Tinea capitis outbreak and other superficial mycosis in an urban community of Medellín / Brote de tinea capitis y otras micosis superficiales en una comunidad urbana de Medellín

Introduction. Dermatophytoses are superficial fungal infections of the keratinized epithelium like tinea capitis. The latte mainly affects school-vulnerable populations. Carpinelo is a peripheral neighborhood in Medellín with poor socioeconomic conditions and where a suspected tinea capitis outbreak took place. Objective. To study and characterize, clinically and microbiologically, patients with suspected dermatophytosis in Carpinelo. Material and methods. We carried out a descriptive and longitudinal study with an active case search of tinea capitis in children and their relatives from the Jardín Educativo Buen Comienzo community in Carpinelo. Patients were clinically evaluated, and samples of scales and hair were taken to perform mycological studies with a 10 % potassium hydroxide and culture in Sabouraud and Mycosel agar. We analyzed the data with the statistical program SPSS™. 25 version. Results. Fifty-seven individuals were studied: 47 were children with a mean age of six years and a ratio of 2:1 male to female. Patients with confirmed diagnosis presented the following clinical forms: tinea capitis (78.95%), tinea faciei (15.79%) or tinea corporis (10.52%). Out of the total, 69.76% of the patients had previous treatment with steroids. The direct test was positive in 53.84% of the samples, and 46.15% had positive cultures. The isolated species were: Microsporum canis (77.77%), Trichophyton spp. (11.11%), Trichophyton rubrum (5.55%), and Malassezia spp. (5.55 %). Conclusion. Tinea capitis was the most common clinical form, and M. canis was the most frequently isolated species. The use of steroids as the first and only option for empiric treatment was worth of notice. The findings of this study point out the importance of microbiological diagnosis in choosing the best treatment for the patients.

Introducción. Las dermatofitosis son infecciones fúngicas superficiales de epitelios queratinizados. La tinea capitis es una de ellas y afecta a poblaciones escolares vulnerables. Carpinelo es un barrio del área periférica de Medellín con precarias condiciones socioeconómicas. Ante la sospecha de un brote de dermatofitosis, los afectados fueron evaluados. Objetivo. Evaluar clínica y microbiológicamente pacientes del barrio Carpinelo con sospecha de micosis cutáneas para determinar la presencia de un brote por dermatofitos. Materiales y métodos. Se llevó a cabo un estudio descriptivo, de corte longitudinal, con muestreo a conveniencia. Se hizo una búsqueda activa de casos en el Jardín Educativo Buen Comienzo de Carpinelo en niños de la institución y sus familiares. Se evaluaron clínicamente y se tomaron muestras de escamas y cabellos para exámenes directos y cultivos microbiológicos. Se analizó el perfil demográfico, clínico y micológico, con el programa estadístico SPSS™, versión 25. Resultados. Se estudiaron 57 pacientes, 47 eran menores de edad con una media de edad de seis años; se observó una proporción de hombres y mujeres de 2:1. Los pacientes con resultados positivos se diagnosticaron con tinea capitis (78,95 %), tinea faciei (15,79 %) y tinea corporis (10,52 %). El 75,43 % de los pacientes recibió tratamiento previo y de estos el 69,73 % fue con esteroides. El examen directo fue positivo en el 53,84 % y los cultivos en el 46,5 % de los casos. Los agentes aislados fueron: Microsporum canis (77,77 %), Trichophyton spp. (11,11 %), Trichophyton rubrum (5,55 %) y Malassezia spp. (5,55 %). Conclusión. Tinea capitis fue la presentación clínica más común y M. canis el dermatofito más frecuentemente aislado. Llamó la atención el uso de esteroides como primera y única opción del tratamiento empírico' lo cual resalta la importancia del diagnóstico microbiológico para proporcionar la terapia apropiada.

Brote de tinea capitis y otras micosis superficiales en una comunidad urbana de Medellín

Introducción. Las dermatofitosis son infecciones fúngicas superficiales de epitelios queratinizados. La tinea capitis es una de ellas y afecta a poblaciones escolares vulnerables. Carpinelo es un barrio del área periférica de Medellín con precarias condiciones socioeconómicas. Ante la sospecha de un brote de dermatofitosis, los afectados fueron evaluados. Objetivo. Evaluar clínica y microbiológicamente pacientes del barrio Carpinelo con sospecha de micosis cutáneas para determinar la presencia de un brote por dermatofitos. Materiales y métodos. Se llevó a cabo un estudio descriptivo, de corte longitudinal, con muestreo a conveniencia. Se hizo una búsqueda activa de casos en el Jardín Educativo Buen Comienzo de Carpinelo en niños de la institución y sus familiares. Se evaluaron clínicamente y se tomaron muestras de escamas y cabellos para exámenes directos y cultivos microbiológicos. Se analizó el perfil demográfico, clínico y micológico, con el programa estadístico SPSS™, versión 25. Resultados. Se estudiaron 57 pacientes, 47 eran menores de edad con una media de edad de seis años; se observó una proporción de hombres y mujeres de 2:1. Los pacientes con resultados positivos se diagnosticaron con tinea capitis (78,95 %), tinea faciei (15,79 %) y tinea corporis (10,52 %). El 75,43 % de los pacientes recibió tratamiento previo y de estos el 69,73 % fue con esteroides. El examen directo fue positivo en el 53,84 % y los cultivos en el 46,5 % de los casos. Los agentes aislados fueron: Microsporum canis (77,77 %), Trichophyton spp. (11,11 %), Trichophyton rubrum (5,55 %) y Malassezia spp. (5,55 %). Conclusión. Tinea capitis fue la presentación clínica más común y M. canis el dermatofito más frecuentemente aislado. Llamó la atención el uso de esteroides como primera y única opción del tratamiento empírico, lo cual resalta la importancia del diagnóstico microbiológico para proporcionar la terapia apropiada.

Introduction. Dermatophytoses are superficial fungal infections of the keratinized epithelium like tinea capitis. The latte mainly affects school-vulnerable populations. Carpinelo is a peripheral neighborhood in Medellín with poor socioeconomic conditions and where a suspected tinea capitis outbreak took place. Objective. To study and characterize, clinically and microbiologically, patients with suspected dermatophytosis in Carpinelo. Material and methods. We carried out a descriptive and longitudinal study with an active case search of tinea capitis in children and their relatives from the Jardín Educativo Buen Comienzo community in Carpinelo. Patients were clinically evaluated, and samples of scales and hair were taken to perform mycological studies with a 10 % potassium hydroxide and culture in Sabouraud and Mycosel agar. We analyzed the data with the statistical program SPSS™. 25 version. Results. Fifty-seven individuals were studied: 47 were children with a mean age of six years and a ratio of 2:1 male to female. Patients with confirmed diagnosis presented the following clinical forms: tinea capitis (78.95%), tinea faciei (15.79%) or tinea corporis (10.52%). Out of the total, 69.76% of the patients had previous treatment with steroids. The direct test was positive in 53.84% of the samples, and 46.15% had positive cultures. The isolated species were: Microsporum canis (77.77%), Trichophyton spp. (11.11%), Trichophyton rubrum (5.55%), and Malassezia spp. (5.55 %). Conclusion. Tinea capitis was the most common clinical form, and M. canis was the most frequently isolated species. The use of steroids as the first and only option for empiric treatment was worth of notice. The findings of this study point out the importance of microbiological diagnosis in choosing the best treatment for the patients.

Neurophysiological Findings in Critical COVID-19 Patients With Peripheral Nervous System Manifestations.

INTRODUCTION: Coronavirus disease 2019 patients hospitalized in intensive care units develop neuromuscular manifestations. However, to our knowledge, a study describing the neurophysiological findings in these patients has not been reported. The objective of this study was to diagnose the cause of neuromuscular deficit in severe coronavirus disease 2019 patients, through neurophysiological examination. METHODS: This is a retrospective, observational case series. Data were collected from April 13, 2020, to May 31, 2020. Twenty-two coronavirus disease 2019 patients with generalized neuromuscular deficit during intensive care unit hospitalization were studied. Neurophysiological examinations included motor and sensory peripheral nerve conductions, needle electromyography, F waves, and repetitive nerve stimulation. RESULTS: The subjects were 14 men (63.6%) and eight women, ranged from 35 to 74 years old (58.0, interquartile ranges 50.7-66.2). Intensive care unit hospitalization time ranged from 14 to 82 days (median 37.5, interquartile ranges 22.7-55.0). Through neurophysiological examination, myopathy was diagnosed in 17 patients (77.3%) and polyneuropathy in four (18.2%). Focal neuropathies were diagnosed in 12 patients (54.6%), with a total of 19 affected nerves. Common peroneal nerve lesions at the fibular head (68.4%) and ulnar nerve lesions at the elbow level (21.1%) were the most frequent locations. No significant differences were established between neurophysiological findings and clinical or analytical data. CONCLUSIONS: In critical coronavirus disease 2019 patients with neuromuscular complaints, neurophysiological examination provides an accurate diagnosis-useful to select treatment measures and establish the prognosis of recovery. Neurophysiological findings are similar to those described for critical illness neuromuscular disease, with myopathy being the most frequent diagnosis.

"Todo Se Hace de Corazón:" An Examination of Role and Identity Among Latina Promotoras de Salud.

Promotoras de salud are community health workers that mostly help the underserved members of Latinx communities. They seek to reduce health disparities through community engagement and work that is voluntary or mostly unpaid. While there is evidence that promotoras aid in prevention, follow-up care, and treatment adherence, little is known about promotoras themselves, specifically, the impact that fulfilling their roles has on their views of themselves and their service identities. Fourteen Spanish-speaking, Latina promotoras were interviewed individually about their experiences and their motivation for the role. Four themes emerged from the content analysis of the participant responses: "Uno Nace Siendo Promotora:" One is Born Being a Promotora, "Poner Esa Semillita:" To Plant a Seed by Sharing Knowledge, "Es un Regalo Ser Promotora:" It is a Gift to be a Promotora, and "Se Hace por Amor pero también Hay Necesidad:" A Labor of Love but there are Needs too. The findings show that assuming and enacting the promotora role had positive benefits, both personal and professional, despite the often-limited recognition they received. The findings have multiple implications for the development of health and prevention programs, particularly for those that involve promotoras de salud.

Las promotoras de salud son trabajadoras comunitarias quienes, en su mayoría, ayudan a las personas que no reciben suficientes servicios en las comunidades Latinas. Las promotoras procuran reducir las disparidades de salud a través de su participación en la comunidad y del trabajo voluntario que llevan a cabo. Aún cuando existen constancias que las promotoras ayudan en la prevención, el seguimiento de los cuidados de salud, y la adherencia al tratamiento, poco se sabe acerca de las promotoras en su carácter más personal, específicamente, el impacto que el cumplimiento de sus funciones tiene en sus identidades, a nivel personal o de servicio. Catorce promotoras Latinas fueron entrevistadas individualmente para conocer más sobre sus experiencias como promotoras y sus motivos para desempeñar el papel de promotora. Cuatro temas surgieron del análisis de contenido de las respuestas de las participantes: "Uno Nace Siendo Promotora," "Poner Esa Semillita" Compartiendo Conocimiento, "Es un Regalo Ser Promotora," y "Se Hace por Amor Pero También Hay Necesidad." Los resultados muestran que el asumir y promulgar el papel de promotora tuvo beneficios positivos, tanto personales como profesionales, a pesar del reconocimiento a menudo limitado que recibieron. Los resultados tienen múltiples implicaciones para el desarrollo de programas de salud y prevención, particularmente para aquellos que involucran a promotoras de salud. PUBLIC SIGNIFICANCE STATEMENT: Latina promotoras de salud (i.e., Latina community health workers) largely enjoy their community engagement and are fulfilled by their roles. They particularly appreciate the opportunity to disseminate health related knowledge and see themselves as uniquely able to reach Latinx underserved communities. While they view their work as a "labor of love" they would appreciate some level of compensation.

A comprehensive approach to complementary and alternative medicine usage among patients from a vascular department.

INTRODUCTION: Use of complementary and alternative medicine (CAM) therapies had been described in patients with disabling, chronic and painful conditions; these characteristics define the majority of vascular surgery (VS) entities. A lack of disclosure about CAM use from patients has been universally cited and may impact effective patient-doctor communication. Our primary objective was to describe CAM use, modalities, perceived benefits, safety, and associated factors among adult patients attending a VS outpatient clinic; we additionally explored patient's attitudes about CAM disclosure with their primary vascular surgeon. METHODS: This cross-sectional study invited 223 consecutive outpatients to an interview where the ICAM-Q (International Complementary and Alternative Medicine Questionnaire) and the PDRQ-9 (Patient-Doctor Relationship Questionnaire-9 items) were applied. In addition, sociodemographics, vascular disease and treatment-related information, comorbidity, and disease severity characteristics were obtained. Appropriated statistics was used; multiple logistic regression analysis identified factors associated to CAM use. All statistical tests were two-sided, and a p value ≤ 0.05 was considered significant. IRB approval was obtained. RESULTS: Patients recruited were primary females (69%) and had a median age of 65 years (54-75). Most frequent vascular diagnoses were chronic venous insufficiency (36.2%) and peripheral artery disease (26%). There were 104 (46.6%) patients who referred CAM use, primarily self-helped practices (96%), and use of herbal, vitamins, or homeopathic medicines (23.7%). Overall, the majority of the patients perceived CAM modalities helpful and 94.6% denied any adverse event. Female sex (OR: 1.768, 95% CI: 0.997-3.135, p = 0.051) and hospitalization during the previous year (OR: 3.173, 95% CI: 1.492-6.748, p = 0.003) were associated to CAM use. The majority of the patients (77%) agreed about CAM disclosure with their primary vascular surgeon; meanwhile, among CAM users, up to 54.9% did not disclose it, and their main reasons were "Doctor didn't ask" (32%) and "I consider it unnecessary" (16%). The patient-doctor relationship was rated by the patients with high scores. CONCLUSIONS: CAM use is frequent and perceived as safe and beneficial among VS outpatients; nonetheless, patients do not disclose CAM use with their primary vascular surgeons, and a wide range of reasons are given by the patients that prevent effective and open communication.

Masa parotídea de rápido crecimiento, representando un dilema diagnóstico / Rapidly growing parotid gland mass, posing a diagnostic dilemma

La toxoplasmosis es una infección parasitaria con distribución mundial, cuyo huésped definitivo son los felinos. Se presenta con un cuadro clínico sintomático difuso solo en el 20 % de los pacientes inmunocompetentes. Además del malestar general, fiebre y adinamia, el hallazgo más importante lo constituye la presencia de adenopatías a nivel cervical. Describimos un caso poco común de un paciente masculino con masa parotídea izquierda de crecimiento rápido, en quien se practicó parotidectomía, a fin de descartar la enfermedad linfoproliferativa. Se comprobó compromiso por Toxoplasma gondii luego de múltiples análisis.

Toxoplasmosis is a parasitic infection with worldwide distribution, whose definitive host is felines. It is only symptomatic in less than 20% of immunocompetent patients. Symptoms may vary from general malaise, fever, weakness and the presence of cervical lymphadenopathy. A description of an uncommon presentation of this disease in a male patient with progressively growing left-sided parotid mass, in whom a parotidectomy was performed to rule out lymphoproliferative disease. Infection by Toxoplasma gondii was diagnosed after a series of exams

Sweet or Bland Dreams? Taste Loss in Isolated REM-Sleep Behavior Disorder and Parkinson's Disease.

BACKGROUND: Hyposmia and isolated REM sleep behavior disorder are well-established features of prodromal Parkinson's disease (PD). OBJECTIVES: The objective of the present study was to evaluate whether taste loss (reported in PD and possibly suggesting brain stem involvement) is present at the isolated REM sleep behavior disorder stage. METHODS: We assessed taste function using the Taste Strip Test (evaluating 4 concentrations of bitter, sweet, sour, and salty) in 44 participants with isolated REM sleep behavior disorder, 19 with PD, and 29 controls. All participants underwent video-polysomnography, standardized questionnaires, and clinical examination, including olfactory assessment. RESULTS: Participants with isolated REM sleep behavior disorder and PD had lower taste scores than controls. There was no difference between isolated REM sleep behavior disorder and PD cohorts, nor was there any correlation between taste and olfaction, age, disease duration, cognition, or autonomic function. CONCLUSION: This study demonstrates for the first time the presence of taste impairment in isolated REM sleep behavior disorder that is independent of olfactory dysfunction and comparable to participants with PD. © 2021 International Parkinson and Movement Disorder Society.

Síndrome cistocerebral: a propósito de un caso / Cystocerebral syndrome: A case report

RESUMEN El síndrome cistocerebral fue descrito por primera vez en 1990 por Blackburn y Dunn. Los casos estudiados fueron varones ancianos con síndrome confusional agudo y retención urinaria aguda que, tras un drenaje vesical, presentaron resolución completa del cuadro clínico. Se reporta el caso de un anciano con disminución rápida del nivel de consciencia, mioclonías, hipotensión arterial, bradicardia y retención aguda de orina que experimentó total remisión del cuadro clínico luego del drenaje vesical correspondiente. Se describen, asimismo, los posibles mecanismos implicados en el origen de este síndrome y las alteraciones hemodinámicas y autonómicas subyacentes. Se sugiere considerar al síndrome cistocerebral en el diagnóstico diferencial de pacientes varones ancianos con síndrome confusional o deterioro cognitivo e hipertrofia prostática y que presenten, además, un episodio de retención urinaria aguda.

SUMMARY Cystocerebral syndrome was first described in 1990 by Blackburn and Dunn, in elderly males with acute confusion syndrome and urinary retention, who after bladder drainage experienced full resolution of the clinical picture. We report the case of an elderly male patient with Cystocerebral syndrome and symptoms such as a rapid decrease in consciousness level, myoclonies, hypotension, bradycardia and acute urinary retention who, after bladder drainage presented a complete remission of the clinical picture. The potential mechanisms involved in the origin of this syndrome are described, as well as its underlying hemodynamic and autonomic alterations. Cystocerebral syndrome should be considered in the differential diagnosis of patients with a confusional syndrome and cognitive impairment, diagnosed with prostatic hypertrophy and presenting, in addition, an episode of acute urinary retention.

Systemic lupus erythematosus diagnosis impacts clinical outcomes of arteriovenous fistulas in comparison to other end-stage renal disease etiologies.

OBJECTIVES: Arteriovenous fistulas primary patency at one-year occurs in 43-85% of the patients with end-stage renal disease. The diagnosis attributable to end-stage renal disease has been suggested to impact arteriovenous fistulas outcomes. The objective was to compare primary patency at one week, 1, 3, 6, and 12 months of follow-ups, among systemic lupus erythematosus patients and two control groups; additionally, we evaluated the impact of systemic lupus erythematosus to predict early patency loss. METHODS: A retrospective review of charts from arteriovenous fistulas created between 2008 and 2017 was performed. One-hundred thirty-four patients were identified and classified according to end-stage renal disease attributable diagnosis as: systemic lupus erythematosus cases (N = 14), control-group-1 (91 patients with primarily diabetes and hypertension), and control-group-2 (29 patients with idiopathic end-stage renal disease). A case-control matched design (1:2:1) was proposed. Logistic regression analysis and Kaplan-Meier curves were used. Institutional Review Board approval was obtained. RESULTS: More systemic lupus erythematosus patients lost primary patency at 3 (28.6%) and 12 months (71.4%) than patients from control-groups-1 (vs. 3.6% and 35.7%, respectively) and -2 (vs. 0% and 14.3%, respectively), (p ≤ 0.011 for both). Days of primary patency survival were shorter in systemic lupus erythematosus patients (p = 0.003). Systemic lupus erythematosus diagnosis was the only factor associated with early patency loss, HR: 3.141, 95%CI: 1.161-8.493 (systemic lupus erythematosus diagnosis vs. control-group-1) and HR: 12.582, 95%CI: 1.582-100.035 (systemic lupus erythematosus diagnosis vs. control-group-2). CONCLUSIONS: Diagnosis attributable to end-stage renal disease has a major impact on arteriovenous fistula outcomes in patients. Systemic lupus erythematosus patients have an increased risk of arteriovenous fistulas patency loss within the first six months of follow-up. Patients with idiopathic end-stage renal disease had an excellent one year arteriovenous fistula patency survival.

Tratamiento homeopático de la cefalea tensional con Nux vómica: reporte de un caso / Homeopathic treatment of tension headache with Nux vomica: a case report

La cefalea tensional constituye una patología de gran prevalencia, que tiene impactos no solo a nivel de la salud física de las personas sino también a nivel laboral y social. Considerando lo anterior, desde Medicinas complementarias existan diferentes herramientas terapéuticas, entre ellas la Homeopatía. El presente trabajo describe el reporte de un caso exitoso de un cuadro de cefalea tensional manejado homeopáticamente con el medicamento Nux vómica en el Centro de Atención de Salud a Estudiantes (CASE), dentro de la consulta de Medicina Alternativa de la Universidad Nacional de Colombia- Sede Bogotá, durante los años 2018-2019. (Texto tomado de la fuente).

Neurofibroma del asa del hipogloso: reporte de caso / Neurofibroma from the Ansa Hypoglossi: Case report

Los neurofibromas son tumores benignos con origen en la vaina de nervios periféricos; aunque raros, son diagnosticados en pacientes sin historia previa de neurofibromatosis tipo 1, en cuyo caso se constituye en una forma esporádica. Se presenta el caso de un paciente masculino de 27 años con una masa supraclavicular izquierda asintomática de crecimiento progresivo. En la intervención se encontró que la masa tenía origen en el asa del hipogloso.

Neurofibromas are benign tumors that originate from the sheet of peripheral nerves; even though rare, they are occasionally seen in patients with a prior history of neurofibromatosis type1, in which case a sporadic form is diagnosed. A 27-year-old male is described with a left asymptomatic supraclavicular slow growing mass, different of the suspected vagus nerve tumor. In surgery, it was found that the tumor was originating from the Ansa Hypoglossi.

Estado de coma y patrón electroencefalográfico de brote-supresión por sobredosis de Baclofeno / Coma state and the electroencephalogram burst-suppression pattern related to baclofen overdose

El baclofeno es un análogo estructural del ácido gamma-aminobutírico empleado principalmente como relajante del músculo esquelético para el tratamiento de espasticidad y distonías. Las manifestaciones clínicas de intoxicación por este fármaco, se deben a alteración del nivel de conciencia que produce somnolencia, estado de coma e incluso la muerte. Desde el punto de vista electroencefalográfico, se ha descrito en estos casos, el llamado patrón de brote- supresión. Se presenta el caso de una mujer que súbitamente presentó dificultad para la bipedestación y mutismo acinético y, posteriormente, evolucionó a un estado de coma sin causa aparente. Una evaluación minuciosa en el Servicio de Emergencia, incluyó electroencefalograma urgente que resultó compatible con un patrón continuo de brote-supresión. Ante la sospecha de una intoxicación por baclofeno, la paciente fue tratada con diálisis, la cual revirtió el cuadro clínico y normalizó la actividad electroencefalográfica en un periodo de cinco días.

Baclofen is a structural analog of gamma-aminobutyric acid, primarily used as a skeletal muscle relaxant for treatment of spasticity and dystonia. The clinical picture of baclofen intoxication includes reduction or loss of consciousness and manifestations such as sleepness, coma or even death. Electroencephalograms performed in these cases have consistently shown the so-called burst-suppression pattern. The case of a female patient who suddenly presented difficulty to still-standing and mutism and later evolved into coma, is presented. A detailed study was performed in the emergency department, including an electroencephalogram compatible with a continuous burst-suppression pattern. The patient was treated with dialysis in the face of a possible baclofen intoxication and, in a period of five days, the clinical symptoms reverted and the electroencephalographic activity was normalized.

Retraso en la mejoría del vértigo posicional paroxístico benigno asociado al consumo de vestibulosupresores / Delay on the improvement of Benign Paroxysmal Positional Vertigo associated with the use of vestibular suppressants

Introducción: el vértigo posicional paroxístico benigno (VPPB) constituye un motivo de consulta común. A pesar de contar con un manejo sencillo con la realización de maniobras los pacientes son tratados de una manera subóptima; secundario a esto, se observa la administración de medicamentos con los cuales no se logra determinar la causa central de su queja, aumentando el número de consultas. Objetivos: explorar la asociación del uso de vestibulosupresores con el tiempo de diagnóstico y recuperación de los pacientes con VPPB. Diseño: estudio observacional, descriptivo, retrospectivo. Metodología: se incluyeron pacientes con diagnóstico de VPPB; fueron distribuidos en dos grupos según el antecedente de consumo de vestibulosupresores en los últimos 3 meses, con lo cual se evaluó el tiempo de diagnóstico y mejoría, entre octubre 1 de 2010 y mayo 31 de 2017. Resultados: se reclutaron 109 pacientes, 18 hombres y 91 mujeres. Pacientes con uso reciente de vestibulosupresores 91 y sin uso 18. El diagnóstico en el primer grupo requirió varias consultas, el segundo grupo requirió solo una consulta. El tiempo de evolución en días del primer grupo comparado con el segundo fue de 76 y 47 días, respectivamente. El tiempo que pasó entre el diagnóstico y la mejoría sintomática completa fue de 41 y 31 días, respectivamente. Conclusiones: el antecedente de consumo de vestibulosupresoresvs. no consumo, genera un aumento en las consultas para llegar al diagnóstico de VPPB, mayor tiempo de evolución clínica, entre el diagnóstico y la mejoría de los síntomas, sin diferencias estadísticamente significativas.

Introduction: Benign Paroxysmal Positional Vertigo (BPPV) constitutes a common chief complaint during consultation. Despite having a simple management with the performance of maneuvers, patients are treated in a suboptimal manner; secondary to this, it is observed that the administration of medications makes it difficult to determine the cause of their chief complaint, increasing the number of consultations. Objectives: To explore the association of the use of vestibular suppressants with the time of diagnosis and recovery in patients with BPPV. Design: Observational, descriptive, retrospective study. Methods: It included patients with a diagnosis of BPPV; Patients were distributed into two groups based on the history of the use of vestibular suppressant in the previous 3 months. The time of diagnosis and improvement for said patients were evaluated between October 1 of 2010 and May 31 of 2017. Results: 109 patients were enrolled, 18 males and 91 females. Patients with recent use of vestibular suppressants were 91, and those with no history of use 18. Diagnosis in the first group required several consultations while only one was required in the second group. Duration of illness in days for the first group compared to the second was 76 and 47 days respectively, and the time between clinical diagnosis and complete symptomatic improvement was 41 and 31 days respectively. Conclusions: history of vestibular suppressant use, is associated with an increased frequency of consultations reaching a diagnosis of BPPV, greater duration of clinical condition and greater delay between the time of diagnosis and time of clinical improvement. However, this association was not found to be statistically significant.

Factores ambientales que influyen en la ictiofauna de la laguna La Mancha, sitio Ramsar, Golfo de México / Environmental factors influencing the ichthyofauna of the La Mancha lagoon, Ramsar site, Gulf of Mexico

Resumen La laguna La Mancha en el Golfo de México, es un sistema costero con categoría Ramsar por su alta biodiversidad, numerosas especies de peces dependen de el para realizar sus ciclos de vida. Fue analizada la variación espacial y temporal de la diversidad, abundancia y asociaciones de peces y su relación con los factores fisicoquímicos. Entre abril de 2005 y enero de 2008, se realizaron 95 muestreos diurnos en siete sitios donde se registraron las características del agua y la composición de la comunidad de peces. El sistema presentó variaciones espacio temporales de los parámetros físicoquímicos, definiendo ambientes contrastantes de acuerdo con los gradientes locales. Se recolectaron 5 974 individuos, pertenecientes a 50 especies, 39 géneros y 25 familias, cuatro especies son registros nuevos para el sistema. La diversidad y riqueza de especies fueron altas en el ambiente salobre y bajos en zonas dulceacuícolas. En septiembre (lluvias) y noviembre (nortes) la diversidad (H' = 1.52) y riqueza (D = 1.99) fue más alta. La abundancia de los peces fue mayor hacia la boca de conexión con el mar. La densidad y biomasa (1.17 indiv./m2, 4.33 g/m2) fue mayor en abril (secas) y el peso promedio (30.82 g/ind) en julio (lluvias). El Índice de Valor de Importancia (IVI) definió cuatro especies dominantes que representan el 75 % de la abundancia numérica y el 46 % de la captura total en peso. El Análisis de Correspondencia Canónica (ACC) mostró que la relación peces-hábitat fue explicada en un 57 % de la varianza total para los primeros dos ejes, donde las variaciones de temperatura, salinidad, oxígeno disuelto y profundidad fueron los factores ambientales que determinaron la composición, distribución, componentes comunitarios y categorías tróficas de los peces en la comunidad. Este estudio aporta información sobre la relación del ambiente con la estructura de la comunidad íctica de La Mancha, y representa una base para realizar monitoreo ecológico que permita incrementar el conocimiento necesario sobre el ecosistema y sus poblaciones de peces, con la finalidad de proponer estrategias de manejo para la conservación de los recursos pesqueros de Veracruz.

Abstract La Mancha lagoon in the Gulf of Mexico, is a coastal system with Ramsar category because of its high biodiversity, many species of fish depend on it to complete their life cycles. In this study we analyzed the spatial and temporal variation of fish diversity, abundance and associations, and its relationship with physicochemical factors. Between April 2005 and January 2008, 95 daytime samplings were carried out at seven sites, where water characteristics and the composition of fish community were recorded. The system presented spatial-temporal variations of the physicochemical parameters, defining contrasting environments according to the local gradients. A total of 5 974 fish individuals, belonging to 50 species, 39 genera and 25 families were collected; four species were new records for the system. The diversity and richness of species were high in the brackish environment and low in freshwaters areas. In September (rainy season) and November ("nortes" season), diversity (H' = 1.52) and richness (D = 1.99) were highest. Fish abundance was greater towards the mouth connecting with the sea. The density and biomass (1.17 ind/m2, 4.33 g/m2) was higher in April (dry season) and the average weight (30.82 g/ind) in July (rainy season). The Importance Value Index (IVI) defined four dominant species representing 75 % of the numerical abundance and 46 % of the total catch in weight. The Canonical Correspondence Analysis (CCA) showed that the fish-habitat relationship was explained in 57 % of the total variance for the first two axes, where the variations in temperature, salinity, dissolved oxygen and depth were the environmental factors that determined the composition, distribution, community components and trophic categories of the fish community. This study provides information on the relationship between the environment and the structure of the fish community in La Mancha, and represents a basis for ecological monitoring to increase the knowledge needed about the ecosystem and fish populations, in order to boost management strategies for the fishery resources conservation in Veracruz. Rev. Biol. Trop. 66(1): 246-265. Epub 2018 March 01.

La didáctica de la simulación Clínica: innovar en el sistema de evaluación de competencias. Estudio de caso en la Universidad Nacional del Nordeste / The didactics of clinical simulation: innovate in the system of assessment of competencies. Case study at the University Northeast National

La investigación detalla el estudio sobre las Prácticas Pedagógicas Innovadoras, acotado al ámbito universitario. Estas prácticas poseen características específicas: actitud investigativa, de revisión y transformación de las propias prácticas. El problema de investigación gira en torno a las concepciones docentes, características y valores de utilidad de las prácticas pedagógicas innovadoras de profesores universitarios de la Universidad Nacional del Nordeste. Esta presentación tiene como objetivo, exponer las prácticas pedagógicas innovadoras vinculadas a prácticas de simulación en la enseñanza clínica que llevaron adelante docentes de la Facultad de Medicina de la Universidad Nacional del Nordeste, buscando identificar la influencia de las mismas en el aprendizaje de los estudiantes. Metodológicamente nos encuadramos el paradigma cualitativo, en el tipo descriptivo- explicativo desde un estudio de casos. En este espacio comunicaremos resultados de los análisis que hemos realizado dentro de la "Práctica Final Obligatoria" de la carrera de Medicina, y específicamente en el "Gabinete de Simulación". Entre los resultados sobresalientes mencionamos que el espacio se ubicaría dentro de un Enfoque Didáctico Problematizador, identificando que los docentes se presentan como mediadores entre los estudiantes y la práctica clínica, proporcionando ayudas necesarias para que el sujeto avance progresivamente en la apropiación de los saberes y el ejercicio de las prácticas profesionales. A modo de conclusión, consideramos que estos docentes, promovieron a la innovación educativa como un "cambio justificado"

A investigação detalha o estudo das Práticas Pedagógicas Inovadoras, no âmbito universitário. Essas práticas possuem caraterísticas específicas: atitude investigativa, de revisão e transformação das próprias práticas. O problema da investigação gira em torno das concepções docentes, caraterísticas e valores de utilidade das práticas pedagógicas inovadoras dos professores universitários da Universidad Nacional del Nordeste. Essa apresentação tem como objetivo, expor as práticas pedagógicas inovadoras vinculadas a práticas de simulação no ensino clínico que levaram adiante docentes da Faculdade de Medicina da Universidade Nacional do Nordeste, buscando identificar a influência das mesmas na aprendizagem dos estudantes. Metodologicamente enquadramo-nos no paradigma qualitativo, do tipo descritivo-explicativo a partir do estudo de casos. Neste espaço vamos comunicar os resultados das análises que temos realizado dentro da "Prática Final Obrigatória" da carreira de Medicina, e especificamente no "Gabinete de Simulação". Entre os resultados sobressalientes mencionamos que o espaço estaria dentro da Abordagem Didática Problematizadora, identificando que os docentes se apresentam como mediadores entre os estudantes e a prática clínica, proporcionando ajudas necessárias para que o sujeito avance progressivamente na apropriação de saberes e o exercício das práticas profissionais. A modo de conclusão, consideramos que esses docentes, promoveram à inovação educativa como uma "mudança justificada" . Palavras chaves:-práticas pedagógicas-inovação educativas-simulação crítica

[Brain death: attitude and knowledge of medical personnel in a third level hospital]. / Muerte encefálica: actitud y conocimientos del personal médico en un hospital de especialidades.

BACKGROUND: Brain death is defined as the irreversible loss of all functions of the brain, including the brainstem. The objective is to know the attitude and knowledge toward brain death of the medical personnel involved in the process of the organ/tissue transplantation and donation in a third level hospital of Mexico City. METHODS: 67 attending physicians were interviewed with the methodology of pen, paper and a printed questionnaire. They were distributed in two groups: group A, consisting of non-surgical physicians, and group B, which was formed by surgical physicians. It was analyzed the attitude and knowledge of the criteria established in the Ley General de Salud (General Law of Health) of Mexico. Thirty-five men and 32 women (median age 42 years) responded to the survey. RESULTS: More than 90 % of both groups would wish to participate in a brain death course, and they would accept to be potential donors or receptors of transplanted organs. A high percentage knows partially the law on brain death (Ley General de Salud) and clinical procedures. Of the interviewed population, 68 % does not know the standard complementary studies to confirm the diagnosis of brain death. Non-significant differences were observed in the attitude and knowledge of both groups (p = 0.170). CONCLUSION: Physicians must improve their knowledge on brain death.

Introducción: la muerte encefálica se define como el cese irreversible de las funciones de las estructuras neurológicas intracraneales, tanto de los hemisferios cerebrales como del troncoencéfalo. El objetivo es conocer la actitud y los conocimientos que tiene ante la muerte encefálica el personal médico relacionado con el trasplante y la donación de órganos y tejidos en un hospital de tercer nivel de la ciudad de México. Métodos: fueron encuestados 67 médicos con el método de pluma, papel y un cuestionario impreso; se distribuyeron en dos grupos: grupo A no quirúrgicos y grupo B quirúrgicos. Se exploraron la actitud y los conocimientos de los criterios establecidos en la Ley General de Salud en México. Contestaron la encuesta 35 hombres y 32 mujeres, con una mediana de edad de 42 años. Resultados: más del 90 % en ambos grupos desearía participar en un curso-taller de muerte encefálica, así como ser potenciales donadores y receptores de órganos. Un alto porcentaje conoce parcialmente la ley sobre muerte encefálica y los conceptos clínicos. El 68 % de la población encuestada no conoce los estudios complementarios establecidos para confirmar el diagnóstico de muerte encefálica. Al comparar ambos grupos no se encontró diferencia significativa (p = 0.170). Conclusión: el médico debe responsabilizarse más en el dominio de la muerte encefálica.

Reactivation of herpes zoster keratitis in an adult after varicella zoster vaccination.

PURPOSE: In this study, the case of a patient who presented with reactivation of herpes zoster (HZ) keratitis and worsening of neurotrophic keratopathy, keratouveitis, and keratoconjunctivitis sicca after vaccination with live attenuated HZ vaccine (Zostavax) is described. METHOD: This is a retrospective case review. RESULTS: A 63-year-old man, with a history of HZ keratouveitis and neurotrophic keratopathy that had been quiescent for 3.5 years off medication, presented with keratouveitis 2 weeks after Zostavax administration. Oral acyclovir and topical prednisolone acetate and cyclopentolate were started, with subsequent improvement in inflammation and visual acuity. However, the patient was unable to be tapered completely off the steroids. CONCLUSIONS: HZ keratouveitis is the result of cell-mediated immunity (CMI) directed toward viral antigens within the eye. The live attenuated HZ vaccine, Zostavax, boosts the recipient's CMI to prevent reactivation of HZ. However, patients with a history of HZ keratitis may have persistent viral antigens in their corneas and can develop recurrence of keratouveitis because of the vaccine-induced increase in CMI. Vaccination should be undertaken with caution in patients with a history of HZ ophthalmicus.

Development and characterization of microsatellite markers for the Cape gooseberry Physalis peruviana.

Physalis peruviana, commonly known as Cape gooseberry, is an Andean Solanaceae fruit with high nutritional value and interesting medicinal properties. In the present study we report the development and characterization of microsatellite loci from a P. peruviana commercial Colombian genotype. We identified 932 imperfect and 201 perfect Simple Sequence Repeats (SSR) loci in untranslated regions (UTRs) and 304 imperfect and 83 perfect SSR loci in coding regions from the assembled Physalis peruviana leaf transcriptome. The UTR SSR loci were used for the development of 162 primers for amplification. The efficiency of these primers was tested via PCR in a panel of seven P. peruviana accessions including Colombia, Kenya and Ecuador ecotypes and one closely related species Physalis floridana. We obtained an amplification rate of 83% and a polymorphic rate of 22%. Here we report the first P. peruviana specific microsatellite set, a valuable tool for a wide variety of applications, including functional diversity, conservation and improvement of the species.

The human immune response to Dengue virus is dominated by highly cross-reactive antibodies endowed with neutralizing and enhancing activity.

Antibodies protect against homologous Dengue virus (DENV) infection but can precipitate severe dengue by promoting heterotypic virus entry via Fcγ receptors (FcγR). We immortalized memory B cells from individuals after primary or secondary infection and analyzed anti-DENV monoclonal antibodies (mAbs) thus generated. MAbs to envelope (E) protein domain III (DIII) were either serotype specific or cross-reactive and potently neutralized DENV infection. DI/DII- or viral membrane protein prM-reactive mAbs neutralized poorly and showed broad cross-reactivity with the four DENV serotypes. All mAbs enhanced infection at subneutralizing concentrations. Three mAbs targeting distinct epitopes on the four DENV serotypes and engineered to prevent FcγR binding did not enhance infection and neutralized DENV in vitro and in vivo as postexposure therapy in a mouse model of lethal DENV infection. Our findings reveal an unexpected degree of cross-reactivity in human antibodies against DENV and illustrate the potential for an antibody-based therapy to control severe dengue.