Estrategia educativa intercultural para la prevención del cáncer de cuello cérvico uterino en el resguardo de Paujil, Amazonia Colombiana / Intercultural educational strategy for the prevention of cervical cancer in Paujil Resguardo Amazonía colombiana

RESUMEN Los pueblos indígenas siguen sufriendo inequidades, a pesar de los avances relacionados con la protección de la diversidad étnica y cultural, siendo las mujeres uno de los grupos de mayor riesgo, sobre todo, en lo referente a la salud sexual y reproductiva, situación contemplada como un compromiso de acción en los objetivos de desarrollo sostenible. En ese contexto, esta investigación acción participativa buscó construir una estrategia educativa intercultural, sostenible y segura culturalmente que, a propósito de la prevención del cáncer de cuello uterino, aportará al empoderamiento y la conservación de la salud de las mujeres habitantes del resguardo de Paujil -Colombia. La iniciativa surgió de mujeres indígenas preocupadas por mejorar la salud de sus congéneres y un grupo de investigadores. La construcción de una estrategia educativa intercultural representa un reto, pues la pedagogía occidental no necesariamente corresponde a las concepciones de enseñanza aprendizaje de las indígenas del resguardo. Hay dificultades lingüísticas, pues cada etnia tiene su propia lengua. Las indígenas lideresas se convirtieron en las facilitadoras del proceso que se centró más en el uso de la oralidad y encuentros entre mujeres, que se conocen entre sí. Las mujeres prefieren estrategias didácticas basadas en compartir experiencias y el uso de cartillas y videos. El trabajo permitió concluir que cualquier estrategia educativa intercultural que se proponga debe ser específica y acorde a las necesidades de las comunidades.

ABSTRACT Despite the advances related to the protection of ethnic and cultural diversity, indigenous people continue to suffer inequities, with women being one of the groups most at risk, especially concerning sexual and reproductive health, a situation considered as a problem, a commitment to action in the sustainable development goals. In this context, this Participatory action research searched to build an intercultural educational strategy, sustainable and culturally safe, which, concerning the prevention of cervical cancer, would contribute to the empowerment and conservation of the health of the women who live in the Paujil reservation-Colombia. The initiative arose from indigenous women concerned about improving the health of their peers, and a group of researchers. The construction of an intercultural educational strategy represents a challenge since western pedagogy does not necessarily correspond to the teaching-learning conceptions of the indigenous people of the reservation. There are linguistic difficulties because each ethnic group has its language. The indigenous leaders became the facilitators of the process that focused more on the use of orality and meetings between women who know each other. Women prefer a didactic strategy based on sharing experiences, and the use of primers, and videos. The work allowed to conclude that any proposed of intercultural educational strategy must be specific and according to the needs of the communities.

Mortalidad por cáncer de cuello uterino en la amazonia de Colombia / Cervical cancer mortality in the Colombian Amazon

Resumen OBJETIVO: Analizar el pico de mortalidad por cáncer de cuello uterino registrado en 2018 en Guainía, Colombia. MATERIALES Y MÉTODOS: Estudio ecológico basado en los datos de todas las instituciones con información de la morbilidad y mortalidad y atenciones relacionadas con el cáncer de cuello uterino en Colombia, entre enero de 2009 y diciembre de 2019. Se incluyeron todos los datos disponibles para Guainía. Se excluyeron las bases sin datos entre 2016 y 2018. Se analizaron la morbilidad y mortalidad, atenciones y procedimientos, y se compararon con el comportamiento en 2018 respecto de los demás años. RESULTADOS: Las personas atendidas, las atenciones y los procedimientos relacionados con cáncer de cuello uterino disminuyeron en 2016 y 2017. La concentración de atenciones por persona más baja del periodo se dio en 2017. En 2019, aumentó la cantidad de personas con diagnóstico de infección por papilomavirus. CONCLUSIONES: La reducción en el tamiz, las atenciones y los procedimientos relacionados con el cáncer de cuello uterino, en un territorio, puede ocasionar aumentos en la mortalidad por este tipo de cáncer. Es fundamental sostener en el tiempo las acciones de prevención, diagnóstico y tratamiento, para evitar esta mortalidad.

Abstract OBJECTIVE: To analyze the cervical cancer mortality peak, in Guainía, in 2018. MATERIALS AND METHODS: Ecological study. Data from all institutions with cervical cancer morbidity, mortality and attention information in Colombia, between January/2009 and December/2019, were analyzed. All available data for Guainía were included. The databases with no data between 2016 and 2018 were excluded. Morbidity, mortality, attention, and procedures were analyzed, comparing the behavior in 2018 to the other years. RESULTS: Cervical cancer-related patients, care and procedures decreased in 2016 and 2017. The lowest concentration of care per person in the period was in 2017. In 2019, the number of people diagnosed with papillomavirus infection increased. CONCLUSIONS: The reduction in screenings, care and procedures related to cervical cancer, in a territory, can lead to increases in mortality from this type of cancer. It is essential to sustain prevention, diagnosis, and treatment actions over time to avoid this mortality.

Consumption of Alcohol, Tobacco and Psychoactive Substances in Adolescents from an Indigenous Territory in the Colombian Amazon. / Consumo de alcohol, tabaco y sustancias psicoactivas de los adolescentes de un territorio indígena en la Amazonía colombiana.

INTRODUCTION: There are very few studies on the consumption of psychoactive substances (PAS) among young people from indigenous territories and evening or blended learning students. In Inírida, a municipality in the Colombian Amazon, there were concerns about a possible consumption issue that had never been characterised before. OBJECTIVE: To characterise the consumption of alcohol, tobacco and PAS in Inírida among teenage evening and blended learning students. METHODS: The Inter-American Uniform Drug Use Data System (SIDUC) survey developed by the Inter-American Drug Abuse Control Commission (CICAD) was adapted to the cultural context and carried out on 95% of 284 evening and blended learning students (262). Descriptive statistics and multiple correspondence analyses were used. RESULTS: Currently, 59% consume alcohol; 28% tobacco; 21% marijuana; 3% cocaine paste; 1% ecstasy (MDMA); 1% cocaine; and 1% inhalants. Also, 61% believe that drugs are available inside and around the vicinity of their school, and that marijuana (62%) and cocaine paste (35%) are easily acquired. Drugs are most commonly offered in neighbourhoods (56%) and at parties (30%). Those offering the highest quantity of drugs are acquaintances (35%) and friends (29%). And 51% stated that they had participated in preventive activities related to consumption. CONCLUSIONS: The population has a higher consumption of the substances studied in comparison with the national reference, that of Orinoquía and Amazonía, with the exception of cocaine and inhalants. The consumption situation was confirmed, so participatory actions are proposed.

Consumo de alcohol, tabaco y sustancias psicoactivas de los adolescentes de un territorio indígena en la Amazonía colombiana,

Introducción: Existen muy pocos estudios sobre el consumo de sustancias psicoactivas (SPA) en jóvenes de territorios indígenas y en estudiantes semipresenciales o nocturnos. En Inírida, municipio de la Amazonía colombiana, preocupaba un posible problema de consumo nunca caracterizado. Objetivo: Caracterizar el consumo de alcohol, tabaco y SPA en adolescentes de Inírida esco larizados en jornada nocturna y semipresencial. Métodos: Encuesta CICAD/SIDUC, ajustada al contexto cultural, al 95% de los 284 estudiantes de la jornada elegida (n = 262). Se utilizó estadística descriptiva y análisis de corresponden cias múltiples. Resultados: Actualmente consume alcohol el 59%; cigarrillo, el 28%; marihuana, el 21%; basuco, el 3%; éxtasis, el 1%; cocaína, el 1%, e inhalables, el 1%. El 61% considera que en el colegio y alrededores hay disponibilidad de drogas y es fácil conseguir marihuana (62%) y basuco (35%). Se ofrecen drogas con mayor frecuencia en el barrio (56%) y las fiestas (30%). Las personas que más les ofrecen drogas son conocidos (35%) y amigos (29%). El 51% manifiesta haber recibido actividades de prevención del consumo. Conclusiones: La población presenta mayor consumo de las sustancias estudiadas que el refe rente nacional y de la Orinoquía y Amazonía, excepto en cocaína e inhalables. Se corrobora la situación de consumo y se proponen acciones participativas.

Introduction: There are very few studies on the consumption of psychoactive substances (PAS) among young people from indigenous territories and evening or blended learning students. In Inírida, a municipality in the Colombian Amazon, there were concerns about a possible consumption issue that had never been characterised before. Objective: To characterise the consumption of alcohol, tobacco and PAS in Inírida among teenage evening and blended learning students. Methods: The Inter-American Uniform Drug Use Data System (SIDUC) survey developed by the Inter-American Drug Abuse Control Commission (CICAD) was adapted to the cul tural context and carried out on 95% of 284 evening and blended learning students (262). Descriptive statistics and multiple correspondence analyses were used. Results: Currently, 59% consume alcohol; 28% tobacco; 21% marijuana; 3% cocaine paste; 1% ecstasy (MDMA); 1% cocaine; and 1% inhalants. Also, 61% believe that drugs are available inside and around the vicinity of their school, and that marijuana (62%) and cocaine paste (35%) are easily acquired. Drugs are most commonly offered in neighbourhoods (56%) and at parties (30%). Those offering the highest quantity of drugs are acquaintances (35%) and friends (29%). And 51% stated that they had participated in preventive activities related to consumption. Conclusions: The population has a higher consumption of the substances studied in com parison with the national reference, that of Orinoquía and Amazonía, with the exception of cocaine and inhalants. The consumption situation was confirmed, so participatory actions are proposed.

Medical labour under neoliberalism: an ethnographic study in Colombia.

OBJECTIVES: In order to increase the knowledge about the impacts of neoliberal market forces on physician's labour, this article's objectives are to analyse how and why the labour of physicians is transformed by neoliberalism, and the implications of these transformations for patient care. METHODS: Ethnographic investigation is carried out through semi-structured interviews with 20 general practitioners at public and private facilities in Colombia. The interviews were contrasted with national studies of physician's labour since the 1960s. A "mock" job search was also simulated. The analysis was guided by Marxian frameworks. The study was approved by a Human Research Ethics Committee, and informed consent was obtained from all participants. RESULTS: The overpowering for-profit administration of the Colombian healthcare system imposes productivity mechanisms on physicians as a result of a deregulated labour market characterized by low salaries, reduced and self-funded social security benefits, and job insecurity. Overworked physicians with reduced autonomy become frustrated for not being able to provide the care their patients need according to clinical standards. CONCLUSIONS: Under neoliberal conditions, medical labour becomes exploitable and directly productive through its formal and real subsumption to Capital. The negative consequences of a progressive loss in physician's autonomy unveil the incompatibility between neoliberal health systems and people's health.

Condiciones en la frontera sur entre Colombia y Venezuela ante la pandemia de COVID-19 / Underlying conditions on the southern border between Colombia and Venezuela to face the COVID-19 pandemic

RESUMEN Objetivos Dimensionar la migración humana en la frontera sur entre Colombia y Venezuela (Departamento de Guainía), y caracterizar las condiciones sociales, de acceso y de atención en salud frente a la pandemia de COVID-19. Métodos Estudio mixto, epidemiológico y etnográfico. Se calcularon: tasa de migrantes venezolanos (según Migración Colombia al 31 de diciembre de 2019), acceso efectivo a atención médica y dotación en puestos de salud (según datos recolectados entre junio de 2017 y julio de 2019, en todos los puestos de salud de Guainía, mediante entrevistas semiestructuradas, observación participante y el uso de Google Earth™ y Wikiloc™). Los tiempos medianos se calcularon y graficaron en Stata™. Se describieron dinámicas culturales y de atención en salud a partir del trabajo de campo y de una permanente revisión documental. Resultados Guainía ocupa el puesto 23 en número total de venezolanos, pero es el cuarto departamento en densidad de venezolanos (14,4%). En ausencia del centro de salud de San José, en el río Guainía los tiempos medianos hasta la institución de referencia real son de 8,7 horas en invierno y 12,3 en verano y los casos complejos requieren remisión aérea. En el río Inírida, sin el centro de Chorro Bocón, los tiempos reales son de 11,9 horas en invierno y 16,1 en verano. Solo el 57% de los puestos de salud tenía insumos para manejar infección respiratoria aguda. Conclusiones Ante la llegada de COVID-19 a territorios sur-fronterizos, es necesario fortalecer inmediatamente servicios médicos y de salud pública para evitar elevadas tasas de letalidad.(AU)

ABSTRACT Objectives To size human migration on the southern border between Colombia and Venezuela (Guainía department), and characterize the social, access and health care conditions relevant to the COVID-19 pandemic. Methods Mixed epidemiological and ethnographic study. Rate of Venezuelan migrants was calculated according to Migration Colombia data until December 31st, 2019, also effective access to medical care, and provision of health posts were calculated, with information from each Guainía health post collected from June 2017 to June 2019, through semi-structured interviews, participant observations, Google Earth™ and Wikiloc™. Stata™ was used to calculate and graph median times of effective access. Cultural dynamics and health care conditions were described by the field work information and a permanent documentary review. Results Guainía is the 23rd department, according to the total number of Venezuelans, but the fourth in Venezuelans density (14,4%). In the Guainía river, the median times to the real reference health institution were 8,7 hours in winter and 12,3 in summer, and complex cases require air referrals. In the Inírida river, the median times to the real reference health institution were 11,9 hours in winter and 16,1 in summer. Only 57% of the health posts had supplies for acute respiratory infections. Conclusions Facing COVID-19 in south border territories, it is necessary to immediately strengthen medical and public health services to avoid high fatality rates.(AU)

Condiciones en la frontera sur entre Colombia y Venezuela ante la pandemia de COVID-19 / Underlying conditions on the southern border between Colombia and Venezuela to face the COVID-19 pandemic

RESUMEN Objetivos Dimensionar la migración humana en la frontera sur entre Colombia y Venezuela (Departamento de Guainía), y caracterizar las condiciones sociales, de acceso y de atención en salud frente a la pandemia de COVID-19. Métodos Estudio mixto, epidemiológico y etnográfico. Se calcularon: tasa de migrantes venezolanos (según Migración Colombia al 31 de diciembre de 2019), acceso efectivo a atención médica y dotación en puestos de salud (según datos recolectados entre junio de 2017 y julio de 2019, en todos los puestos de salud de Guainía, mediante entrevistas semiestructuradas, observación participante y el uso de Google Earth™ y Wikiloc™). Los tiempos medianos se calcularon y graficaron en Stata™. Se describieron dinámicas culturales y de atención en salud a partir del trabajo de campo y de una permanente revisión documental. Resultados Guainía ocupa el puesto 23 en número total de venezolanos, pero es el cuarto departamento en densidad de venezolanos (14,4%). En ausencia del centro de salud de San José, en el río Guainía los tiempos medianos hasta la institución de referencia real son de 8,7 horas en invierno y 12,3 en verano y los casos complejos requieren remisión aérea. En el río Inírida, sin el centro de Chorro Bocón, los tiempos reales son de 11,9 horas en invierno y 16,1 en verano. Solo el 57% de los puestos de salud tenía insumos para manejar infección respiratoria aguda. Conclusiones Ante la llegada de COVID-19 a territorios sur-fronterizos, es necesario fortalecer inmediatamente servicios médicos y de salud pública para evitar elevadas tasas de letalidad.(AU)

ABSTRACT Objectives To size human migration on the southern border between Colombia and Venezuela (Guainía department), and characterize the social, access and health care conditions relevant to the COVID-19 pandemic. Methods Mixed epidemiological and ethnographic study. Rate of Venezuelan migrants was calculated according to Migration Colombia data until December 31st, 2019, also effective access to medical care, and provision of health posts were calculated, with information from each Guainía health post collected from June 2017 to June 2019, through semi-structured interviews, participant observations, Google Earth™ and Wikiloc™. Stata™ was used to calculate and graph median times of effective access. Cultural dynamics and health care conditions were described by the field work information and a permanent documentary review. Results Guainía is the 23rd department, according to the total number of Venezuelans, but the fourth in Venezuelans density (14,4%). In the Guainía river, the median times to the real reference health institution were 8,7 hours in winter and 12,3 in summer, and complex cases require air referrals. In the Inírida river, the median times to the real reference health institution were 11,9 hours in winter and 16,1 in summer. Only 57% of the health posts had supplies for acute respiratory infections. Conclusions Facing COVID-19 in south border territories, it is necessary to immediately strengthen medical and public health services to avoid high fatality rates.(AU)

[Underlying conditions on the southern border between Colombia and Venezuela to face the COVID-19 pandemic]. / Condiciones en la frontera sur entre Colombia y Venezuela ante la pandemia de COVID-19.

OBJECTIVES: To size human migration on the southern border between Colombia and Venezuela (Guainía department), and characterize the social, access and health care conditions relevant to the COVID-19 pandemic. METHODS: Mixed epidemiological and ethnographic study. Rate of Venezuelan migrants was calculated according to Migration Colombia data until December 31st, 2019, also effective access to medical care, and provision of health posts were calculated, with information from each Guainía health post collected from June 2017 to June 2019, through semi-structured interviews, participant observations, Google Earth™ and Wikiloc™. Stata™ was used to calculate and graph median times of effective access. Cultural dynamics and health care conditions were described by the field work information and a permanent documentary review. RESULTS: Guainía is the 23rd department, according to the total number of Venezuelans, but the fourth in Venezuelans density (14,4%). In the Guainía river, the median times to the real reference health institution were 8,7 hours in winter and 12,3 in summer, and complex cases require air referrals. In the Inírida river, the median times to the real reference health institution were 11,9 hours in winter and 16,1 in summer. Only 57% of the health posts had supplies for acute respiratory infections. CONCLUSIONS: Facing COVID-19 in south border territories, it is necessary to immediately strengthen medical and public health services to avoid high fatality rates.

Mielinolisis extrapontina en una paciente embarazada, con hiperémesis e hiponatremia. Reporte de un caso / Extrapontine myelinolysis in a pregnant with hyperemesis and hyponatremia. A case report

Resumen: ANTECEDENTES: La mielinolisis extrapontina forma parte del síndrome de desmielinización osmótica que lesiona los oligodendrocitos y ocasiona la pérdida de mielina en regiones del sistema nervioso central diferentes al puente del tronco encefálico. Se origina por la corrección rápida de sodio en pacientes con hiponatremia y en mujeres embarazadas se asocia con hiperémesis gravídica. CASO CLÍNICO: Paciente indígena, de 32 años, enviada a un hospital universitario de alta complejidad en Bogotá, desde un territorio de la Amazonia colombiana, en el marco de un nuevo modelo de salud, con embarazo de 15 semanas, quien tuvo un episodio convulsivo, afasia y automatismo bucal, con antecedente de hiperémesis gravídica y otro episodio de hiperémesis con hiponatremia un mes antes. Inicialmente se sospechó eclampsia y neuroinfección; se implementó tratamiento para la corrección rápida del sodio y prescripción de anticonvulsivos. La resonancia magnética cerebral fue compatible con mielinolisis extrapontina. Luego de un mes regresó a su territorio de origen para rehabilitación. Tuvo parto domiciliario a las 38.3 semanas y acudió al hospital para el alumbramiento. CONCLUSIONES: La mielinolisis extrapontina debe considerarse en el diagnóstico diferencial entre embarazo con cuadro neurológico agudo y antecedente de hiperémesis e hiponatremia. Es importante integrar, sistemáticamente, hospitales universitarios o de alta complejidad en los territorios rurales para optimizar el diagnóstico y tratamiento de estas pacientes.

Abstract: BACKGROUND: Extrapontine myelinolysis is part of the osmotic demyelination syndrome, being an acute non-inflammatory demyelinating disease caused by hyperosmotic stress that injures oligodendrocytes and causes myelin loss in regions of the central nervous system other than the pons of the brain stem. Primarily caused by a rapid sodium correction in patients with hyponatremia, in pregnant women its most frequent association is with hyperemesis gravidarum. CLINICAL CASE: A 32-year-old indigenous woman was referred to a university hospital of high complexity, in Bogotá, from a territory of the Colombian Amazon, within the framework of a new health care model, with a 15-week pregnancy, who had a convulsive episode, aphasia and oral automatism, and a recent history of hyperemesis gravidarum. Another history of hyperemesis and hyponatremia a month ago. Initially, eclampsia and neuroinfection were suspected, a rapid correction of sodium, anticonvulsant, remission and management in the intensive care unit was performed. MRI was compatible with extrapontin myelinolysis. After a month she returned to the territory of origin for rehabilitation. She had a home delivery at 38.3 weeks and went to the hospital for placental delivery. CONCLUSION: Extrapontin myelinolysis should be considered in the differential diagnosis between pregnancy with acute neurological symptoms conditions and a history of hyperemesis or hyponatremia. In case of a repeated history of acute hyponatremia in pregnant women with hyperemesis, chronicity should be considered. It is recommended to integrate university hospitals to rural territories to optimize the diagnosis and management of this type of cases.

Pacientes procedentes de un territorio disperso que fallecieron en un hospital universitario: serie de casos / Patients from a scattered territory who died in a university hospital. A case series / Pacientes de um territorio disperso, que morreram em um hospital universitário. Série de casos

Introducción: Guainía, departamento con población dispersa, pluriétnico y multifronterizo, fue seleccionado en 2016 como piloto del Modelo Integral de Atención en Salud (MIAS). Dentro de la operación del MIAS se encuentra el Hospital de San José (HSJ), hospital universitario ubicado en Bogotá, que recibe pacientes remitidos por aire desde Guainía para atención especializada. Objetivo: Describir las características de los pacientes remitidos de Guainía que murieron en el HSJ, en el marco del MIAS. Métodos: Estudio tipo serie de casos de los pacientes procedentes de Guainía y remitidos al HSJ que fallecieron durante la estancia hospitalaria entre el 1 de julio de 2016 y el 31 de diciembre de 2017. Se analizaron variables demográficas y clínicas mediante estadística descriptiva. Para identificar muertes evitables se usó el inventario de indicadores de mortalidad evitable adaptado a Colombia (INIME). Resultados: De los 238 pacientes recibidos, 18 fallecieron, 3 de los cuales murieron antes de 48 horas de estancia hospitalaria. La mayoría requirió unidad de cuidado intensivo. Entre los diagnósticos de ingreso predominó la neumonía en el grupo de las patologías infecciosas y la desnutrición en las no infecciosas. Las muertes de todos los menores de 18 años y del 70 % de adultos tenían causas potencialmente evitables según los grupos del INIME. Discusión: El predominio de causas de mortalidad evitables, con muertes por desnutrición infantil y enfermedad diarreica aguda, indica la necesidad de actividades que impacten los determinantes sociales y la determinación social de la salud. Conclusión: La alta frecuencia de muertes evitables sugiere que la implementación de la estrategia de atención primaria en salud no fue óptima en el periodo estudiado. Además, para los casos graves, el estrés del desplazamiento aéreo a Bogotá no parece una buena opción. Es necesario incrementar las capacidades del Hospital de Inírida para reducir remisiones de casos.

Introduction: Guainía, a department with a dispersed, multi-ethnic and multi-border population, was selected in 2016 as a pilot of the Integral Model of Health Care (MIAS). Within the MIAS operation is the Hospital de San José (HSJ), a university hospital located in Bogotá, which receives air-remited patients from Guainía for specialized care. Objective: To describe the characteristics of Guainía patients who died in HSJ, under the MIAS. Methods: Serial case study of patients from Guainía referred to HSJ, who died during the hospital stay, between July 01, 2016 and December 31, 2017. Demographic and clinical variables were analyzed using descriptive statistics. The inventory of Colombia-adapted avoidable mortality indicators (INIME) was used to identify preventable deaths. Results: Of the 238 patients received, 18 died, 3 of them died before 48 hours of hospital stay. Most required Intensive Care Unit. Among the entrance diagnoses, pneumonia prevailed in the group of infectious pathologies and malnutrition in non-infectious ones. The deaths of all children under the age of 18 and 70 % of adults had potentially avoidable causes according to INIME groups. Discussion: The prevalence of preventable causes of mortality, with deaths from child malnutrition and acute diarrhoeal disease, indicates the need for activities that impact social determinants and social determination of health. Conclusion: The high frequency of avoidable deaths suggests that the implementation of the Primary Health Care strategy was not optimal in the period studied. Moreover, for severe cases, the stress of air travel to Bogotá does not seem like a good option. It is necessary to increase the capacities of Inírida Hospital to reduce critical case referrals.

Introdução: Guainía, departamento com população dispersa, multiétnica e multi-fronteira, foi selecionado em 2016 como piloto do Modelo de Atenção Integral à Saúde (MIAS). Dentro da operação do MIAS, encontra-se o Hospital San José (HSJ), um hospital universitário localizado em Bogotá, que recebe pacientes encaminhados por via aérea de Guainía para atendimento especializado. Objetivo: Descrever as características dos pacientes encaminhados por Guainía que morreram no HSJ, no âmbito do MIAS. Métodos: Estudo de série de casos de pacientes de Guainia e encaminhados ao HSJ que faleceram durante a internação hospitalar, entre 1 de julho de 2016 e 31 de dezembro de 2017. As variáveis demográficas e clínicas foram analisadas por estatística descritiva. Para identificar mortes evitáveis, foi utilizado o inventário de indicadores de mortalidade evitável adaptados à Colômbia (INIME). Resultados: Dos 238 pacientes recebidos, 18 morreram, 3 dos quais morreram dentro de 48 horas após a internação hospitalar. A maioria necessitava de unidade de terapia intensiva. Entre os diagnósticos de admissão, a pneumonia predominou no grupo de doenças infecciosas e a desnutrição em doenças não infecciosas. As mortes de todos os menores de 18 e 70 % dos adultos tiveram causas potencialmente evitáveis, de acordo com os grupos do INIME. Discussão: A prevalência de causas evitáveis de mortalidade, com mortes por desnutrição infantil e doença diarréica aguda, indica a necessidade de atividades que impactem os determinantes sociais e a determinação da saúde social. Conclusão: A alta frequência de mortes evitáveis sugere que a implementação da estratégia de Atenção Primária à Saúde não foi ótima no período estudado. Além disso, em casos graves, o estresse nas viagens aéreas para Bogotá não parece ser uma boa opção.

Guillain-Barré syndrome in patients with a recent history of Zika in Cúcuta, Colombia: A descriptive case series of 19 patients from December 2015 to March 2016.

PURPOSE: Zika virus (ZIKV) infection is an emerging global threat and a public health problem in the Americas. Guillain-Barré syndrome (GBS) has been recently associated to ZIKV. This report presents a case series of GBS possibly associated to ZIKV. METHODS: Clinical and demographic data from patients with GBS treated in 5 intensive care units and with recent history of ZIKV in Cúcuta, Colombia were collected from December 1 2015 to April 30 2016. Electrophysiological examination, lumbar puncture, and reverse transcriptase-polymerase chain reaction for ZIKV were performed in 14, 10, and 1 patients, respectively. RESULTS: Nineteen patients with GBS and a recent history of acute viral syndrome compatible with ZIKV infection were studied (mean age, 44 years; range, 17-78). Neurologic symptoms developed at a median of 10 days after the onset of the viral symptoms. Albuminocytological dissociation was found in 8 cases. Electrophysiological criteria for acute motor axonal neuropathy were found in all patients tested. Five patients met level 1, 8 patients level 2, and 6 patients level 3 of diagnostic certainty for GBS in the Brighton classification. Fifteen patients required respiratory assistance, 16 received intravenous immunoglobulins, and 3 had plasmapheresis. Seventy-nine percent of patients were in Hughes GBS disability scale 4 to 5 at discharge and no patients died during the observation period. Acute ZIKV infection, confirmed by reverse transcriptase-polymerase chain reaction, was observed for 1 patient. CONCLUSIONS: All cases of this GBS outbreak had a recent history ZIKV infection, reinforcing existing evidence for the association between GBS and ZIKV. Future genetic and immunologic studies are warranted to further investigate the cause of the outbreak in detail.

Disforia de género, presentación de un caso masculino a femenino (MTF) en el Hospital de San José / Gender dysphoria: Presentation of a male to female (MTF) case in San José Hospital, Bogotá, Colombia

La identidad de género es el sentido de masculinidad o feminidad que puede tener una persona o una combinación de ambas; desde 1940 Harry Benjamín plantea el término transexualidad o trastorno de identidad de género (TIG) cuando hay alteración de esta. Su manejo debe hacerse de manera multi e interdisciplinaria a través del proceso de reasignación de género. A continuación se presenta el caso de una paciente de 50 anos con diagnóstico de disforia de género masculino a femenino (MTF), quien desde la infancia presentaba insatisfacción con su sexo asignado al nacimiento, lo cual la hace candidata a terapia de reemplazo hormonal, tratamiento quirúrgico de feminización y asignación de sexo.

Gender identity is a person concept of self as being male or female, or ambivalent sex. Trans-sexuality or gender identity disorder was given that name by Harry Benjamin since 1940. The treatment should be multi and inter-disciplinary through a process of a gender reassignment. A case is presented of a 50 year-old patient with a diagnosis of male to female (MTF) gender dysphoria, who felt dissatisfied since childhood with her gender assigned at birth, thus being a candidate for hormone replacement therapy, surgical feminisation treatment, and gender assignment.

Gamma interferon levels and antibody production induced by two PvMSP-1 recombinant polypeptides are associated with protective immunity against P.vivax in Aotus monkeys.

Effector mechanisms responsible for providing protective immunity against Plasmodium vivax (Pv) infection were examined in Aotus monkeys vaccinated with two Pv Merozoite Surface Protein-1 (PvMSP-1) recombinant polypeptides that had previously been shown to protect vaccines against parasite challenge. Vaccine efficacy was reproducible in this trial, showing that one out of the five monkeys immunised with the recombinant protein mixture was partially protected while three others controlled parasitaemia. Antibodies reactive to the parasite's native proteins, the recombinant polypeptides and peptides spanning both recombinant fragments were detected in most vaccinees. Despite substantial Peripheral Blood Mononuclear Cell (PBMC) antigen-specific cellular proliferation not being detected, high rPvMSP-1(20) specific gamma interferon (IFN-gamma) production was found in the three animals that controlled parasitaemia. Altogether the results suggest that antibody titres and antigen-specific IFN-gamma production mediate protective immunity against P. vivax.

Identifying and characterising the Plasmodium falciparum merozoite surface protein 10 Plasmodium vivax homologue.

Plasmodium vivax malaria is one of the most prevalent parasitic diseases in Asia and Latin-America. The difficulty of maintaining this parasite culture in vitro has hampered identifying and characterising proteins implied in merozoite invasion of red blood cells. We have been able to identify an open reading frame in P. vivax encoding the Plasmodium falciparum merozoite surface protein 10 homologous protein using the partial sequences from this parasite's genome reported during 2004. This new protein contains 479 amino-acids, two epidermal growth factor-like domains, hydrophobic regions at the N- and C-termini, being compatible with a signal peptide and a glycosylphosphatidylinositol anchor site, respectively. The protein is expressed during the parasite's asexual stage and is recognised by polyclonal sera in parasite lysate using Western blot. P. vivax-infected patients' sera highly recognised recombinant protein by ELISA.

Plasmodium vivax merozoite surface protein 8 cloning, expression, and characterisation.

Plasmodium vivax, one of the four parasite species causing malaria in humans, is the most widespread throughout the world, leading to nearly 80 million cases per year, mainly in Latin-America and Asia. An open reading frame encoding the Plasmodium falciparum merozoite surface protein 8 P. vivax homologue has been identified in the present study by screening the current data obtained from this parasite's partially sequenced genome. This new protein contains 487 amino-acids, two epidermal growth factor like domains, hydrophobic regions at the N- and C-termini compatible with a signal peptide, and a glycosylphosphatidylinositol anchor site, respectively. This gene's transcription and its encoded protein expression have been assessed, as well as its recognition by P. vivax-infected patients' sera. Based on this recognition, and a previous study showing that mice immunised with the Plasmodium yoelii homologous protein were protected, we consider the PvMSP8 a good candidate to be included in a multi-stage multi-antigen P. vivax vaccine.

Splenectomised and spleen intact Aotus monkeys' immune response to Plasmodium vivax MSP-1 protein fragments and their high activity binding peptides.

Two E. coli expressed recombinant polypeptides (rPvMSP-1(14) and rPvMSP-1(20)) contained in the 33kDa fragment, located within Plasmodium vivax merozoite surface protein (PvMSP-1) 42kDa C-terminal region, and a cocktail of high reticulocyte binding synthetic peptides located within these fragments, were evaluated for immunogenicity and protective immune responses in splenectomised and spleen intact Aotus nancymaae monkeys. Thirty splenectomised monkeys who had been previously immunised with either rPvMSP-1(14), rPvMSP-1(20), or a mixture of both recombinant fragments were intravenously challenged with the heterologous P. vivax VCG-1 strain (as determined by DNA sequencing); full protection was observed in five monkeys and low parasitaemia levels were obtained in eight more monkeys. Splenectomised control monkey group rapidly developed high parasitaemia levels, while no significant parasitaemia was obtained in the non-splenectomised control group. Although PvMSP-1 42 and 33kDa fragments were recognised by Western Blot and whole parasites by IFAT when tested with immune monkey sera, no correlation between protection and antibody titres by IFAT and ELISA was observed, suggesting that protection is not being solely mediated by a humoral immune response. This data showed that partial protection against a heterologous strain challenge was best achieved when immunising with a rPvMSP-1(14)-rPvMSP-1(20) mixture (2 were fully protected and 4 with low parasitaemia out of 12) suggesting for the first time, that these fragments could be good candidates for inclusion in a P. vivax multi-stage, multi-antigen vaccine.

Expression, polymorphism analysis, reticulocyte binding and serological reactivity of two Plasmodium vivax MSP-1 protein recombinant fragments.

Among the four parasite species causing malaria in humans, Plasmodium vivax prevails on both the Asian and the American continents. Several antigens from this parasite's erythrocytic stages have been characterised and some of them are considered to be good vaccine candidates. The P. vivax merozoite surface protein-1 (PvMSP-1) is a 200 kDa antigen, thought to mediate the initial contact between the merozoite and the erythrocyte. An effective blockage of this interaction could be important in anti-malarial vaccine design. This study analyses the genetic polymorphism, binding to both reticulocytes and erythrocytes, antigenicity and immunogenicity of two recombinant proteins belonging to the 33 kDa PvMSP-1 proteolytic fragment. Both regions showed very low genetic variation, bound reticulocytes with higher affinity than erythrocytes, were recognised by naturally P. vivax-infected patient sera and were immunogenic when used to immunise rabbits, making them good vaccine candidates against P. vivax, to be further preclinically tested in the Aotus monkey model.