The Image Warping Test: A Novel Method to Quantify and Qualify Metamorphopsia.

PURPOSE: To determine the validity, accuracy and acceptability of the Image Warping Test (IWT), a novel test for the measurement of visual distortion in the central visual field. METHODS: 25 volunteers with metamorphopsia secondary to vitreoretinal pathology were recruited at a tertiary referral center. All subjects underwent ophthalmological examination and measurement of metamorphopsia via Amsler grid, Morphision, M-CHARTS and the IWT. Construct validity was determined through assessment of the association between symptoms, pathology, visual acuity, established metamorphopsia test results and IWT results. RESULTS: There was close association between subjective estimation of metamorphopsia severity and IWT score (p=0.005), between Morphision result and IWT score (p=0.015), and between the nature of vitreoretinal pathology and IWT score (p=0.007). There was no statistically significant correlation between best corrected distance visual acuity and IWT score, and between M-CHARTS score and IWT score. CONCLUSION: The IWT allows the creation of a digital map of subjective metamorphopsia which effectively measures its severity and nature, and opens the possibility to its non-invasive correction in future through inverse mapping of the distortion map onto live images.

Características del consumo de alimentos y la cultura alimentaria en convalecientes de COVID-19 / Characteristic of foods consumption and alimentary culture in COVID-19 convalescent individuals i:en

Introducción: Una nutrición adecuada es clave para desarrollar inmunidad, protección contra las enfermedades e infecciones, y apoyar la recuperación. Objetivo: Identificar las características del consumo de alimentos y la cultura alimentaria en convalecientes de COVID-19. Métodos: Se realizó un estudio observacional, descriptivo y transversal, desde mayo hasta diciembre del 2020, de 67 pacientes mayores de 20 años de edad convalecientes de la COVID-19, con resultados negativos en la prueba de reacción en cadena de la polimerasa durante un mes, quienes pertenecían a un área de salud de La Habana. Se analizaron variables sociodemográficas, dietéticas y de estado nutricional. Resultados: La enfermedad se presentó con mayor frecuencia en el sexo masculino (59,7 %) y el grupo etario de 20 a 39 años (47,8 %). Se identificó un alto porcentaje de sobrepeso global (59,7) y los alimentos de mayor consumo y preferencia fueron los energéticos en el horario de la tarde-noche (89,6 %), así como aquellos productos fritos y la piel de aves (38,8 %). La ingestión de vegetales y frutas resultó escasa (29,9 y 40,3 %, respectivamente) y la alimentación, poco variada (86,4 %), pues no consumían diariamente alimentos de los 7 grupos básicos, aunque la mayoría (70,0 %) realizaba las 3 comidas principales del día. Conclusiones: Los sujetos estudiados poseían una cultura alimentaria deficiente expresada por conocimientos escasos o errados, lo que advierte sobre la necesidad de disponer de un instrumento educativo para la adopción de actitudes y prácticas alimentarias saludables que conduzcan a la restauración de la inmunidad.

Introduction: An appropriate nutrition is the key to develop immunity, protection against diseases and infections, and support the recovery. Objective: To identify the characteristics of foods consumption and alimentary culture in COVID-19 convalescent persons. Methods: An observational, descriptive and cross-sectional study was carried out, from May to December 2020, of 67 patients over 20 years convalescent from COVID-19, with negative results in the polymerase chain reaction test for a month, who belonged to a health area of Havana city. Some sociodemographic, dietary and nutritional state variables were analyzed. Results: The disease was presented more frequently in male sex (59.7%) and the 20 to 39 age group (47-8%). A high percentage of general overweight was identified (59.7), and the most consumed and preferred foods were the energy-giving in the afternoon-night time (89.6%), as well as those fried products and poultry skin (38.8%). The consumption of vegetables and fruits was low (29.9 and 40.3%, respectively) and there was a poor variety in the diet (86.4%), since they didn't consume foods from the 7 basic groups daily, although most of them (70.0%) had 3 meals a day. Conclusions: The studied individuals possessed a poor alimentary culture expressed by limited or wrong knowledge, what is a warning about the necessity of having an educational instrument for the adoption of attitudes and healthy alimentary habits leading to the restoration of immunity.

Incidental diagnosis of asymptomatic lipaemia retinalis in a patient with uncontrolled type 2 diabetes mellitus: 'white lines'.

A man in his 60s presented for his medical retina clinic appointment, reporting increasing shortness of breath, aches and pains, and increasing insulin requirements during a difficult early lockdown. Wide-field colour fundus imaging (Optos Optomap) and an optical coherence tomography scan (Heidelberg Spectralis) revealed whitened and enlarged hyper-reflective vessels. Retinal colour photography also confirmed a creamy white discolouration of the vessels, which prompted the team to order a lipid profile. The profile showed a raised cholesterol level of 17.5 mmol/L (normal: <4mmol/L) and a marked elevated triglyceride level of 38.41 mmol/L (normal: <1.7 mmol/L).The clinical picture, alongside the biochemical results, suggested a diagnosis of secondary lipaemia retinalis due to poorly controlled diabetes. With aggressive treatment, the patient's biochemistry and vessels returned to baseline.This rare condition should be taken as an indicator of a potential underlying life-threatening medical condition and the role an ophthalmologist has in initiating potential lifesaving intervention.

Retinal Vein Occlusion in a Patient on Dabrafenib and Trametinib Therapy for Metastatic Melanoma.

The purpose of this case report is to highlight the ocular complications of dabrafenib and trametinib treatment. We discuss the case of an 81-year-old female treated with dabrafenib and trametinib for metastatic melanoma, who developed a retinal branch vein occlusion with macular edema in the right eye. The other eye was healthy. The treatment was discontinued and her macular edema was managed with a loading dose of three injections of anti-vascular endothelial growth factor (anti-VEGF) medication with a good response. The use of BRAF and MEK inhibitors is increasingly becoming widespread, and hence it is important to report cases of these adverse effects to achieve earlier diagnoses and initiate fast and effective treatments.

Big Data to Knowledge Analytics Reveals the Zika Virus Epidemic as Only One of Multiple Factors Contributing to a Year-Over-Year 28-Fold Increase in Microcephaly Incidence.

During the 2015-2016 Zika Virus (ZIKV) epidemic in Brazil, the geographical distributions of ZIKV infection and microcephaly outbreaks did not align. This raised doubts about the virus as the single cause of the microcephaly outbreak and led to research hypotheses of alternative explanatory factors, such as environmental variables and factors, agrochemical use, or immunizations. We investigated context and the intermediate and structural determinants of health inequalities, as well as social environment factors, to determine their interaction with ZIKV-positive- and ZIKV-negative-related microcephaly. The results revealed the identification of 382 associations among 382 nonredundant variables of Zika surveillance, including multiple determinants of environmental public health factors and variables obtained from 5565 municipalities in Brazil. This study compared those factors and variables directly associated with microcephaly incidence positive to ZIKV and those associated with microcephaly incidence negative to ZIKV, respectively, and mapped them in case and control subnetworks. The subnetworks of factors and variables associated with low birth weight and birthweight where birth incidence served as an additional control were also mapped. Non-significant differences in factors and variables were observed, as were weights of associations between microcephaly incidence, both positive and negative to ZIKV, which revealed diagnostic inaccuracies that translated to the underestimation of the scope of the ZIKV outbreak. A detailed analysis of the patterns of association does not support a finding that vaccinations contributed to microcephaly, but it does raise concerns about the use of agrochemicals as a potential factor in the observed neurotoxicity arising from the presence of heavy metals in the environment and microcephaly not associated with ZIKV. Summary: A comparative network inferential analysis of the patterns of variables and factors associated with Zika virus infections in Brazil during 2015-2016 coinciding with a microcephaly epidemic identified multiple contributing determinants. This study advances our understanding of the cumulative interactive effects of exposures to chemical and non-chemical stressors in the built, natural, physical, and social environments on adverse pregnancy and health outcomes in vulnerable populations.

Correlation Between Retrograde Trans-Synaptic Degeneration of Ganglion Cells and Optical Coherence Tomography Angiography Following Ischemic Stroke.

Objective Following nerve injury, the projection of posterior visual pathway lesions into the macular ganglion cell layer (GCL) region indicates retrograde trans-synaptic degeneration (RTSD) as a mechanism of functional damage. Our purpose is to assess GCL damage and the impacts of ischemic brain lesions affecting the visual pathway on macular microvascularization in patients with stroke. Methods In a case-control study, we examined 15 ischemic stroke patients who showed visual field defects and 50 healthy controls using the high-resolution optical coherence tomography (OCT) techniques such as spectral domain-OCT (SD-OCT) to measure retinal nerve fiber layer (RNFL) and GCL thicknesses, and OCT angiography (OCTA) to assess damage to the macular microvasculature. Results In the cases, the correlation was detected among the site of vascular damage, visual field defect, retinal GCL thinning, and normal RNFL thickness. Further observations were significant reductions in macular thickness, GCL thickness, outer retinal layer vascular density, and vascular area in deeper retinal layers (p < 0.05). Conclusion Our findings suggest that ocular microvasculature abnormalities could serve as diagnostic and/or prognostic markers in patients with stroke and support the described use of GCL thickness as an image marker of visual pathway RTSD after brain injury.

Estado nutricional de las gestantes a la captación del embarazo / Nutritional State of Pregnant Women at the First Gestational Visit

Introducción: Un buen estado nutricional, tanto preconcepcional como durante el embarazo, es de vital importancia por igual para la madre como para el producto de la gestación. Objetivo: Evaluar el estado nutricional de las embarazadas en el momento de la captación del municipio Regla. Métodos: Estudio descriptivo, transversal en 81 gestantes, aparentemente sanas a la captación, en el área de salud Lidia y Clodomira, en el período comprendido de enero a mayo del 2019. Las variables a estudiar fueron: sociodemográficas, antecedente obstétrico y estado nutricional. Se utilizó el SPSS-22 para Windows para la estadística. Resultados: La edad materna más frecuente se encontró en el grupo de edades de 20 a 35 años, en su mayoría amas de casa con un alto nivel escolar, y baja paridad. El 56,8 por ciento presentó un estado nutricional adecuado (79 por ciento sin anemia), aun así, el resto mostró alteraciones del peso (por defecto o exceso). No todas las mujeres realizaban las 6 frecuencias alimentarías recomendadas ni consumían diariamente los alimentos de los 7 grupos básicos. Conclusiones: La mayoría de las gestantes tenían un estado nutricional adecuado a la captación del embarazo: expresión del estado nutricional pregestacional. Sin embargo, presentaban hábitos alimentarios no saludables durante esta etapa de la vida, en la cual la alimentación es fundamental para la madre y el producto de la concepción(AU)

Introduction: A good nutritional state, both in the preconception stage and during pregnancy, is of vital importance for the mother as well as for the product of pregnancy. Objective: To assess the nutritional status of pregnant women from Regla Municipality at the first gestational visit. Methods: Descriptive and cross-sectional study carried out, in the period from January to May 2019, with 81 pregnant women, apparently healthy in the first gestational visit, from the health area belonging to Lidia and Clodomira Polyclinic. The study variables were sociodemographic ones, obstetric history and nutritional state. SPSS-22 for Windows was used for statistics. Results: The most frequent maternal age was found in the age group of 20 to 35 years, mostly housewives, with a high educational level and low parity. 56.8 percent presented an adequate nutritional status (79 percent without anemia), yet the rest showed weight alterations (by default or excess). Not all the women did the six recommended food frequencies nor did they consume the foods from the seven basic groups daily. Conclusions: Most of the pregnant women had an adequate nutritional state in the first gestational visit, which is consistent with the nutritional state before pregnancy. However, they presented unhealthy eating habits during this stage of life, in which food is essential for the mother and the product of conception(AU)

Self-Reported DHA Supplementation during Pregnancy and Its Association with Obesity or Gestational Diabetes in Relation to DHA Concentration in Cord and Maternal Plasma: Results from NELA, a Prospective Mother-Offspring Cohort.

Maternal supplementation of docosahexaenoic acid (DHA) during pregnancy has been recommended due to its role in infant development, but its effect on materno-fetal DHA status is not well established. We evaluated the associations between DHA supplementation in pregnant women with obesity or gestational diabetes mellitus (GDM) and maternal and neonatal DHA status. Serum fatty acids (FA) were analyzed in 641 pregnant women (24 weeks of gestation) and in 345 venous and 166 arterial cord blood samples of participants of the NELA cohort. Obese women (n = 47) presented lower DHA in serum than those lean (n = 397) or overweight (n = 116) before pregnancy. Linoleic acid in arterial cord was elevated in obese women, which indicates lower fetal retention. Maternal DHA supplementation (200 mg/d) during pregnancy was associated with enhanced maternal and fetal DHA levels regardless of pre-pregnancy body mass index (BMI), although higher arterial DHA in overweight women indicated an attenuated response. Maternal DHA supplementation was not associated with cord venous DHA in neonates of mothers with GDM. The cord arteriovenous difference was similar for DHA between GDM and controls. In conclusion, maternal DHA supplementation during pregnancy enhanced fetal DHA status regardless of the pre-pregnancy BMI while GDM may reduce the effect of DHA supplementation in newborns.

Massive application of the SARS-CoV-2 diagnostic test: simulation of its effect on the evolution of the epidemic in Spain.

In Spain, the epidemic curve caused by COVID-19 has reached its peak in the last days of March. The implementation of the blockade derived from the declaration of the state of alarm on 14th March has raised a discussion on how and when to deal with the unblocking. In this paper, we intend to add information that may help by using epidemic simulation techniques with stochastic individual contact models and several extensions.

In vitro antifungal activity of silver nanoparticles against fluconazole-resistant Candida species.

Nowadays, current advances in nanotechnology constitute a promising alternative in the development of new antimicrobial agents. Silver nanoparticles (AgNPs) are some very interesting products currently provided by available nanotechnology for control of microbial infection. In the present study, AgNPs were synthesized by eco-friendly method, using cysteine as a reducing agent. Also, antifungal activity against Candida species with resistance to fluconazole was evaluated through determination of Minimum Inhibitory Concentration (MIC50) according to protocol M27-A3 of Clinical and Laboratory Standards Institute (CLSI) and Minimum Fungicide Concentration (MFC). This study was carried out with strains Candida krusei and Candida glabrata. As a result, the formation of spherical nanoparticles was obtained with mean sizes of 19 nm and positive surface charge. Values of MIC50 were 0.1 µg ml(-1) AgNPs for the studied species, and MFC were 0.25 and 0.5 µg ml(-1) for C. glabrata and C. krusei, respectively. The AgNPs synthesized showed cytotoxic effect in 50% of Murine Fibroblast Cells (CC50) at a mean concentrations of 10 µg ml(-1) (100 times higher than MIC50). Consequently, AgNPs could be considered as an alternative potential in the development of new antifungal agents with minimum cytotoxicity in fibroblasts and lethal action on Candida species with resistance to conventional antifungal compounds.

Caracterización de la anemia durante el embarazo y algunos factores de riesgo asociados, en gestantes del municipio regla / Characterization of anemia during pregnancy and some associated risk factors in pregnant women at Regla municipality

Introducción: la anemia como problema mundial constituye un indicador general de pobre salud. En Latinoamérica la anemia ferripriva afecta a los grupos vulnerables como las embarazadas. Cuba no está exenta de esta carencia nutricional y su prevalencia alcanza el 25 por ciento de las embarazadas. Objetivo: caracterizar la anemia durante la gestación y su relación con posibles factores asociados. Métodos: se realizó un estudio observacional, descriptivo y de corte transversal en 68 gestantes entre 28 y 32 semanas del Policlínico Lidia y Clodomiro, en el período de octubre a noviembre de 2010. Se aplicó una encuesta con datos sociodemográficos, antecedentes obstétricos y del embarazo actual y se determinó la hemoglobina. Resultados: se observó una disminución de los valores medios de hemoglobina entre el primer trimestre 112 g/L y el tercero 108 g/L. También se constató una alta frecuencia de anemia tanto en el primer trimestre 35,3 por ciento como en el tercer trimestre del embarazo 56,0 por ciento, con una anemia moderada más alta. La anemia al inicio del embarazo resultó un factor de riesgo ρ=0,02 de la existencia de anemia al tercer trimestre. Conclusiones: existió una alta frecuencia de anemia, siendo la anemia moderada la más frecuente, tanto en el primer trimestre como en el tercer trimestre de las embarazadas estudiadas. La anemia al inicio del embarazo resultó ser el factor de riesgo más importante encontrado en nuestro estudio a la existencia de anemia en el tercer trimestre, con independencia de otros posibles factores involucrados...

Introduction: anemia as a worlwide problem constitutes a general indicator of poor health. In Latin America anemia ferripriva affects vulnerable groups such as pregnant women. Cuba is not exempt from this lack of nutrition and its prevalence reaches 25 percent of pregnant women. Objective: to characterize anemia during gestation and its relationship with possible associated factors. Method: a study was conducted from September - November 2010, including 68 pregnant women that were in the beginning of their third trimester. Starting from gathering obstetric clinical history and from personal interviews, a survey was conducted to collect sociodemographic data and prior and current obstetric history. Samples of blood were taken to determine the hemoglobin levels. Results: a significant decrease of the hemoglobin mean values was observed during the first trimester 112 g/L and the third 108 g/L and a high frequency of anemia also during the first trimeter 35.3 percent as in the third 56.0 percent, with a relatively higher moderate anemia. Anemia at the begining of the pregnancy resulted to be a risk factor p=0.02 of the existence of anemia in the third trimester. Conclusions: in this study we report to the anemia like a problem of public health in the municipality it Regla. It was evidenced the magnitude and the grade of severity of the anemia in the studied gestantes and that the anemia to the beginning of the pregnancy can constitute a factor of important risk as cause of anemia...

Caracterización de la anemia durante el embarazo y algunos factores de riesgo asociados, en gestantes del municipio regla / Characterization of anemia during pregnancy and some associated risk factors in pregnant women at Regla municipality

Introducción: la anemia como problema mundial constituye un indicador general de pobre salud. En Latinoamérica la anemia ferripriva afecta a los grupos vulnerables como las embarazadas. Cuba no está exenta de esta carencia nutricional y su prevalencia alcanza el 25 por ciento de las embarazadas. Objetivo: caracterizar la anemia durante la gestación y su relación con posibles factores asociados. Métodos: se realizó un estudio observacional, descriptivo y de corte transversal en 68 gestantes entre 28 y 32 semanas del Policlínico Lidia y Clodomiro, en el período de octubre a noviembre de 2010. Se aplicó una encuesta con datos sociodemográficos, antecedentes obstétricos y del embarazo actual y se determinó la hemoglobina. Resultados: se observó una disminución de los valores medios de hemoglobina entre el primer trimestre 112 g/L y el tercero 108 g/L. También se constató una alta frecuencia de anemia tanto en el primer trimestre 35,3 por ciento como en el tercer trimestre del embarazo 56,0 por ciento, con una anemia moderada más alta. La anemia al inicio del embarazo resultó un factor de riesgo ρ=0,02 de la existencia de anemia al tercer trimestre. Conclusiones: existió una alta frecuencia de anemia, siendo la anemia moderada la más frecuente, tanto en el primer trimestre como en el tercer trimestre de las embarazadas estudiadas. La anemia al inicio del embarazo resultó ser el factor de riesgo más importante encontrado en nuestro estudio a la existencia de anemia en el tercer trimestre, con independencia de otros posibles factores involucrados(AU)

Introduction: anemia as a worlwide problem constitutes a general indicator of poor health. In Latin America anemia ferripriva affects vulnerable groups such as pregnant women. Cuba is not exempt from this lack of nutrition and its prevalence reaches 25 percent of pregnant women. Objective: to characterize anemia during gestation and its relationship with possible associated factors. Method: a study was conducted from September - November 2010, including 68 pregnant women that were in the beginning of their third trimester. Starting from gathering obstetric clinical history and from personal interviews, a survey was conducted to collect sociodemographic data and prior and current obstetric history. Samples of blood were taken to determine the hemoglobin levels. Results: a significant decrease of the hemoglobin mean values was observed during the first trimester 112 g/L and the third 108 g/L and a high frequency of anemia also during the first trimeter 35.3 percent as in the third 56.0 percent, with a relatively higher moderate anemia. Anemia at the begining of the pregnancy resulted to be a risk factor p=0.02 of the existence of anemia in the third trimester. Conclusions: in this study we report to the anemia like a problem of public health in the municipality it Regla. It was evidenced the magnitude and the grade of severity of the anemia in the studied gestantes and that the anemia to the beginning of the pregnancy can constitute a factor of important risk as cause of anemia.(AU)

The effects of the armed conflict on the life and health in Colombia

O presente trabalho trata das conseqüências do conflito armado interno (CAI) que a Colômbia tem vivido durante as últimas quatro décadas. Começa identificando o contexto e o momento atual do conflito. A seguir, são descritas algumas das formas, expressões e conseqüências do conflito armado interno com maior impacto sobre a vida, a qualidade de vida, a saúde e as doenças da população, e sobre os serviços de saúde no país. Especial ênfase é dada às altas taxas de mortalidade por homicídio, ao fenômeno do deslocamento forçado pela violência, aos sequestros e às minas antipessoais. Entre os grupos populacionais mais afetados, destacam-se homens jovens, mulheres, crianças e as minorias étnicas indígenas e afrodescendentes. Esta análise também se refere ao sério problema das contínuas infrações da Lei Humanitária Internacional e aos ataques contra a Missão Médica, assim como às conseqüências negativas do conflito sobre a prestação de serviços de saúde. Para concluir, são feitos alguns comentários gerais sobre a situação descrita e dadas algumas sugestões para o estudo do problema e possíveis ações partindo do setor saúde.

Efeitos do conflito armado sobre a vida e a saúde na Colômbia / The effects of the armed conflict on the life and health in Colombia

O presente trabalho trata das conseqüências do conflito armado interno (CAI) que a Colômbia tem vivido durante as últimas quatro décadas. Começa identificando o contexto e o momento atual do conflito. A seguir, são descritas algumas das formas, expressões e conseqüências do conflito armado interno, com maior impacto sobre a vida, a qualidade de vida, a saúde e as doenças da população e sobre os serviços de saúde no país. Especial ênfase é dada às altas taxas de mortalidade por homicídio, ao fenômeno do deslocamento forçado pela violência, aos seqüestros e às minas antipessoais. Entre os grupos populacionais mais afetados, destacam-se homens jovens, mulheres, crianças e as minorias étnicas indígenas e afrodescendentes. Esta análise também se refere ao sério problema das contínuas infrações da Lei Internacional Humanitária e aos ataques contra a Missão Médica, assim como às conseqüências negativas do conflito sobre a prestação de serviços de saúde. Para concluir, são feitos alguns comentários gerais sobre a situação descrita e dadas algumas sugestões para o estudo do problema e possíveis ações partindo do setor saúde.

This article is an approach to the consequences of the internal armed conflict that Colombia has lived during the last four decades. It starts with the identification of the conflict's context and its current characteristics. It then focuses on the different manifestations and consequences of the conflict and on their deep impact on the life, quality of life, health,disease, and health services of the population. In special we refer to the high homicide rates, forced internal displacement, kidnapping and the use of antipersonnel mines. Among the most affected groups are young men, women, children, and ethnic minorities such as indigenous and afro-american people. This analysis also refers to the frequent violations of International Human Rights and to the negative impact of violence on the provision of health services. Finally, general conclusions are drawn, and alternatives for studies on the problem and for possible solutions from the standpoint of the health sector are proposed.

Homicidios en Medellín, Colombia, entre 1990 y 2002: actores, móviles y circunstancias / Homicides in Medellín, Colombia, from 1990 to 2002: victims, motives and circumstances

En Medellín, Colombia, el homicidio es la primera causa de morbimortalidad desde hace 20 años y sus tasas de mortalidad superan las de grandes capitales de América Latina. Se describen los actores, las circunstancias y los móviles de los homicidios en Medellín entre 1990 y 2002. De los 55.365 homicidios del período se estudiaron aleatoriamente 1.394, el 93,6 por ciento (IC95 por ciento: 92,2 por ciento-94,8 por ciento) eran hombres, el 77,0 por ciento (IC95 por ciento: 75,0 por ciento-79,5 por ciento) menores de 35 años, una cuarta parte estaban ebrios y en 9 de cada 10 fueron muertos con armas de fuego. Los principales móviles del homicidio fueron los ajustes de cuentas y los atracos. El 37,0 por ciento (IC95 por ciento: 34,0 por ciento-41,0 por ciento) de los muertos provenían de los estratos más bajos de la ciudad y el riesgo de homicidio fue mayor a medida que el estrato socioeconómico era menor. Las características de los asesinatos en Medellín han permanecido invariables desde la década de los ochenta, cuando se inició el período de violencia más alto en la historia de la ciudad. Los grupos más afectados son los hombres jóvenes que viven y mueren en los barrios de estratos socioeconómicos más bajos, en hechos individuales que no dejan heridos.

[Homicides in Medellín, Colombia, from 1990 to 2002: victims, motives and circumstances]. / Homicidios en Medellín, Colombia, entre 1990 y 2002: actores, móviles y circunstancias.

In Medellín, Colombia, homicide has been the first cause of morbidity and mortality for 20 years. Medellín has the highest homicide rates of all major cities in Latin America. This study describes the victims, motives, and circumstances in homicides in Medellín from 1990 to 2002. The period included 55,365 homicides, of which 1,394 were randomly studied. Of this sample, 93.6% (95%CI: 92.2%-94.8%) were males, 77.0% (95%CI: 75.0%-79.5%) less than 35 years of age, one-fourth had consumed alcohol, and nine out of ten were killed with firearms. The main motives were revenge and armed robbery. 37.0% (95%CI: 34.0%-41.0%) of the victims lived in the lowest socioeconomic stratum of the city. Characteristics of homicides in Medellín have remained unchanged since the 1980s, when the most violent period in the city's history began. The most heavily affected groups are young males who live and die in poor neighborhoods, and the murders are individual acts that leave no wounded behind.