infections with other infectious agents including intestinal parasites are of particular concern, mainly in developing countries like Colombia. OBJECTIVE: To conduct a cross-sectional study in patients attending an HIV care program in Antioquia given that there have been few intestinal parasites prevalence studies among the HIV population in the country. MATERIAL AND METHODS: We evaluated stool samples from 192 patients by direct wet mount and concentration, modified Ziehl Neelsen staining, and agar plate culture. Univariate and correlation analyses were done to explore the association between socio-demographic and clinical characteristics and parasitological data. RESULTS: The overall prevalence of intestinal parasites in HIV-positive subjects was 29.2% (56/192; 95% CI: 22.8% - 35.6%). Entamoeba histolytica/dispar/moshkosvkii with 13.0% (25/192; 95% CI: 8.2% - 17.8%) and Blastocystis with 12.0% (23/192; 95% CI: 7.4% - 16.6%) were the most frequent. Opportunistic parasites like Cryptosporidium spp. and Cystoisospora belli were less prevalent, each one with 0.5% of positive samples (1/192; 95% CI: 0.1% - 1.5%). Commensal protozoa were also detected with a prevalence of 18.8% (36/192; 95% CI: 13.3% - 24.3%). Most of the individuals in the study had a controlled viral load and an LTCD4 count greater than 200 cel/µL. A small percentage (9.3%) had diarrhea. Bivariate analysis and multivariate logistic regression showed that only age and having pets had a significant association with intestinal parasites in this cohort. CONCLUSIONS: Our results confirmed that the evaluated population is at high risk of intestinal parasite infection, which highlights the need for routine screening of gastrointestinal parasites to provide prompt treatment and reduce possible complications.

Introducción. La infección por HIV y las coinfecciones con otros agentes infecciosos, incluidos los parásitos intestinales, son motivo de especial preocupación en países en desarrollo como Colombia. Objetivo. Hacer un estudio transversal en pacientes que asisten a un programa de atención de HIV en el departamento de Antioquia, dado que los estudios de prevalencia de parásitos intestinales en la población con HIV son escasos en el país. Materiales y métodos. Se evaluaron 192 muestras de materia fecal mediante examen coprológico directo y por concentración, tinción de Ziehl-Neelsen modificada, y aislamiento en agar. Se hicieron análisis univariados y de correlación, para explorar la asociación entre las características sociodemográficas y clínicas, y los datos parasitológicos. Resultados. La prevalencia global de parásitos intestinales en pacientes positivos para VIH fue del 29.2 % (56/192; IC95% 22.8-35.6 %), siendo Entamoeba histolytica/dispar/moshkosvkii, con 13.0 % (25/192; IC95% 8.2-17.8 %), y Blastocystis, con 12.0 % (23/192; IC95% 7.4-16.6 %), los mas frecuentes. Los parásitos oportunistas Cryptosporidium spp. y Cystoisospora belli fueron menos prevalentes, cada uno con 0.5 % (1/192; IC95% 0.1-1.5 %) de muestras positivas. También, se detectaron protozoos comensales, con una prevalencia del 18,8 % (36/192; IC95% 13,3-24,3 %). La mayoría de los individuos tenía una carga viral controlada y un recuento de linfocitos T CD4 superior a 200 células/µl. Un pequeño porcentaje (9,3 %) presentó diarrea. La edad y el tener mascotas mostraron una asociación significativa con la presencia de parásitos intestinales. Conclusión. Se confirmó que la población evaluada tiene un alto riesgo de infección por parásitos intestinales, lo que resalta la necesidad de un protocolo de diagnóstico para el cribado de dichos agentes, con el fin de brindar un tratamiento rápido y reducir las posibles complicaciones.

Prevalence of intestinal parasites in a cohort of HIV- infected patients from Antioquia, Colombia / Prevalencia de parásitos intestinales en una cohorte de pacientes positivos para HIV en Antioquia, Colombia

Abstract | Introduction: HIV infection is still a public health problem worldwide and co-infections with other infectious agents including intestinal parasites are of particular concern, mainly in developing countries like Colombia. Objective: To conduct a cross-sectional study in patients attending an HIV care program in Antioquia given that there have been few intestinal parasites prevalence studies among the HIV population in the country. Material and methods: We evaluated stool samples from 192 patients by direct wet mount and concentration, modified Ziehl Neelsen staining, and agar plate culture. Univariate and correlation analyses were done to explore the association between socio-demographic and clinical characteristics and parasitological data. Results: The overall prevalence of intestinal parasites in HIV-positive subjects was 29.2% (56/192; 95% CI: 22.8% - 35.6%). Entamoeba histolytica/dispar/moshkosvkii with 13.0% (25/192; 95% CI: 8.2% - 17.8%) and Blastocystis with 12.0% (23/192; 95% CI: 7.4% -16.6%) were the most frequent. Opportunistic parasites like Cryptosporidium spp. and Cystoisospora belli were less prevalent, each one with 0.5% of positive samples (1/192; 95% CI: 0.1% - 1.5%). Commensal protozoa were also detected with a prevalence of 18.8% (36/192; 95% CI: 13.3% - 24.3%). Most of the individuals in the study had a controlled viral load and an LTCD4 count greater than 200 cel/µL. A small percentage (9.3%) had diarrhea. Bivariate analysis and multivariate logistic regression showed that only age and having pets had a significant association with intestinal parasites in this cohort. Conclusions: Our results confirmed that the evaluated population is at high risk of intestinal parasite infection, which highlights the need for routine screening of gastrointestinal parasites to provide prompt treatment and reduce possible complications.

Resumen | Introducción. La infección por HIV y las coinfecciones con otros agentes infecciosos, incluidos los parásitos intestinales, son motivo de especial preocupación en países en desarrollo como Colombia. Objetivo. Hacer un estudio transversal en pacientes que asisten a un programa de atención de HIV en el departamento de Antioquia, dado que los estudios de prevalencia de parásitos intestinales en la población con HIV son escasos en el país. Materiales y métodos. Se evaluaron 192 muestras de materia fecal mediante examen coprológico directo y por concentración, tinción de Ziehl-Neelsen modificada, y aislamiento en agar. Se hicieron análisis univariados y de correlación, para explorar la asociación entre las características sociodemográficas y clínicas, y los datos parasitológicos. Resultados. La prevalencia global de parásitos intestinales en pacientes positivos para VIH fue del 29.2 % (56/192; IC95% 22.8-35.6 %), siendo Entamoeba histolytica/dispar/moshkosvkii, con 13.0 % (25/192; IC95% 8.2-17.8 %), y Blastocystis, con 12.0 % (23/192; IC95% 7.4-16.6 %), los mas frecuentes. Los parásitos oportunistas Cryptosporidium spp. Y Cystoisospora belli fueron menos prevalentes, cada uno con 0.5 % (1/192; IC95% 0.1-1.5 %) de muestras positivas. También, se detectaron protozoos comensales, con una prevalencia del 18,8 % (36/192; IC95% 13,3-24,3 %). La mayoría de los individuos tenía una carga viral controlada y un recuento de linfocitos T CD4 superior a 200 células/μl. Un pequeño porcentaje (9,3 %) presentó diarrea. La edad y el tener mascotas mostraron una asociación significativa con la presencia de parásitos intestinales. Conclusión. Se confirmó que la población evaluada tiene un alto riesgo de infección por parásitos intestinales, lo que resalta la necesidad de un protocolo de diagnóstico para el cribado de dichos agentes, con el fin de brindar un tratamiento rápido y reducir las posibles complicaciones.

Características sociodemográficas y clínicas, según el índice CD4: CD8, de una población de personas infectadas con el VIH que consultó en la Corporación para Investigaciones Biológicas de Medellín, Colombia / Sociodemographic and clinical characteristics based on their cd4: cd8 ratio. of HIV infected persons who consulted at Corporación para Investigaciones Biológicas of Medellín, Colombia

RESUMEN Objetivo: las personas infectadas con el virus de la inmunodeficiencia humana tipo 1 (VIH-1+) con un índice CD4:CD8 menor a 1, presentan un mayor riesgo de morbilidad y mor-talidad por eventos no asociados con el SIDA. El objetivo de este trabajo fue explorar‚ en la población seleccionada‚ variables sociodemográficas y clínicas de acuerdo con dicho índice, debido a que este es más informativo que LT CD4+ y LT CD8+ por sí solos. Materiales y métodos: estudio observacional en pacientes con VIH-1+ atendidos en la Corporación para Investigaciones Biológicas (CIB). En 227 pacientes se evaluaron diferencias en edad‚ recuento de LT CD4+‚ carga viral‚ número y tipo de esquemas. Se dividieron los pacientes en dos grupos: (A con índice CD4:CD8 ≥ 1 y, B < 1). Resultados: el estudio se compuso de la siguiente forma, 71 % hombres y 29 % mujeres. El 22,5 % pertenecía al grupo A y el 77,5 % al B. La media de la edad fue 42‚8 años en el grupo A y 45 en el B (p = 0‚176). El 100 % de los individuos en el grupo A recibían tratamiento y, 97‚7 % en el B. La media de LT CD4+ fue de 772‚4 para el grupo A y, 448‚1 en el B (p = 0‚00001). En el grupo A el 90‚2 % tenían carga viral indetectable‚ en contraste con el 68‚8 % del B (p = 0‚002). El 41‚2 % en el grupo A tuvieron un solo esquema‚ en relación con el 43,8 % del B (p = 0‚744). Conclusiones: la mayoría de los pacientes presentaron un índice CD4:CD8 < 1 a pesar de haber presentado LT CD4+ aceptables. Fue más frecuente encontrar un índice < 1 en los pacientes sin un adecuado control virológico. Se requieren más estudios para determinar las variables asociadas con su normalización.

SUMMARY Introduction: Human Immunodeficiency Virus type 1 (HIV-1+) patients with a CD4:CD8 ratio < 1 presents a higher risk of morbidity and mortality due to not-associated AIDS events. The aim was to explore, in the selected population, sociodemographic and clinical variables, based on that ratio, because it is more informative than LT CD4+ and LT CD8+ by themselves. Materials and Methods: Observational, in HIV-1 infected patients attended at Biological Research Corporation. In 227 patients, age differences, LT CD4+ count, viral load, number and type of treatments were evaluated. The patients were divided in group A with a CD4:CD8 ratio equal or above to 1, and B bellow 1. Results: The study includes 71% of male and 29% of female. 22,5% were from group A and 77,5% from B. The mean of age was 42,8 years old in A and 45,3 years old in B (p=0,176). 100% of individuals from group A receive treatment, meanwhile 97,7% in B. Mean of LT CD4+ count was 772,4 cell/μL in A and 448,1 cell/μL in B (p=0,00001). In A, 90,2% had undetectable viral load vs 68,8% in B (p=0,002). 41,2% in A had only one type of treatment, vs 43,8% in B (p=0,744). Conclusion: Most of the patients had a CD4:CD8 ratio bellow to 1, despite an acceptable count of LTCD4++. To find a ratio bellow 1 in patients without an adequate virological control was more frequent. More studies to determinate variables associated with its normalization are required.

Mortalidad por Cáncer de Mama. Policlínico 13 de Marzo. 2017-2018 / Breast Cancer Mortality. Polyclinic March 13. 2017-2018 / Mortalidade por câncer de mama. Policlínica 13 de Março. 2017-2018

RESUMEN El cáncer de mama es la neoplasia más frecuente en el sexo femenino y una de las principales causas de muerte en este grupo. Se realizó un estudio descriptivo retrospectivo, de mujeres fallecidas por cáncer de mama en el período 2017 al 2018, con el objetivo de describir la mortalidad de esta enfermedad, teniendo en cuenta la zona de residencia, promedio de edad de las fallecidas y años de vida potencialmente perdidos según Consejos Populares. Las medidas estadísticas utilizadas fueron, tasa de mortalidad, valores absolutos, valores promedios, números absolutos y años de vidas potencialmente perdidos, observándose un incremento de la tasa de mortalidad, con un predominio en la zona urbana, el promedio de edad de los fallecidos se encuentra por encima de los 50 años y son los Consejos Populares de San Juan-El Cristo los que aportaron, las mayores tasa de años de vida potencialmente perdidos.

ABSTRACT Breast cancer is the most common neoplasm in the female sex and one of the leading causes of death in this group. A retrospective descriptive study was conducted of women who died of breast cancer in the period 2017 to 2018, with the aim of describing the mortality of this disease, taking into account the area of residence, average age of the deceased and years of life potentially lost according to Popular Councils. The statistical measures used were, mortality rate, absolute values, average values, absolute numbers and years of lives potentially lost, with an increase in the mortality rate, with a predominance in the urban area, the average age of the deceased is above 50 years and it is the People's Councils of St. John-The Christ who contributed, the highest rate of potentially lost life years.

RESUMO O câncer de mama é a neoplasia maiscomum no sexo feminino e uma das principais causas de mortenesse grupo. Foi realizado umestudo retrospectivo descritivo de mulheres que morreram de câncer de mama no período de 2017 a 2018, como objetivo de descrever a mortalidade da doença, levando emconsideração a área de residência, idademédia do falecido e anos de vida potencialmente perdidos segundo Conselhos Populares. As medidas estatísticas utilizadas foram, taxa de mortalidade, valores absolutos, valores médios, números absolutos e anos de vidas potencialmente perdidos, com aumento da taxa de mortalidade, compredomíniona área urbana, a idademédia do falecido é superior a 50 anos e são os Conselhos Do Povo de São João-O Cristo que contribuíram, a maiortaxa de anos de vida potencialmente perdidos.

Efecto del cambio de la terapia antirretroviral en la falla virológica en una cohorte de pacientes que conviven con el VIH en Medellín, Antioquia, Colombia / Effect of the change in antirretroviral therapy on virological failure in a cohort of patients living with HIV in Medellín, Antioquia, Colombia

Objetivo: determinar el efecto del cambio en la terapia antirretroviral sobre el control virológico en una cohorte de pacientes VIH positivos de una institución prestadora de servicios de salud en Medellín, Antioquia (Colombia) en el año 2017. Materiales y métodos: estudio observacional analítico transversal, comparativo entre pacientes que cambiaron y no cambiaron el esquema inicial de terapia antirretroviral. Se realizó en una cohorte de 1245 pacientes que conviven con el VIH. Resultados: un total de 322 pacientes fueron evaluados. El principal motivo de cambio fue la presencia de efectos adversos a la terapia antirretroviral, seguido de la falla virológica sin genotipo e intolerancia a la terapia antirretroviral. La falla virológica, RP 1,4 IC95% (1,2-1,6, p0,00), el tener genotipo, RP 1,2 IC95% (1,1-1,3, p 0,00) y el padecer una infección oportunista, RP 1,3 IC95% (1,0-1,6, p 0,03), se asociaron a mayor número de cambios a la TAR. La adherencia a la terapia antirretroviral, RP 0,18 IC95% (0,1-0,3, p 0,00) y la toma de otros medicamentos no relacionados al VIH (RP 0,6, IC95% 0,4-0,8, p 0,005) se asociaron a menor frecuencia de cambio de la terapia antirretroviral. El cambio de la terapia antirretroviral (OR ajustado 3,4, IC 95% (2,0-5,8), continúa siendo el factor pronóstico más importante para falla virológica. Conclusión: el cambio de la terapia antirretroviral, definida en este estudio como la principal variable de exposición, representa el principal factor de riesgo para falla virológica, incluso cuando fue ajustado por otras variables..Au

Objective: to determine the effect of the change in antiretroviral therapy on virological control in a cohort of HIV positive patients corresponding to a healthcare institution in Medellín, Antioquia (Colombia) in 2017. Materials and methods: cross-sectional,comparative analytical observational study. It was performed in a cohort of 1245 patients living with HIV. Results: a total of 322 patients were evaluated. The main reason for change was the presence of adverse effects to antiretroviral therapy, followed by virological failure without genotype and antiretroviral therapy intolerance. Virological failure, PR 1.4 95% CI (1.2-1.6, p 0,00), having genotype, PR 1.2 95% CI (1.1-1.3, p0,00 ) and suffering from an opportunistic infection, PR 1.3 95% CI (1.0-1.6, p 0,03),were associated with a greater number of changes to antiretroviral therapy. Adherence to antiretroviral therapy, PR 0.18 95% CI (0.1-0.3, p 0,00) and taking other non-HIVrelated medications (PR 0.6, 95% CI 0.4-0 , 8, p 0,005) were associated with a lower frequency of change of antiretroviral therapy. The change in antiretroviral therapy (adjusted OR 3.4, 95% CI (2.0-5.8)) remains the most important prognostic factor for virological failure. Conclusion: the change in antirretroviral therapy, defined in this study as the main exposure variable, represents the main risk factor for virological failure, even when was adjusted for other variables..Au

An interferon gamma release assay specific for Histoplasma capsulatum to detect asymptomatic infected individuals: A proof of concept study.

Histoplasmosis is the most common endemic mycosis in the Americas. Currently, there is no laboratory test capable to detect subclinical or latent infections by Histoplasma capsulatum (Hc), which might develop as severe infections in immunocompromised individuals. For the first time to our knowledge, we explore the suitability of an interferon gamma release assay (IGRA) to detect latent Hc infection in asymptomatic individuals. A cohort of 126 volunteers was enrolled in the study, 13 of which underwent a Hc infection in the past, and 93 of them showing risk factors for this infection. The remaining 20 participants did not refer any risk factors of Hc infection, but eight of them showed evidences of infection with Mycobacterium tuberculosis. All participants were recruited in Medellin, Colombia, between January 2014 and December 2017. Whole blood samples were cultured with four different Hc crude antigens and phytohemaglutinin as positive control. The interferon (IFN)-γ released by T lymphocytes upon antigen stimulation was quantified by ELISA. A defined cutoff value of 20 pg/ml for the IFN-γ concentration allowed us to distinguish between the group with documented past infections and the group of noninfected individuals with high sensitivity (70-92%) and specificity (85-95%), for the four tested antigens. Positive 82-95% and negative 77-92% predictive values were also very high, comparable to those reported for commercially available IGRAs. The new test constitutes a promising screening method to detect individuals with latent Hc infection, even decades after the primary infection, as evidenced in this study.

Evaluación de operaciones lógico-matemáticas mediante dos métodos distintos en niños del pueblo indígena Shipibo-Konibo / Assessment of mathematical operations by two different methods in Shipibo-Konibo indigenous children

Se presentan los resultados de una evaluación de las operaciones matemáticas de adición y sustracción, en un grupo de niños de enseñanza primaria (5 niñas y 2 niños) de 7, 9 y 11 años, de una comunidad nativa Shipibo-Konibo de la región Ucayali, en la Amazonía del Perú. Se realizó con dos métodos distintos, la Entrevista Clínico-crítica de Piaget, que incluyó problemas culturalmente contextualizados y material representativo y manipulable como figuras de animales y bolitas para armar collares, y una prueba tradicional de lápiz y papel. Ambas pruebas evaluaron el mismo tipo de operaciones, extraídas de lo que propone el diseño curricular nacional para esos grados. Los resultados muestran que los niños tienen dificultades tanto en la adición como en la sustracción y no logran resolver con éxito todas las tareas. Sin embargo, se pueden observar mejores resultados con la evaluación cualitativa por medio de la entrevista clínico-crítica, en contraste con la evaluación tradicional de lápiz y papel que evidencia resultados mucho más pobres. La primera otorga además mayor información sobre el proceso operativo de los niños y muestra que los niveles de desarrollo de sus competencias matemáticas van de la mano con lo que plantea la teoría piagetiana. Los resultados se discuten señalando la universalidad del conocimiento lógico-matemático y su pertinencia para comprender los procesos de aprendizaje en contextos de diversidad cultural y analizando críticamente el modo en que la evaluación constructivista ofrece mayor información y recursos para los docentes de educación intercultural bilingüe de comunidades amazónicas del Perú.

Elementary-school children from a Shipibo-Konibo indigenous community in the Ucayali region, in the Amazonian rainforest of Perú, were evaluated regarding their abilities to solve addition and subtraction problems. These operations were assessed by two means: through Jean Piaget's clinical-critical method (using culturally contextualized problems and concrete materials such as pictures of Amazonian fish, pictures of arrows, or beads and thread to make necklaces), and by a traditional pencil-and-paper test. Both the clinical interview and the pencil-and-paper test evaluated the same type of operations, which were taken from the national curricular program for these school grades. The Shipibo-Konibo people are an Amazonian indigenous group that speaks a native language in the Panoan family; since most members of this group are fluent in Spanish, however, no translator was needed and the assessments were conducted in Spanish. The Shipibo-Konibo people are principally settled along the Ucayali River in the Amazon rainforest in Perú, although currently many of them have relocated to other areas of the country, including Lima the capital city, in search of better work or education opportunities. After the Asháninka and the Awajún, the Shipibo-Konibo is the third largest Amazonian indigenous group in Perú. Informed consent was obtained following the guidelines of Frisancho, Delgado, and Lam (2015), which are based on previous experience working with Amazonian indigenous communities in the Ucayali region of Peru. As research has shown that individuals from cultural diverse backgrounds may have different expectations for the research process, and may perceive it in a different way than people from industrialized nations (Lakes, Vaughan, Jones, Burke, Baker, & Swanson 2012), informed consent included both individual consent and a communitarian meeting. It also included the donation of gifts (tools, groceries, and other useful items) for the community, and a debriefing meeting with the community's school teachers. The assessment was conducted by two researchers in a school classroom. It took around 30 minutes with the older children and 45 with the younger ones. In all cases the clinical-critical interview was applied first (addition and then subtraction), and finally the pencil-and-paper test. Although a native speaker of shipibo was present during the evaluation, his services were not needed as children were fluent in Spanish. Results show that children have difficulties in the development of both addition and subtraction. They make counting mistakes and have trouble understanding the logic of subtraction (taking a number from another, larger one). Some do not conceptualize subtraction as the opposite of addition and, in consequence, cannot foresee that joining two numbers that were previously separated will result in the same original quantity. Children aged seven were unable to solve any of the operations in the pencil-and-paper test. However, better results were obtained through qualitative, Piagetian assessments, in contrast to the quantitative, pencil-and-paper assessments. During the interviews, children were able to show their cognitive processes and ways of thinking while solving the problems, and with scaffolding, the use of concrete materials such as pictures or beads, and strategic help from the evaluators (Parrat, 2016a, 2016b), many of them were also able to develop a better comprehension of the problem and self-correct their initial answers. Developmental levels for addition and subtraction consistent with Piagetian theory were identified. These levels show a progression from the impossibility of grasping logical addition or subtraction, to the capabilities of psychological reversibility and logical composition of inverse and direct operations. The results are discussed using Piaget's theory and the problem of particulars and universals in cognitive development, and analyzing critically how this kind of assessment can help elementary school teachers respond to the needs of intercultural bilingual education in Peru's Amazonian indigenous communities.

Frecuencia de los transcriptos p190BCR-ABL y p210BCR-ABL en una población colombiana con leucemia mieloide crónica (LMC) usando RT-PCR cualitativa / Detection of p190BCR-ABL AND p210BCR-ABL fusion transcripts in patients with chronic myeloid leukemia (CML) using qualitative RT-PCR / Frequência dos transcritos p190BCR-ABL e p210BCR- ABL numa população colombiana com leucemia mielóide crônica (LMC) usando RT-PCR qualitativa

Introducción: la leucemia mieloide crónica (LMC) se caracteriza por la presencia del cromosoma Filadelfia (Ph) que resulta de la translocación recíproca balanceada t(9;22)(q34;q11); este marcador cromosómico se encuentra con menor frecuencia en pacientes con leucemia linfoide aguda (LLA). Objetivo: determinar la frecuencia de las fusiones génicas BCR-ABL, que codifican para los transcriptos p210BCR-ABL y p190 BCR-ABL en pacientes colombianos con diagnóstico de LMC, en diferentes fases de la enfermedad o de su tratamiento. Materiales y métodos: estudio descriptivo de corte transversal de 31 pacientes con LMC (15-78 años). El análisis se hizo a partir de muestras de sangre periférica con la técnica PCR anidada cualitativa para las isoformas P210 BCR-ABL (b3a2 e b2a2) y P190 BCR-ABL (e1a2). Resultados: se detectó el transcripto p210BCR-ABL en 29 de los 31 casos (93,6%). En ellos se identificaron las fusiones génicas b2a2 (16/29; 55,2%), b3a2 (10/29; 34,5%) y la coexpresión b3a2 y b2a2 (3/29; 10,3%). Conclusión: la fusión génica b2a2 fue la más frecuente en esta población con LMC.

Introduction: Chronic myelogenous leukemia (CML) is characterized by the presence of the Philadelphia chromosome (Ph), resulting from the balanced reciprocal translocation t(9;22)(q34;q11). This marker chromosome is found less frequently in patients suffering from acute lymphoblastic leukemia. Objective: To determine the frequency of BCR-ABL gene fusions encoding the p210BCR-ABL y p190 BCR-ABL transcripts in Colombian patients diagnosed with CML in different stages of the disease and/or its treatment. Materials and methods: Cross sectional, descriptive study of thirty one CML patients (aged 15-78). Analysis was carried out through qualitative nested PCR for the isoforms P210 BCR-ABL (b3a2 e b2a2) and P190 BCR-ABL (e1a2), and based on peripheral blood samples. Results: In 29 of the 31 patients (93.6%) transcript p210BCR-ABL was detected; b2a2 and b3a2 gene fusions and the coexpression b3a2 y b2a2 were identified in 55.2% (16/29), 34.5% (10/29) and 10.3% (3/29) of the cases, respectively. Conclusion: b2a2 gene fusion was the most frequent in this CML population.

Introdução: a leucemia mielóide crônica (LMC) caracteriza- se pela presença do cromossomo Filadélfia (Ph) que resulta da translocação recíproca balanceada t(9;22)(q34;q11); este marcador cromossômico se encontra com menor frequência em pacientes com leucemia linfoide aguda (LLA). Objetivo: determinar a frequência das fusões genéticas BCR-ABL, que codificam para os transcritos p210BCR-ABL e p190 BCR-ABL em pacientes colombianos com diagnóstico de LMC, em diferentes fases da doença ou de seu tratamento. Materiais e métodos: estudo descritivo de corte transversal de 31 pacientes com LMC (15-78 anos). A análise se fez a partir de mostras de sangue periférico com a técnica PCR aninhada qualitativa para as isoformas P210 BCR-ABL (b3a2 e b2a2) e P190 BCR-ABL (e1a2). Resultados: detectou-se o transcrito p210BCR-ABL em 29 dos 31 casos (93,6%). Neles se identificaram as fusões genéticas b2a2 (16/29; 55,2%), b3a2 (10/29; 34,5%) e a co-expressão b3a2 e b2a2 (3/29; 10,3%). Conclusão: a fusão genética b2a2 foi a mais frequente nesta população com LMC.

Evaluación de tres técnicas coproparasitoscópicas para el diagnóstico de geohelmintos intestinales / Evaluation of three coproparasitoscopic techniques for the diagnosis of intestinal geohelminthiases

Introducción: las geohelmintiasis son un problema de salud pública; sin embargo, para su diagnóstico no se ha establecido una técnica de referencia (estándar de oro) sino que se han empleado diferentes pruebas coproparasitoscópicas con distintas tasas de sensibilidad. Objetivo: determinar la sensibilidad de la técnica coproparasitoscópica de Kato-Katz frente a la combinación del examen directo y la concentración de Ritchie para detectar geohelmintos y establecer el grado de infección. Metodología: se comparó la técnica de Kato-Katz con la combinación del coprológico directo y por concentración de Ritchie, estas dos últimas tomadas como estándar de oro, en 90 muestras de materia fecal provenientes de niños del barrio La Cruz, localizado en el Nororiente de Medellín. Resultados: la sensibilidad de la técnica de Kato-Katz para el diagnóstico de infecciones por geohelmintos fue similar a la obtenida con la combinación del coprológico directo y por concentración. Conclusión: la técnica de Kato-Katz da resultados confiables con alta sensibilidad para el diagnóstico de las geohelmintiasis intestinales más frecuentes en Colombia.

Introduction: Soil transmitted helminths (geohelminthiases) are a worldwide public health problem. However, no reference technique (gold standard) for their diagnosis has been established; contrariwise, several coproparasitoscopic tests, with variable sensibility rates, have been used. Objective: To compare the sensibility of the coproparasitoscopic Kato-Katz technique with that of the combination of direct coprologic examination and Ritchie's concentration, for the detection of geohelminths, and to determine the degree of infection. Methodology: The comparison was made in 90 stool specimens obtained from school children living in a low-income community in Medellín, Colombia. Results: Sensibility of the Kato-Katz technique was similar to the one obtained with the combination of direct microscopic examination and coprology by concentration. Conclusion: The Kato-Katz technique provides reliable results with high sensibility rate for the diagnosis of the intestinal geohelminths more frequent in Colombia.

Prevalencia de parásitos intestinales en niños que asisten al Templo Comedor Sagrado Corazón Teresa Benedicta de la Cruz, del barrio Vallejuelos, Medellín, 2007 / Intestinal parasites prevalence in children from "Templo-Comedor Sagrado Corazón Teresa Benedicta de la Cruz",Vallejuelos-Medellín, 2007.

Introducción: los seres humanos estamos expuestos a los parásitos presentes en el medio en quehabitamos, lo que puede plantear un problema de salud pública, especialmente en los países en vías de desarrollo como Colombia. La población más vulnerable es la infantil, especialmente la de comunidades en condiciones socioeconómicas precarias.Objetivo: determinar la prevalencia de parásitos intestinales en los niños que acuden a un templocomedor en un barrio marginal de Medellín.Métodos: en octubre y noviembre de 2007 se hizo un estudio descriptivo transversal, mediante un coprológico directo y por concentración, en 58 de los 150 niños que acuden al templo-comedor; lo anterior se complementó con una encuesta sobre algunas variables sociodemográficas.Resultados: se halló que 54 de los 58 niños (93%) estaban parasitados y que en 48 de ellos (88,9%) losparásitos eran potencialmente patógenos; entre estos predominó Entamoeba histolytica/dispar(46,6%), seguida por Giardia intestinalis (25,9%), Trichuris trichiura (25,9%), Ascaris lumbricoides (24,1%) y Enterobius vermicularis (8,6%). Se halló multiparasitismo en 21 niños (38,8%). En cuanto a la relación entre algunas variables sociodemográficas y la frecuencia de parásitos solo se halló que el hacinamiento en la vivienda se asociaba significativamente con la presencia de Entamoeba histolytica/dispar y de Blastocystis hominis, y la tenencia de mascotas, con la infección por Enterobiusvermicularis.Conclusión: la prevalencia de parasitosis intestinales hallada en este trabajo superó la de otros grupos tanto colombianos como extranjeros. Se discuten las implicaciones de este hallazgo desde el punto de vista de la salud pública.

Introduction: Human beings are exposed to the parasites present in their habitat. This situation poses a public health problem, especially in underdeveloped countries such as Colombia. The pediatric population is the most vulnerable, particularly that of communities in poor socioeconomic conditions.Objective: To determine the prevalence of intestinal parasites in children attending a social aid institution in a poor neighborhood of Medellín, Colombia.Methods: In October and November 2007 a descriptive cross-sectional study was carried out by means of direct and concentration stool examination in 58 out of 150children attending the aforementioned institution. In addition, a survey was made of some socio-demographicvariables.Results: 54 of the 58 children (93%) were infected by intestinal parasites. In 48 of them (88.9%) potentiallypathogen parasites were present, namely: Entamoeba histolytica/dispar (46.6%), Giardia intestinalis (25.9%), Trichuris trichiura (25.9%), Ascaris lumbricoides (24.1%), and Enterobius vermicularis (8.6%). Twenty one children (38.8%) were infected with either 2 or 3 parasites. The only significant associations between socio demographic variables and parasitic infections were as follows:overcrowding was associated with Entamoeba histolytica/dispar and Blastocystis hominis, and thepresence of pets (mostly dogs) in the house was associated with Enterobius vermicularis.Conclusion: Prevalence rate of intestinal parasites was higher in the studied group than in other communities, both Colombian and from other countries. Implicationsof this finding from the public health perspective are discussed.

Giardia intestinalis and nutritional status in children participating in the complementary nutrition program, Antioquia, Colombia, May to October 2006.

Giardia intestinalis infection is prevalent throughout the world and widely distributed in developing countries. In general, children display serious consequences to their state of health, including slow height-weight development; therefore, the main aim of this study was to determine the association between Giardia infection and the nutritional status of children who participate in the program of complementary feeding (Mejoramiento Alimentario y Nutricional de Antioquia (MANA) - Instituto Colombiano de Bienestar Familiar (ICBF)). A cross-sectional study examining the association of giardiasis with nutritional status was conducted. A total of 2035 children aged eight months to six years-old were studied. Data were collected using structured questionnaires, anthropometric measurements and laboratory analysis of blood and stool samples. Analysis of the results showed that 27.6% of children were infected with G. intestinalis, while 8.1% and 1.9% were mildly and significantly underweight, respectively, and 14.1% presented stunting. Giardiasis was statistically identified as a strong predictor of stunting in this study population.

Giardia intestinalis and nutritional status in children participating in the complementary nutrition program, Antioquia, Colombia, May to October 2006 / Giardia intestinalis e estado nutricional em crianças participantes do programa de nutrição complementar, melhoramento alimentar e nutricional da Antioquia (MANA): Instituto Colombiano de Bem-Estar Familiar (ICBF), Antióquia, Colombia, maio a outubro de 2006

Giardia intestinalis infection is prevalent throughout the world and widely distributed in developing countries. In general, children display serious consequences to their state of health, including slow height-weight development; therefore, the main aim of this study was to determine the association between Giardia infection and the nutritional status of children who participate in the program of complementary feeding (Mejoramiento Alimentario y Nutricional de Antioquia (MANA) - Instituto Colombiano de Bienestar Familiar (ICBF)). A cross-sectional study examining the association of giardiasis with nutritional status was conducted. A total of 2035 children aged eight months to six years-old were studied. Data were collected using structured questionnaires, anthropometric measurements and laboratory analysis of blood and stool samples. Analysis of the results showed that 27.6% of children were infected with G. intestinalis, while 8.1% and 1.9% were mildly and significantly underweight, respectively, and 14.1% presented stunting. Giardiasis was statistically identified as a strong predictor of stunting in this study population.

A infecção pela Giardia intestinalis está amplamente distribuída no mundo apresentando a maior prevalência nos países em desenvolvimento. Em crianças, esta parasitose pode ter conseqüências graves no estado geral de saúde assim como no ganho de peso e estatura. O objetivo desta pesquisa foi estabelecer a associação entre a infecção com Giardia e o estado nutricional das crianças beneficiárias do programa de complementação alimentar - MANA. Um estudo de corte no qual foram avaliadas 2035 crianças entre os oito meses e os seis anos de idade foi realizado. A informação foi obtida a partir de questionários estruturados, medições antropométricas e exame de fezes. Os resultados mostraram que 27,6% das crianças estavam infectadas com Giardia intestinalis, das quais 8,1% apresentaram desnutrição moderada, 1,9% desnutrição grave e 14,1% franca queda no crescimento. Em conclusão, nesta população a Giardíase foi indicador de desnutrição grave.

Situación socioeconómica, desnutrición, anemia, deficiencia de hierro y parasitismo en niños que pertenecen al programa de complementación alimentaria alianza MANA-ICBF. Antioquia 2006 / Socio-economic situation, malnutrition, anemia, storage iron deficiency,and parasitic disease in children who participate in a nutritional complement program: MANA-ICBF. Antioquia 2006

Objetivo general: analizar las prevalencias de desnutrición, anemia, deficiencia de hierro y parasitismo en los niños que participan en el programa de complementación alimentaria Alianza-MANA ICBF. Metodología: estudio transversal. Muestra: representativa y aleatoria de los niños que participan en el Programa de Complementación Alimentaria de Antioquia, con una confianza del 95 porciento y un error del 5 porciento, constituida por 2.759 niños. Métodos: estado nutricional con las referencias NCHS desnutrición < -2 124 puntaje Z, hemoglobina en HemoCue por el método Azida-Metahemoglobina, ferritina plasmática por quimioluminiscencia natural, parasitismo por coprológico directo y por concentración. Resultados: el 14,0 porciento (IC; 95 porciento:12,7-15,3) de los niños tenían retraso del crecimiento, el 8,0 porciento (IC; 95 porciento:7,1-9,1) déficit de peso y el 1,9 porciento (IC;95 porciento:1,4-2,4) emaciación. El 6,4 porciento (IC; 95 porciento:5,5-7,3) estaban anémicos y el 16,3 porciento (IC; 95 porciento:14,9-17,2) tenían déficit de hierro. El 70,7 porciento (IC; 95 porciento:68,7-72,7) de los niños estaban parasitados y entre ellos el 33,5 porciento (IC; 95 porciento:31,4-35,6) con parásitos potencialmente patógenos y el 27,8 porciento(IC; 95 porciento: 25,9-29,7 porciento) con multiparasitismos. Conclusiones: en el contexto colombiano, los niños del programa no presentan un estado nutricional por antropometría muy deteriorado. La prevalencia de anemia es baja, más no así el déficit de hierro. Dadas las precarias condiciones sanitarias las prevalencias de parasitismo son altas.