Retropupillary Iris-fixated versus Sutured Scleral-fixated Intraocular Lenses.

Aim: To compare the anatomical and functional results and patient satisfaction following retropupillary implantation of Artisan Aphakia iris-fixated intraocular lens (rAAIF) and sutured scleral fixated intraocular lens (SFIOL). Subjects and methods: We presented a prospective double-arm non-blinded study. Forty-one eyes with acquired aphakia, no age-related macular degeneration, no previous keratoplasty, no combined procedures, no AC reaction (cells, fibrin), normal intraocular pressure, no history of endothelial corneal dystrophy in relatives or fellow eye were included. Indications, complications, corrected distance visual acuity (CDVA), endothelial cell density (ECD), and patient satisfaction score were assessed. Results: Retropupillary AAIF was implanted in 21 (51.22%) eyes and SFIOL in 20 (48.78%) eyes. The most common indication was complicated cataract surgery in 18 cases (43.90%), followed by trauma in 16 (39.02%), and spontaneous dislocation in 7 (17.07%). No difference between rAAIF and SFIOL in terms of sex, laterality (χ=0.13, p=0.72), indications (χ=0.78, p=0.68), previous ocular history, and comorbidities was observed. The complications and the visual outcomes at 6 months postoperatively were similar between the two groups (p=0.95 and p=0.321, respectively). The ECD loss in the two groups was also similar (p=0.89). The patient satisfaction score was 58.67±8.80 in the rAAIF and 56.69±11.50 in the SFIOL group, which was statistically similar (p=0.764). Conclusion: Retropupillary AAIF and SFIOL showed similar results concerning visual acuity, endothelial cell loss, and patient satisfaction. Careful preoperative individual assessment is required to have optimal results with either technique. Abbreviations: AAIF = Artisan Aphakia iris-fixated intraocular lens, rAAIF = retropupillary Artisan Aphakia iris-fixated intraocular lens, CDVA = corrected distance visual acuity, ECD = endothelial cell density, IOL = intraocular lens, SD = standard deviation, SFIOL = scleral fixated intraocular lens.

KRAS Gene Mutation in Patients Undergoing Liver Resections for Colorectal Cancer. Is There an Advantage to Anatomical Resections?

Introduction: Several factors have been described to make a prognostic assessment of patients with liver metastases due to colorectal cancer and to define the benefit of the surgical management of metastatic involvement; one of these factors is the status of the KRAS gene since its mutation is associated with worse outcomes. This study aims to describe the outcomes for a retrospective series of patients after liver resections for metastatic colorectal cancer concerning KRAS gene status. Materials and methods: The study involves a retrospective cohort of patients undergoing liver metastasectomy for colorectal cancer with KRAS mutation study from 2009-2013 at the National Institute of Cancerology in Colombia. Five-year survival analyses (overall and disease-free) were performed according to KRAS mutation status and the type of liver resection performed using the Kaplan-Meier estimate. Results: 35 patients undergoing liver metastasectomy were analyzed, of which 42.8% had KRAS gene mutation. Median overall survival was 34.2 months for patients with KRAS- mutant and 46.5 for non-mutant. The median survival for KRAS-mutant patients with anatomic resections was 43.5 months versus 23.5 months for nonanatomic resections. Conclusions: Performing anatomic resections during liver metastasectomy in patients with KRAS mutants could be associated with an improvement in overall survival. It is necessary to continue building the evidence for adequate decision-making in patients with KRAS mutants who will undergo liver resections.

Introducción: se han descrito varios factores para realizar una evaluación pronóstica de los pacientes con metástasis hepáticas por cáncer colorrectal y definir el beneficio en el manejo quirúrgico del compromiso metastásico; uno de estos factores es el estado del gen KRAS, debido a que su mutación está relacionada con peores desenlaces. El objetivo de este estudio es describir los desenlaces para una serie retrospectiva de pacientes después de resecciones hepáticas por metástasis de cáncer colorrectal en relación con el estado del gen KRAS. Metodología: cohorte retrospectiva de pacientes llevados a metastasectomía hepática por cáncer colorrectal con estudio de mutación KRAS durante el período 2009-2013, en el Instituto Nacional de Cancerología en Colombia. Se realizaron análisis de supervivencia a 5 años (global y libre de enfermedad) según el estado de mutación KRAS y según el tipo de resección hepática realizada mediante el método de Kaplan-Meier. Resultados: se analizaron a 35 pacientes llevados a metastasectomía hepática, de los cuales el 42,8% presentaba mutación del gen KRAS. La supervivencia global media fue de 34,2 meses para los pacientes con KRAS mutado y de 46,5 para los no mutados. La supervivencia media para los pacientes con KRAS mutado con resecciones anatómicas fue de 43,5 meses frente a 23,5 meses en los que se realizaron resecciones no anatómicas. Conclusiones: realizar resecciones anatómicas durante la metastasectomía hepática en los pacientes con KRAS mutado podría estar asociado con una mejoría en la supervivencia global. Se requiere continuar en la construcción de la evidencia que permita una adecuada toma de decisiones de los pacientes con KRAS mutado que serán llevados a resecciones hepáticas.

Genetic diversity and Kdr mutations of natural Aedes (Stegomyia) aegypti (Diptera: Culicidae) populations of Brazil

ABSTRACT Aedes (Stegomyia) aegypti is an important vector of dengue, yellow fever, chikungunya and Zika virus. It is well known that resistance monitoring and genetic diversity data help designing the vector control programs. This study aimed to evaluate resistance to pyrethroids (PYs) through the frequency of kdr mutations Val1016IIe and F1534C, and the genetic variation of the mitochondrial gene ND4 in six natural populations of A. aegypti from Paraná - Brazil. Adults were obtained from eggs collected from Alvorada do Sul, Marilena, Maringá, Nova Londrina, Paranavaí and São Carlos do Ivaí. From these adults, 345 were used to identify the 1016 and 1534 sites, and 120 were used to perform the ND4 gene analysis. The studied populations from Paraná showed PYs resistance, low gene flow and genetic diversity. Additionally, a relationship was observed among the haplotypes of populations from the Amazon and Southeastern Brazil, Peru, Mexico, and North America.

Panel-based next-generation sequencing identifies novel mutations in Bulgarian patients with inherited retinal dystrophies.

BACKGROUND: Next-generation sequencing (NGS)-based method is being used broadly for genetic testing especially for clinically and genetically heterogeneous disorders, such as inherited retinal degenerations (IRDs) but still not routinely used for molecular diagnostics in Bulgaria. Consequently, the purpose of this study was to evaluate the effectiveness of a molecular diagnostic approach, based on targeted NGS for the identification of the disease-causing mutations in 16 Bulgarian patients with different IRDs. METHODS: We applied a customized NGS panel, including 125 genes associated with retinal and other eye diseases to the patients with hereditary retinopathies. RESULTS: Systematic filtering approach coupled with copy number variation analysis and segregation study lead to the identification of 16 pathogenic and likely pathogenic variants in 12/16 (75%) of IRD patients, 2 of which novel (12.5%): ABCA4-c.668delA (p.K223Rfs18) and RР1-c.2015dupA (p.K673Efs*25). Mutations in the ABCA4, PRPH2, USH2A, BEST1, RР1, CDHR1, and RHO genes were detected reaching a diagnostic yield between 42.9% for Retinitis pigmentosa cases and 100% for macular degeneration, Usher syndrome, and cone-rod dystrophy patients. CONCLUSION: Our results confirm the usefulness of targeted NGS approach based on frequently mutated genes as a comprehensive and successful genetic diagnostic tool for IRDs with significant impact on patients counseling.

Dispersion routes of the main vectors of human malaria in the Americas: Genetic evidence from the mitochondrial COI gene.

BACKGROUND AND OBJECTIVES: In America, of the 44 species of Anopheles, nine are main vectors of malaria and, of these, genetic information exists for seven. Hence, this study sought to know the gene flow and diversity of the seven principal vectors of malaria at the Americas level. METHODS: For the seven species and the sequences of the mitochondrial cytochrome c oxidase I (COI) gene obtained from the GenBank and Bold System, genetic analyzes of populations and genetic structure were performed and haplotype networks and phylogenetic trees were obtained. RESULTS: For the seven species, 1440 sequences were analyzed and 519 haplotypes were detected. The Hd and π values were higher within a continental context than by countries. Neutrality tests indicated positive and negative values with most of these being significant (p < 0.05). Phylogenetic analyses for all the species recovered three clades with no geographic pattern among them. INTERPRETATION & CONCLUSION: Studies suggest that native species of Anopheles from the Americas have greater haplotype diversity and low genetic differentiation due to the lack of physical barriers to impede gene flow among these populations. Moreover, all the species are interconnected by roadways. This scenario complicates the epidemiological picture of malaria in the Americas.

Gene Flow Patterns of the Aedes aegypti (Diptera: Culicidae) Mosquito in Colombia: a Continental Comparison Suggests Multiple Invasion Routes and Gene Exchange

ABSTRACT In Colombia Aedes aegypti is present in 80% of the country up to 2,300 m; however, little is known of its genetic relations within a country context and, hence, within a broader context, for example, America. The aforementioned, herein, analyzed the gene flow within a context of the Americas, its directionality and genetic diversity of the mitochondrial lineages in the A. aegypti populations for Colombia. This called for the use of the sequences for A. aegypti available of the mitochondrial ND4 gene in the GenBank for Colombia and the American continent. No presence was found of nuclear mitochondrial pseudogenes (NUMTs) for Colombia. It is estimated that in Colombia the gene flow of the A. aegypti populations is occurring from the southeast and northeast toward the center of the country. In comparison with the mitochondrial sequences for America, the vector's haplotypes in Colombia suggest connections between the populations of mosquitoes from the south with those from the north of the continent. The gene flow model at continental scale suggests bidirectional connections between the populations from the north of the continent with those from the south, while at South American scale it proposes the gene flow in all the directions with respect to the Colombian. The Colombian A. aegypti vector monitoring and control strategies must pay special attention to the vector's points of entry into Colombia related with Peru, Venezuela, Brazil, Mexico, and North America to avoid the entry of populations with characteristics like resistance to insecticides or vector competition.

Potential geographic distribution of the tiger mosquito Aedes albopictus (Skuse, 1894) (Diptera: Culicidae) in current and future conditions for Colombia.

In Colombia, little is known on the distribution of the Asian mosquito Aedes albopictus, main vector of dengue, chikungunya, and Zika in Asia and Oceania. Therefore, this work sought to estimate its current and future potential geographic distribution under the Representative Concentration Paths (RCP) 2.6 and 8.5 emission scenarios by 2050 and 2070, using ecological niche models. For this, predictions were made in MaxEnt, employing occurrences of A. albopictus from their native area and South America and bioclimatic variables of these places. We found that, from their invasion of Colombia to the most recent years, A. albopictus is present in 47% of the country, in peri-urban (20%), rural (23%), and urban (57%) areas between 0 and 1800 m, with Antioquia and Valle del Cauca being the departments with most of the records. Our ecological niche modelling for the currently suggests that A. albopictus is distributed in 96% of the Colombian continental surface up to 3000 m (p < 0.001) putting at risk at least 48 million of people that could be infected by the arboviruses that this species transmits. Additionally, by 2050 and 2070, under RCP 2.6 scenario, its distribution could cover to nearly 90% of continental extension up to 3100 m (≈55 million of people at risk), while under RCP 8.5 scenario, it could decrease below 60% of continental extension, but expand upward to 3200 m (< 38 million of people at risk). These results suggest that, currently in Colombia, A. albopictus is found throughout the country and climate change could diminish eventually its area of distribution, but increase its altitudinal range. In Colombia, surveillance and vector control programs must focus their attention on this vector to avoid complications in the national public health setting.

Effectiveness and safety of the enhanced recovery program in colorectal surgery: overview of systematic reviews / Efectividad y seguridad del programa multimodal perioperatorio en cirugía colorrectal: Revisión sistemática de revisiones

Abstract Introduction Multimodal enhanced recovery programs are a new paradigm in perioperative care. Objective To evaluate the certainty of evidence pertaining to the effectiveness and safety of the multimodal perioperative care program in elective colorectal surgery. Data source: A search was conducted in the Medline, EMBASE, and Cochrane databases, up until February 2020. Eligibility criteria Systematic reviews that take into account the perioperative multimodal program in patients with an indication for colorectal surgery were included. The primary outcomes were morbidity and postoperative deaths. The secondary outcome was hospital length of stay. Study quality and synthesis method The reviews were evaluated with AMSTAR-2 and the certainty of the evidence with the GRADE methodology. The findings are presented with measures of frequency, risk estimators, or differences. Results Six systematic reviews of clinical trials with medium and high quality in AMSTAR-2 were included. Morbidity was reduced between 16 and 48%. Studies are inconclusive regarding postoperative mortality. Hospital length of stay was reduced by an average of 2.5 days (p <0.05). The certainty of the body of evidence is very low. Limitations The effect of the program, depending on the combination of elements, is not clear. Conclusions and implications Despite the proven evidence that the program is effective in reducing global postoperative morbidity and hospital stay, the body of evidence is of very low quality. Consequently, results may change with new evidence and further research is required.

Resumen Introducción Los programas multimodales de cuidado perioperatorio son nuevos paradigmas de atención en salud, particularmente en el paciente quirúrgico. Objetivo Evaluar la certeza en la evidencia de la efectividad y seguridad del programa multimodal perioperatorio en cirugía colorrectal electiva. Fuente de datos Se consultaron las bases de datos Medline, EMBASE y Cochrane hasta febrero de 2020. Criterios de elegibilidad Se incluyeron revisiones sistemáticas que consideraron como intervención el programa multimodal perioperatorio en pacientes con indicación de cirugía colorrectal. Los desenlaces primarios fueron morbilidad y mortalidad postoperatoria. El desenlace secundario fue estancia hospitalaria. Evaluación de los estudios y método de síntesis La calidad de las revisiones fue evaluada con AMSTAR-2 y la certeza de la evidencia con la metodología GRADE. Los hallazgos se presentan con medidas de frecuencia, estimadores de riesgo o diferencias. Resultados Se incluyeron seis revisiones sistemáticas de ensayos clínicos de media y alta calidad en AMSTAR-2. La morbilidad se redujo entre el 16 y el 48 %. Para la mortalidad postoperatoria no se reportan diferencias a favor del programa. La estancia hospitalaria se redujo en promedio 2,5 días (p < 0,05). La certeza del cuerpo de la evidencia es muy baja. Limitaciones El efecto del programa en función de combinación de elementos no es claro. Conclusiones e implicaciones A pesar de que la evidencia sugiere que el programa es efectivo en la reducción de morbilidad postoperatoria global y estancia hospitalaria, el cuerpo de la evidencia es de muy baja calidad, por lo que los resultados podrían cambiar con nueva evidencia. Se requieren nuevas investigaciones.

The Mayaro virus and its potential epidemiological consequences in Colombia: an exploratory biomathematics analysis.

BACKGROUND: Mayaro virus (Togaviridae) is an endemic arbovirus of the Americas with epidemiological similarities with the agents of other more prominent diseases such as dengue (Flaviviridae), Zika (Flaviviridae), and chikungunya (Togaviridae). It is naturally transmitted in a sylvatic/rural cycle by Haemagogus spp., but, potentially, it could be incorporated and transmitted in an urban cycle by Aedes aegypti, a vector widely disseminated in the Americas. METHODS: The Mayaro arbovirus dynamics was simulated mathematically in the colombian population in the eight biogeographical provinces, bearing in mind the vector's population movement between provinces through passive transport via truck cargo. The parameters involved in the virus epidemiological dynamics, as well as the vital rates of Ae. aegypti in each of the biogeographical provinces were obtained from the literature. These data were included in a meta-population model in differential equations, represented by a model structured by age for the dynamic population of Ae. aegypti combined with an epidemiological SEI/SEIR-type model. In addition, the model was incorporated with a term of migration to represent the connectivity between the biogeographical provinces. RESULTS: The vital rates and the development cycle of Ae. aegypti varied between provinces, having greater biological potential between 23 °C and 28 °C in provinces of Imerí, biogeographical Chocó, and Magdalena, with respect to the North-Andean Moorland (9.33-21.38 °C). Magdalena and Maracaibo had the highest flow of land cargo. The results of the simulations indicate that Magdalena, Imerí, and biogeographical Chocó would be the most affected regarding the number of cases of people infected by Mayaro virus over time. CONCLUSIONS: The temperature in each of the provinces influences the local population dynamics of Ae. aegypti and passive migration via transport of land cargo plays an important role on how the Mayaro virus would be disseminated in the human population. Once this arbovirus begins an urban cycle, the most-affected departments would be Antioquia, Santander, Norte de Santander, Cesar (Provinces of Magdalena), and Valle del Cauca, and Chocó (biogeographical province of Chocó), which is why vector control programmes must aim their efforts at these departments and include some type of vector control to the transport of land cargo to avoid a future Mayaro epidemic.

Effect of altitude on wing metric variation of Aedes aegypti (Diptera: Culicidae) in a region of the Colombian Central Andes.

In mosquitoes of medical importance, wing shape and size can vary with altitude, an aspect that can influence dispersion and, consequently, their vector capacity. Using geometric morphometry analysis, Aedes aegypti wing size and shape variation of males and females was studied in four altitudes in the second-smallest department in Colombia: 1,200 m (Tebaida), 1,400 m (Armenia), 1,500 m (Calarcá), and 1,700 m (Filandia). Wing shape in males (P < 0.001) and females (P < 0.001) was significantly different through the altitudinal gradient; in turn, wing size in males followed the altitudinal gradient males (R2 = 0.04946, P = 0.0002), females (R2 = 0.0011, P = 0.46). Wing allometry for males (P < 0.001) and females (P < 0.001) was significant. Likewise, the shape and size of the wings of males (P < 0.001) and females (P < 0.001) had significant fluctuating asymmetry. It is concluded that, in a small scale with an altitudinal variation of 500 meters, it is detected that the size and shape of the wings varied in A. aegypti, main vector the agents that cause dengue, chikungunya, and Zika. The fluctuating asymmetry is present in the individuals studied and could be associated with environmental effects caused by vector control campaigns present in some sampling locations.

Control de Aedes (Stegomyia) aegypti utilizando Bacillus thuringiensis var. israelensis en Armenia, Quindío, Colombia / Control of Aedes (Stegomyia) aegypti using Bacillus thuringiensis var. israelensis in Armenia, Quindío, Colombia

RESUMEN En Colombia, Aedes aegypti es resistente a la mayoría de insecticidas utilizados. Debido al lento desarrollo de resistencia a Bacillus thuringiensis var. israelensis (Bti), así como su alta especificidad e inocuidad ambiental, el uso de este larvicida, se torna una alternativa en el manejo de este vector. En este trabajo, se evaluó experimentalmente y describió por medio de un modelo matemático, la dinámica del control de poblaciones naturales de A. aegypti, utilizando Bti. Se determinó el perfil de susceptibilidad, a través de bioensayos dosis-respuesta con larvas colectadas de Armenia (Quindío, Colombia). Adicionalmente, con los datos de mortalidad de las localidades analizadas, un nuevo análisis fue realizado, para estimar el perfil de susceptibilidad del municipio de Armenia. Los datos de mortalidad fueron utilizados para calcular las concentraciones letales 50 y 95. Con éstas, se realizaron simulaciones hipotéticas del comportamiento del vector, obtenidas a partir de un modelo matemático, que describe la dinámica poblacional, usando aplicaciones sucesivas de Bti y diferentes intervalos de tiempo. Los bioensayos dosis-respuesta indican que las poblaciones del vector analizadas son susceptibles al Bti, por presentar una respuesta biológica similar a la obtenida en la cepa de referencia Rockefeller. Las simulaciones aplicando un control periódico sostenido, sugieren que el Bti es efectivo para controlar el vector; sin embargo, su eficiencia a largo plazo depende de la relación entre concentración letal y frecuencia de aplicación. Se concluye que la aplicación sostenida de Bti constituye una alternativa viable para el control de poblaciones de A. aegypti, a largo plazo.

ABSTRACT In Colombia, Aedes aegypti is resistant to most used insecticides. Due to the slow development of resistance to Bacillus thuringiensis var. israelensis (Bti) as well as its high specificity and environmental safety, the use of this larvicide becomes an alternative in the management of this vector. In this work, we evaluated experimentally and describe by a mathematical model the dyamics of control of natural populations of A. aegypti using Bti. The susceptibility profile to Bti was determined through dose-response bioassays with larvae collected in Armenia (Quindío, Colombia). In addition, in order to estimate the susceptibility profile, an analysis was carried out using the mortality data obtained from the four localities analyzed. The mortality data were used to estimate the lethal concentrations (LC50 and 95) from each locality. Using these LC, hypothetical simulations of vector behavior were carried out, obtained from a mathematical model that describes the population dynamics, using successive applications of Bti at different time intervals. The dose-response bioassays indicate tha the analyzed vector populations are susceptible to Bti since they present a biological response similar to the one obtained from A. aegypti Rockefeller strain. Computer simulations using sustained periodic inspection indicate Bti is effective for the vector control. Nevertheless, its long-term efficiency depends on relation between the LC and the frequency of application. It is concluded that the sustained application of Bti represents a long-term viable alternative for the control of A. aegypti populations.

Factores relacionados con la aplicación del proceso de enfermería en instituciones hospitalarias de Colombia / Factors related to applying the nursing process in Colombian hospital institutions / Fatores relacionados à aplicação do processo de enfermagem em instituições hospitalares na Colômbia

Resumen Introducción La aplicación del proceso de enfermería, beneficia la salud del paciente y promueve la autonomía de la profesión. Objetivo Describir la aplicación del proceso de enfermería de los profesionales de enfermería del área hospitalaria en la Orinoquia colombiana al momento de brindar cuidado. Materiales y Métodos Se realizó un estudio descriptivo transversal, mediante entrevista estandarizada, muestra no probabilística constituida por 100 enfermeros del área hospitalaria, de centros de atención de alta complejidad, se calcularon medidas de resumen, y razones de ventajas. Resultados: 84% eran mujeres, edad promedio:31 ± 9,1 años; promedio de pacientes por turno: 12,2 ± 15,5; 59% refirieron aplicar el proceso de enfermería, 98% refieren la falta de tiempo como factor para la no aplicación del proceso de enfermería; se encontró asociación estadísticamente significativa para aumentar la aplicación del proceso de atención de enfermería cuando este es considerado como un facilitador para brindar el cuidado (OR: 4,52 IC95%: 1,1-18,2); cuando el profesional de enfermería encuentra aplicación y relación con la teoría recibida en la universidad (OR: 4,06 IC95%: 1,7-9,5). Discusión y Conclusiones La posibilidad de aplicar el proceso de enfermería aumenta por factores como la percepción de beneficios, el nivel de apropiación que tienen los profesionales de enfermería, y no se limitó a condiciones laborales o académicas.

Abstract Introduction Application of the nursing process benefits the patient's health and promotes the profession's autonomy. Objective To describe the application of the nursing process by nursing professionals when providing care in the hospital setting in the Colombian Orinoquía region. Materials and Methods A cross-sectional, descriptive study was conducted through standardized survey, but not probabilistic, comprising 100 nurses from the hospital area of high-complexity health care centers. Summary measures were calculated, along with reasons for advantages. Results: Of the number of subjects surveyed, 84% were women, mean age of 31 ± 9.1 years; average number of patients per shift: 12.2 ± 15.5; 59% reported applying the nursing process, 98% referred to the lack of time as a factor for not applying the nursing process. A statistically significant association was found to increase the application of the nursing care process when it is considered a facilitator to provide care (OR: 4.52 95%CI: 1.1-18.2), when the nursing professional finds application and relation with the theory received in the university (OR: 4.06 95%CI: 1.7-9.5). Discussion and Conclusions The possibility of applying the nursing process increases due to factors, like the perception of benefits, level of appropriation by the nursing professionals, and it was not limited to work or academic conditions.

Resumo Introdução A aplicação do processo de enfermagem beneficia a saúde do paciente e promove a autonomia da profissão. Objetivo Descrever a aplicação do processo de enfermagem dos profissionais de enfermagem da área hospitalar na Orinoquia colombiana no momento da prestação de cuidado. Materiais e Métodos Realizou-se um estudo descritivo transversal, utilizando uma entrevista padronizada, amostra não probabilística composta por 100 enfermeiros da área hospitalar, de centros de prestação de alta complexidade, foram calculadas medidas de resumo e razões de vantagens. Resultados 84% eram mulheres, idade média: 31 ± 9.1 anos; número médio de pacientes por turno: 12.2 ± 15.5; 59% relataram aplicar o processo de enfermagem, 98% referem falta de tempo como fator para não aplicação do processo de enfermagem; foi encontrada associação estatisticamente significativa para aumentar a aplicação do processo de cuidados de enfermagem quando este é considerado como um facilitador para prestar cuidados (OR: 4.52 IC95%: 1.1-18.2); quando o profissional de enfermagem encontra aplicação e relação com a teoria recebida na universidade (OR: 4.06 IC95%: 1.7-9.5). Discussão e Conclusões: A possibilidade de aplicar o processo de enfermagem aumenta por fatores como a percepção de benefícios, o nível de apropriação que têm os profissionais de enfermagem, e não se limitou a condições de trabalho ou acadêmicas.

Prevalencia del Síndrome de Burnout en profesionales de enfermería de la Orinoquia colombiana, 2016 / Prevalence of Burnout syndrome in nursing professionals from Orinoquia, Colombia in 2016

Resumen Introducción: El síndrome de Burnout es descrito como una inadecuada forma de afrontar el estrés laboral, los rasgos principales son el agotamiento emocional, la despersonalización y disminución del desempeño personal. Objetivo: Determinar la prevalencia del Síndrome de Burnout en los profesionales de enfermería que laboran en la Orinoquia colombiana. Materiales y métodos: Se realizó un estudio analítico transversal, muestreo por intención, la población de estudio estuvo constituida por 100 enfermeros, se utilizó el instrumento de Maslach Burnout. Se calcularon medidas de resumen, prevalencia y razón de prevalencia, con el programa SPSS. Resultados: El 90% de la muestra estudiada eran mujeres, 53% solteros, 54% menores de 28 años y 42% sin hijos. La prevalencia general del síndrome de Burnout fue de 16%, en el área de atención hospitalaria fue de un 25,5% y en áreas diferentes a esta fue 6,1%; en el área hospitalaria se presentaron mayores proporciones en cansancio emocional 42%, despersonalización emocional 38%, falta de realización personal 30%, se encontró diferencias estadísticamente significativas para la prevalencia del síndrome de Burnout en el área de atención hospitalaria (RP 4,2, IC95% 1,3-13,7, P 0,008), para profesionales menores de 28 años (RP 3,7 IC95% 1,1- 12,1, P 0,017). Conclusiones: La prevalencia del síndrome de Burnout es mayor en enfermeros del área hospitalaria, tener menos de 28 años se asoció a una mayor prevalencia, los enfermeros clasificados como enfermos con síndrome de Burnout debían cuidar un mayor número de pacientes en su jornada laboral.

Abstract Introduction: Burnout syndrome is described as an inadequate way of coping with labor stress. The main traits are emotional exhaustion, depersonalization and decreased personal performance. Objective: To determine the prevalence of Burnout syndrome in nursing professionals working in the Colombian Orinoquia. Materials and methods: A transverse analytical study was carried out with sampling by intention. The study population was constituted by 100 nurses and the Maslach Burnout instrument was used. Summary, prevalence and prevalence ratio measurements were calculated with the SPSS program. Results: 90% of the sample studied were women, 53% single, 54% under 28 and 42% without children. The general prevalence of Burnout syndrome was 16%, in the area of hospital care was 25.5% and in areas other than this was 6.1%. In the hospital area, there were greater proportions in emotional fatigue with a 42%, emotional depersonalization with a 38% and lack of personal realization with a 30%. Statistically significant differences for the prevalence of Burnout syndrome in the area of hospital care were found (RP 4.2, IC95% 1,3-13.7, P 0.008) for professionals under 28 (RP 3.7 IC95% 1.1-12.1, p 0.017). Conclusions: The prevalence of Burnout syndrome is higher in nurses in the hospital area. Being under 28 years of age was associated with a higher prevalence. Nurses classified as sick with Burnout syndrome had to take care of a greater number of patients in their workday.

Solución salina hipertónica para modificar la lesión tisular por isquemia/reperfusión: modelo porcino de oclusión de aorta / Hypertonic saline solution for modifying tissue ischemia/reperfusion injury: Porcine aortic occlusion model

Abstract Introduction: Decreased blood flow disrupts the endothelium, changes the nitric oxide/endothelin -1 ratio, narrows the capillaries and results in microcirculatory dysfunction. Secondary anoxia leads to mitochondrial energy imbalance, depletion of adenosine-triphosphate and disruption of the intracellular hydrogen, sodium and calcium homeostasis. If the flow is restored, the reperfusion stimulates the endothelial expression of adhesion molecules attracting polymorphic nucleotides and platelets, with sub endothelial infiltration of these cells and their entrapment in the microvasculature, as well as vasoconstriction, endothelial edema and reduced flexibility of the cellular membrane. Ischemia/reperfusion may result in inflammation and organ failure. Objective: To determine whether hypertonic saline solution reduces the ischemic/reperfusion injury in the liver, the kidney, and the ileum. Materials and methods: Experimental trial in pigs. Aortic blood flow suppression (15 min) and reperfusion (60 min). The experimental group was pretreated with 7.5% hypertonic saline and the control group received normal 0.9% saline solution. Hemodynamic, gasometric, and biochemical measurements were taken, and the serum and tissue levels of ET-1, TNF-alpha, IL-10, and IL-2 were determined. Results: There were no significant differences in the tissue expression of ET-1, TNF-alpha, IL-10, and IL-2 between the two groups. The hemodynamic behavior was similar in both groups. The group treated with hypertonic solution showed an increasing post-perfusion systolic rate up to the basal values, while the systolic rate in the control group dropped significantly (p = 0.015). Conclusion: Hypertonic solution prior to the ischemic insult improves the ventricular function after reperfusion.

Resumen Introducción: La disminución del flujo sanguíneo altera el endotelio, cambia la relación óxido nítrico/endotelina-1, estrecha capilares y produce disfunción microcirculatoria. La anoxia secundaria lleva a desacople energético mitocondrial, depleción de adenosín-trifosfato y alteración de la homeostasis intracelular de hidrógeno, sodio y calcio. Si el flujo se reanuda, la reperfusión estimula la expresión endotelial de moléculas de adhesión que atraen polimorfonucleares y plaquetas, con infiltración subendotelial de estas células y su atrapamiento en la microvasculatura, así como vasoconstricción, edema endotelial y disminución de la flexibilidad de la membrana celular. La isquemia/reperfusión puede derivar en inflamación y fallo orgánico. Objetivo: Determinar si la solución salina hipertónica disminuye la lesión isquemia/reperfusión en hígado, riñón e íleon. Materiales y métodos: Estudio experimental en cerdos. Supresión del flujo sanguíneo aórtico (15 min) y reperfusión (60 min). El grupo experimental recibió pretratamiento con solución salina hipertónica al 7,5% y el grupo control solución salina normal al 0,9%. Se realizaron mediciones hemodinámicas, gasométricas, bioquímicas y determinación sérica y tisular de ET-1, TNF-alfa, IL-10, IL-2. Resultados: No hubo diferencias significativas en la expresión tisular de ET-1, TNF-alfa, IL-10, IL-2 entre los grupos. Los grupos presentaron un comportamiento hemodinámico similar. El grupo tratado con hipertónica exhibió un índice sistólico post-reperfusión que aumentó hasta los valores basales, mientras que el índice sistólico del grupo control presentó una caída significativa (p = 0,015). Conclusión: La solución hipertónica antes del insulto isquémico mejora la función ventricular después de la reperfusión.

How much is known about the genetic diversity of the Asian tiger mosquito? A systematic review / ¿Cuánto se conoce acerca de la diversidad genética del mosquito tigre? Una revisión sistemática

ABSTRACT Introduction: Aedes (Stegomyia) albopictus (Skuse, 1894) is a vector for dengue and chikungunya viruses in the field, along with around 24 additional arboviruses under laboratory conditions. Knowledge of the genetic diversity of insect vectors is critical for the effective control and elimination of vector-borne diseases. Objective: We determined the current scenario of the genetic diversity in natural populations of A. albopictus through a systematic review. Methodology: It was possible to establish the first reports and distribution of A. albopictus populations in the world, as well as its genetic diversity, population genetic structure and molecular markers used to determine its genetic diversity. Results: A. albopictus is distributed worldwide with genetically structured populations and low diversity; however, 89.5% of the genetic diversity known is based on the use of RFLP, allozymes, isozymes, and mtDNA molecular markers that exhibit significant problems according to the literature. After the results were obtained, a critical analysis was carried out and existing shortcomings were detected. Conclusion: The current knowledge of genetic diversity of A. albopictus is based on genetic markers that exhibit significant problems reported in the literature; therefore, vector control programs targeting A. albopictus populations, may be compromised.

RESUMEN Introducción: Aedes (Stegomyia) albopictus (Skuse, 1894) es un vector para los virus del dengue y chicunguña en la naturaleza, junto con cerca de 24 arbovirus en condiciones de laboratorio. El conocimiento de la diversidad genética de los insectos vectores es fundamental para el control eficaz y la eliminación de enfermedades transmitidas por estos. Objetivo: Aquí se determinó el escenario actual de la diversidad genética en poblaciones naturales de A. albopictus a través de una revisión sistemática. Metodología: Se pudieron establecer los primeros registros y distribución de las poblaciones de A. albopictus en el mundo, así como su diversidad genética, estructura genética poblacional y marcadores moleculares utilizados para determinar su diversidad genética. Resultados: A. albopictus se distribuye en todo el mundo con poblaciones genéticamente estructuradas y baja diversidad; Sin embargo, el 89,5% de la diversidad genética conocida se basa en el uso de RFLP, aloenzimas, isoenzimas y marcadores moleculares mitocondriales que presentan problemas significativos según la literatura. Una vez obtenidos los resultados, se realizó un análisis crítico y se detectaron deficiencias existentes. Conclusión: El conocimiento actual de la diversidad genética de A. albopictus se basa en marcadores genéticos que presentan problemas significativos reportados en la literatura; Por lo tanto, los programas de control de vectores dirigidos a las poblaciones de A. albopictus pueden verse comprometidos.

Situación epidemiológica de la intoxicación por sustancias químicas en el departamento del meta-colombia, periodo 2009-2014 / Epidemiological situation of poissoning with chemical substances in the department of meta-colombia, period 2009-2014

Introducción: La intoxicación por sustancias químicas es un problema de salud pública, que afecta a la población de los municipios del departamento del Meta. Objetivo: Describir la situación epidemiológica de la intoxicación por sustancias químicas en el Meta. Metodología: Se realizó un estudio descriptivo de corte transversal, utilizando base de datos estatales de salud pública (2009-2014) constituida por 5.208 casos de intoxicación reportadas en este periodo, se calcularon la incidencia de periodo y la tasa de mortalidad; se analizaron variables epidemiológicas de morbilidad, mortalidad, tipo de sustancia, ubicación geográfica, tipo y vía de exposición, edad y sexo. Resultados: Los plaguicidas ocasionan el mayor número de intoxicaciones del Meta, causando el 68% de la incidencia y el 66% de la mortalidad, otro tipo de sustancias causan el 27,7% de los casos de morbilidad y 34% de la mortalidad. El 52,1% de las intoxicaciones ocurren de manera accidental, seguidas por la intención suicida y ocupacional con el 21,2% y 18,1% respectivamente; las vías de exposición fueron la oral, la respiratoria y la dérmica. Discusión: Meta es un departamento caracterizado por alta producción agrícola y una frontera agrícola en expansión, lo cual explicaría la elevada incidencia de los plaguicidas, la utilización de sustancias químicas en suicidios ocurren debido al fácil acceso que se tiene de las sustancias, la exposición ocupacional está ligada a la actividad agrícola y pecuaria, la exposición accidental ocurre por manejo inadecuado de sustancias químicas en las viviendas y la contaminación ambiental. Conclusiones: la actividad agropecuaria del Meta, junto con actividades cotidianas como la limpieza y el control de plagas en las viviendas, traen consigo la utilización de sustancias químicas, esta proximidad permite la exposición a estas sustancias y la posterior intoxicación que generan morbilidad y mortalidad humana.

Introduction: Chemical poisoning is a public health problem, affecting the population of the municipalities of Meta. Objective: To describe the epidemiological situation of chemical poisoning in the department of Meta. Methodology: A descriptive cross-sectional study was conducted, using statal public health data bases (2009-2014) consisting of 5,208 cases of poisoning reported in this period. The incidence, morbidity, mortality, substance type, geographic location, type and route of exposure, age and sex were analyzed. Results: Pesticides cause the highest number of poisonings of the Meta, causing 68% of incidence and 66% of mortality, and other types of substances cause 27.7% of cases of morbidity and 34% of mortality. 52.1% of the poisonings occur accidentally, followed by suicidal and occupational intent with 21.2% and 18.1% respectively; the routes of exposure were oral, respiratory and dermal. Discussion: Meta is a department characterized by high agricultural production and agricultural frontier expansion, which would explain the high incidence of pesticides, the use of chemicals in suicides occur due to the easy access of substances; occupational exposure is linked to agricultural and livestock activities, accidental exposure occurs through improper handling of chemicals in homes and environmental pollution. Conclusions: Agricultural activity in the department of Meta, along with everyday activities such as cleaning and pest control in homes bring the use of chemicals, this proximity allows exposure to these substances and the subsequent intoxication which generates morbidity and human mortality.

First report of the Phe1534Cys kdr mutation in natural populations of Aedes albopictus from Brazil.

BACKGROUND: Knockdown resistance (kdr), caused by alterations in the voltage-gated sodium channel (NaV), is one of the mechanisms responsible for pyrethroid (PY) resistance. In the Asian tiger mosquito, Aedes albopictus, at least four different mutations were described in the IIIS6 NaV segment in populations from Asia, North America and Europe. In contrast, in Aedes aegypti at least 12 non-synonymous mutations have been reported at nine different codons, mostly in the IIS6 and IIIS6 NaV segments. The Phe1534Cys kdr mutation in the IIIS6 NaV segment is the most prevalent in populations of Ae. aegypti worldwide, also found in Ae. albopictus from Singapore. Herein, we investigated the DNA diversity corresponding to the IIS6 and IIIS6 NaV segments in natural populations of Ae. albopictus from Brazil. METHODS: DNA from eight Brazilian Ae. albopictus natural populations were individually extracted and pooled by states of origin, amplified, cloned and sequenced for the corresponding IIS6 and IIIS6 NaV segments. Additionally, samples from each location were individually genotyped by an allelic specific PCR (AS-PCR) approach to obtain the genotypic and allelic frequencies for the 1534 NaV site. RESULTS: No non-synonymous substitutions were observed in the IIS6 sequences. However, the Phe1534Cys kdr mutation was evidenced in the Ae. albopictus NaV IIIS6 segment sequences from Paraná (PR) and Rondônia (RO) states, but not from Mato Grosso (MT) state. The 1534Cys kdr allele varied from 3% (Marilena/PR and Porto Velho/RO) to 10% (Foz do Iguaçu/PR). To our knowledge, this paper reports the first occurrence and provides distribution data of a possible kdr mutation in Ae. albopictus in South America. CONCLUSION: The emergence of a likely kdr mutation in Ae. albopitus natural populations is a signal of alert for vector control measures since PY are the most popular insecticides adopted by residents. Additionally, once the kdr allele is present, its frequency tends to increase faster under exposition to those compounds. Although the Asian tiger mosquito is not incriminated as an important vector of dengue, chikungunya and Zika viruses in South America, its importance in this regard has been extensively discussed since Ae. albopictus is rapidly spreading and can also migrate between sylvatic and urban environments. Therefore, insecticide resistance monitoring initiatives should also be extended to Ae. albopictus in Brazil in order to maintain chemical compounds as an efficient vector control tool when needed.

Prevalencia de vida por autorreporte y factores asociados de infecciones de transmisión sexual en estudiantes universitarios de Pamplona (Colombia), 2013, estudio SEXUNI / Prevalence of life by self-reported and associated factors of sexually transmitted infections in university students in Pamplona (Colombia), 2013, SEXUNI study / Prevalencia de vida por auto-relato e fatores associados de infecções sexualmente transmissíveis entre os estudantes universitários em Pamplona (Colômbia), 2013, estudo SEXUNI

Introducción. La transición entre la adolescencia y el inicio de la edad adulta, se ha identificado como una etapa crítica en el desarrollo de los adultos jóvenes. Tal etapa está influenciada por un continuo cambio social y sexual. Objetivo. Determinar la prevalencia de vida por autorreporte y los factores asociados a infecciones de transmisión sexual, en una muestra de estudiantes colombianos de una universidad pública. Metodología. Se llevó a cabo un estudio descriptivo transversal en estudiantes universitarios de 18 a 26 años de edad; el tamaño de la muestra fue de 551 participantes. La información de la infección de transmisión sexual se evaluó por medio del autorreporte, mediante un cuestionario estructurado. Resultados. Los estudiantes que declararon tener más de dos parejas actualmente, los ateos o con 'otra' creencia religiosa y quienes manifestaron ser homosexuales presentaron los mayores porcentajes de infecciones de transmisión sexual según el autorreporte (26,5 %, 30,5 % y 45,2 %, respectivamente). En el análisis de regresión logística se encontró que las características que mostraban asociación con haber desarrollado, al menos una vez en la vida, una infección de transmisión sexual, fueron: ser hombre (odds ratio, OR=2,49; IC95% 1,41-4,38), ser mayor de 23 años (OR=2,08; IC95% 1,12-3,89), ser homosexual (OR=7,81; IC95% 3,90-15,67), ser bisexual (OR=5,09; IC95% 1,91-13,56), haber ini-ciado relaciones sexuales antes de los 15 años (OR=4,22; IC95% 1,22-14,60) y tener actualmente más de dos parejas sexuales (OR=4,59; IC95% 1,45-14,52). Conclusión. La prevalencia de vida fue alta entre la muestra estudiada. Estos resultados muestran la necesidad de generar acciones en salud que integren medidas educativas para concientizar sobre el uso de preservativos.

Introduction. The transition between adolescence and early adulthood has been identified as a critical stage in the development of young adults. This stage is influenced by continuous social and sexual change. Objective. To determine the lifetime prevalence of sexually transmitted infections and associated factors on a sample of Colombian students from a public university. Methodology. A cross-sectional descriptive study was carried out on college students aged between 18 to 26 years of age; our sample size was 551 participants. Information on the sexually transmitted infection was assessed through self-report, using a questionnaire structured. Results. Students who reported having more than two partners currently, atheists or with 'other' religious beliefs and those who claimed to be homosexual had the highest percentage of sexually transmitted infections according to self-report (26.5%, 30.5% and 45, 2%, respectively).In the logistic regression analysis, the characteristics that showed an association with having deve-loped, at least once in life, a sexually transmitted infection were: being male (odds ratio, OR = 2.49 CI95% 41-4,38), being older than 23 years (OR = 2.08 CI95% 1.12-3.89), being homosexual (OR = 7.81 CI95% 3.90-15.67), being bisexual (OR = 5.09 CI95% 1.91-13.56), having started sexual intercourse before age 15 (OR = 4.22 CI95% 1.22-14.60) and currently having more than two sexual partners (OR = 4.59 CI95% 1.45-14.52). Conclusion. The lifetime prevalence was high among the sample studied. These results show the need of generating actions on health that integrate educational measures to raise awareness about the use of condoms

Introdução. A transição entre a adolescência e o início da idade adulta, tem sido identificada como uma fase crítica no desenvolvimento dos adultos jovens. Tal etapa é influenciada por uma mudança continua social e sexual. Objetivo. Determinar a prevalência de vida por auto-relato e fatores associados às doenças sexualmente transmissíveis, em uma amostra de estudantes colombianos de uma universidade pública colombiana. Metodologia. Foi realizado um estudo descritivo transversal nos estudantes universitários com idade entre 18 a 26 anos; o tamanho da amostra foi de 551 participantes. A Informação da infecção sexualmente transmissível foi avaliada através da auto-relatório, com questionário estruturado em cumplimento de uma pesquisa. Resultados. Os estudantes que relataram ter mais de dois casais na atualidade, os ateus ou com 'outra' crença religiosas e aqueles que afirmaram ser homossexuais, tiveram as maiores taxas de infe-cções sexualmente transmissíveis segundo o auto-relato (26,5%, 30,5% e 45, 2%, respectivamente).Na análise de regressão logística revelou, que as características que mostraram associação com ter desenvolvido pelo menos uma vez na vida uma infecção sexualmente transmissível foram: ser do sexo masculino (odds ratio, OR=2,49; IC95% 1,41-4,38), ter mais de 23 anos (OR=2,08; IC95% 1,12-3,89), Ser homosexual (OR=7,81; IC95% 3,90-15,67), Ser bisexual (OR=5,09; IC95% 1,91-13,56) ter começado relações sexuais aos 15 anos (OR = 4,22, IC 95%: 1,22-14,60) e ter atualmente mais de dois casais (OR = 4,59, IC 95%: 1,45-14,52 ). Conclusão. A prevalência da vida foi elevada entre a população estudada. Esses resultados mostram a necessidade de gerar ações de saúde que integram medidas educacionais para aumentar a conscien-tização sobre o uso de preservativos.

Mortalidad en pacientes menores de edad con diagnóstico de dengue y su relación con el uso de Dipirona / Mortality in minor patients with diagnosis of dengue and its relationship with the use of Dipirone

Introducción: El dengue es una de las diez causas de hospitalización más frecuentes en los servicios de urgencias de pediatría, en la atención sintomática se utiliza la Dipirona como antipirético, la guía clínica de manejo del dengue de la Organización Panamericana de la Salud (OPS) evidencia restricciones para su uso en pacientes con dengue y según la Guía de Atención Clínica Integral del paciente con dengue, no se debe administrar en pacientes pediátricos. Objetivo: Determinar la relación de la Dipirona con casos de mortalidad en menores de 16 años con dengue en el Meta. Materiales y métodos: Se realizó un estudio de casos y controles basado en la mortalidad por dengue en menores de edad reportados al Sistema de Vigilancia en Salud Pública del departamento del Meta, años 2008 a 2011. Resultados: La razón de las ventajas (OR) evidencia que la mortalidad por dengue es 17,6 veces mayor en menores de edad que recibieron Dipirona con un intervalo de confianza de 95% entre 3,7-84,5 y un valor de P de 0,0002. Conclusión: El grupo de casos que recibió Dipirona en su tratamiento presentó una mayor mortalidad, la revisión de literatura no evidencia resultados sobre la relación de la Dipirona y mortalidad en niños con dengue, se debe seguir estudiando el fenómeno para contar con mayor evidencia científica.

Introduction: Dengue is one of the ten most frequent causes of hospitalization in the emergency department of pediatrics where Dipyrone is used as an antipyretic in the symptomatic care. The clinical management guide for dengue of the Panamerican Health Organization (PHO) evidences restrictions for its use in patients with dengue, and according to the Integral Clinical Care Guide for patients with dengue, it should not be administered in pediatric patients. Objective: To determine the relationship between the uses of Dipyrone with the cases of mortality in children under 16 who suffered from dengue in Meta. Materials and methods: A case-control study was conducted based on mortality from dengue in minors reported to the Surveillance System in Public Health in the department of Meta, from 2008 to 2011. Results: The odds ratio (OR) shows that dengue mortality is 17.6 times greater in children Dipyrone treated with a confidence interval of 95% between 3.7 to 84.5 and a P value of 0.0002. Conclusion: The case group who received Dipyrone in their treatment had a higher mortality. There is no evidence or results in the literature review about the relationship of Dipyrone and mortality in children with dengue. This phenomenon should continue to be studied to have greater scientific evidence.