Biodegradation of Polystyrene by Galleria mellonella: Identification of Potential Enzymes Involved in the Degradative Pathway.

Galleria mellonella is a lepidopteran whose larval stage has shown the ability to degrade polystyrene (PS), one of the most recalcitrant plastics to biodegradation. In the present study, we fed G. mellonella larvae with PS for 54 days and determined candidate enzymes for its degradation. We first confirmed the biodegradation of PS by Fourier transform infrared spectroscopy- Attenuated total reflectance (FTIR-ATR) and then identified candidate enzymes in the larval gut by proteomic analysis using liquid chromatography with tandem mass spectrometry (LC-MS/MS). Two of these proteins have structural similarities to the styrene-degrading enzymes described so far. In addition, potential hydrolases, isomerases, dehydrogenases, and oxidases were identified that show little similarity to the bacterial enzymes that degrade styrene. However, their response to a diet based solely on polystyrene makes them interesting candidates as a potential new group of polystyrene-metabolizing enzymes in eukaryotes.

Clinical Guidelines for the Surgical/Orthodontic Management of Impacted Maxillary Central Incisors Based on a Decision Tree.

Maxillary central incisors are critical to occlusal function, smile esthetics, and even one's self-image. Furthermore, their impaction at an early age could have harmful psychological consequences on the individual. Maxillary central incisors can be impacted due to early dentoalveolar trauma to the upper anterior region that displaces the incisor in formation and, in rare instances, tooth germs are deformed. The aftermath of trauma during primary dentition is seen later during mixed dentition. Other causes are either an impediment in the eruption pathway of the maxillary central incisor due to the presence of odontomas or supernumerary teeth, an insufficient eruption space, or, very rarely, syndromic and/or other general medical conditions. Diagnosis is completed through a detailed medical/dental history, clinical evaluation, and appropriate imaging. Arch width increase, space opening, removal of obstructions if present, suitable soft-tissue management, well-designed orthodontic traction mechanics, and long-term periodontal follow-up are all essential elements in resolving cases of impacted maxillary central incisors.

Atención de los profesionales de la salud a personas trans en América Latina y el Caribe / Health professionals care for trans people in Latin America and the Caribbean

Resumen El presente estudio tuvo por objetivo analizar las características de artículos científicos publicados durante el último quindenio respecto a la atención en salud a personas trans en América Latina y el Caribe. Se desarrolló una revisión sistematizada de artículos publicados en cuatro bases de datos, entre los años 2005 y 2020, en la que se encontraron 20 estudios que fueron objeto de análisis. En su mayoría, estos dan cuenta de las percepciones que tienen las comunidades trans y, en menor frecuencia, las experiencias de los profesionales de la salud sobre la atención en salud. Los resultados permiten identificar barreras que influyen en los procesos de atención y los desafíos para mejorarla. Sobresale la formación deficiente e insuficiente en los profesionales sobre identidades trans y los enfoques diferenciales y afirmativos del género, y la necesidad de fortalecer los abordajes integrales entre las comunidades académicas, de la salud y la generación de políticas públicas transformativas.

Abstract Health care is important for the transitions of people with trans life experiences and to strengthen the processes of health and disease. Health professionals are educating and accompanying agents; however, the literature frequently reports that there are barriers perceived by professionals regarding their competencies to accompany such processes, in addition to others related to social representations regarding trans identities, the limited scientific evidence regarding the processes of gender reaffirmation and representing the communities themselves according to their historical and sociocultural characteristics. The aim of this study was to analyze the characteristics of scientific articles published during 15 years regarding health care for trans persons in Latin America and the Caribbean. A systematized review of articles published in four databases between 2005 and 2020 was carried out. 20 studies were analyzed in the research. Most of them report the perceptions of trans communities and, less frequently, the experiences of health professionals on health care. The results allow the identification of barriers that influence the processes of care and the challenges to improve it. The deficient and insufficient training of professionals on trans identities and differential and affirmative gender approaches stand out, as well as the need to strengthen comprehensive approaches among the academic and health communities and the generation of trans affirmative public policies. On the other hand, the results evidence a construction of science with respect to gender that is cisnormative and invisibilizes gender diversities. In addition, many of the studies establish vertical relationships between participants, including researchers, which generates research dynamics in which trans communities are considered more as informants and less as expert peers, community researchers or participants in a collaborative and co-creative research process. These findings support the need and renew the urgency to generate processes of knowledge construction with and for trans communities that allow nurturing educational, social, public policy and health spaces that represent their needs for gender transitions, in case the person considers so, and that welcome in an integral and humanized way the processes of health and disease. Research on health and health care in trans communities both in Colombia and in the rest of Latin America and the Caribbean does not show the implementation of health policies focused on the community and that respond to their health needs. Health professionals, around the world, should accompany from care actions focused on the processes of self-identification and self-determination of gender. Being recognized and made visible based on gender identities and expressions has a positive impact on the mental health of trans people and their well-being. In professional practice, it is important and essential to overcome the barriers of social inequality, promoting a critical social vision and understanding of the reality of this population. It is necessary to expand research from gender diversities and separate from the LGBTIQ+ umbrella given the complex social, cultural, biological, and psychological diversities faced by each community. As for health professionals, it is necessary to deepen the measurement and understanding of attitudes, knowledge, beliefs, skills and gaps identified by all staff, from doctors and nurses to institution managers. This in order to articulate and triangulate information and develop intervention programs aimed at comprehensive and accessible care, especially for their reports about the little information on sexual and gender diversity received during their professional training process and organizational culture. Finally, each country should develop clinical guidelines based on local, national, and international evidence that responds to the psychological and sociocultural needs and experiences of trans communities that include the process of gender transitions from hormone therapy, affirmative surgeries and other non-binary processes of gender expressions, family, psychosocial support, and community accompaniment.

Funcionalidad en personas mayores con EPOC, rehabilitación presencial y telerrehabilitación: una revisión sistemática / Functionality in elderly people with COPD, face-to-face rehabilitation and telerehabilitation: A systematic review

Resumen Objetivo: Sintetizar la evidencia existente sobre los principales resultados de programas de rehabilitación presenciales y/o mediante telerrehabilitación, sobre la funcionalidad en personas mayores con Enfermedad Pulmonar Obstructiva Crónica (EPOC). Materiales y método: Se realizó la búsqueda de artículos científicos en las bases de datos: Medline vía PubMed y BVS Lilacs que cumplan con los criterios de elegibilidad, entre la fecha del 1 de enero del 2019 hasta el 1 de enero de 2021, seleccionando 4 documentos. Para la identificaciónde artículos se utilizó las palabras clave "Aged", "Pulmonary Disease, Chronic Obstructive", "Rehabilitation - Telerehabilitation". Resultados: La edad promedio de las personas participantes, fue de 65.4, predominaron los estudios en género masculino y de las personas mayores incluidas con EPOC, el 50% lo padecía de forma severa. Sobre la descripción de los programas de rehabilitación, el 75% tuvo seguimiento de los resultados, desde los 3 a los 12 meses, el 50% de los programas tuvo una duración de 10 semanas, en el 50% de los casos se les proporcionó a los pacientes tecnología para el uso en domicilio y solo un 15% utilizó una aplicación móvil. Conclusión: Los resultados respaldan la opinión de que los proveedores de atención médica pueden usar la telerrehabilitación, para el tratamiento de las personas mayores con EPOC junto con la rehabilitación habitual.

Abstract Objective: To synthesize the existing evidence on the main results of face-to-face and/or telerehabilitation rehabilitation programs on functionality in elderly people with COPD. Materials and method: We searched for scientific articles in the following databases: Medline via PubMed and BVS Lilacs that met the eligibility criteria, between January 1, 2019 and January 1, 2021, selecting 4 documents. The keywords "Aged", "Pulmonary Disease, Chronic Obstructive", "Rehabilitation - Telerehabilitation" were used to identify articles. Results: The average age of the participants was 65.4, male studies predominated and of the elderly included with COPD, 50% suffered from severe COPD. Regarding the description of the rehabilitation programs, 75% had follow-up of the results, from 3 to 12 months, 50% of the programs had a duration of 10 weeks, in 50% of the cases the patients were provided with technology for home use and only 15% used a mobile application. Conclusion: The results support the view that health care providers can use telerehabilitation for the treatment of older persons with COPD in conjunction with usual rehabilitation.

Intermittent fasting for health care, a review / El ayuno intermitente, ¿un éxito o una desventaja para el cuidado de la salud?

The incidence of obesity and overweight in the world has been increasing in recent years due to poor diet and lack of physical activity; people suffering obesity and overweight, related with malnutrition due to excess, often resort to calorie restriction diets that are usually not very effective. In this context, intermittent fasting (IF) has become popular due to the possibilities for weight loss that it offers. This diet consists of alternating periods of fasting with unrestricted eating; however, its effectiveness and consequences are unknown to most users. This narrative review analyzes whether intermittent fasting contributes to the improvement of body and metabolic composition. The purpose of the review was to examine the available data on the contribution of intermittent fasting to the improvement of body and metabolic composition, in order to provide information and to define the parameters that condition safe achievement of its benefits. IF dieting triggers adaptive cell responses that cause a decrease in lipid oxidative stress markers in individuals with obesity and prediabetes. Metabolic alterations have been found to go hand in hand with the alteration of circadian rhythms; if IF contributes to this effect, it may assist in treating and preventing obesity and associated diseases. However, there are also disadvantages, such as the loss of lean muscle mass by wasting, and increased hypoglycemia(AU)

La incidencia de obesidad y sobrepeso en el mundo ha ido en aumento en los últimos años debido a la mala alimentación y la falta de actividad física; Las personas que padecen obesidad y sobrepeso, relacionadas con la desnutrición por exceso, suelen recurrir a dietas de restricción calórica que suelen ser poco efectivas. En este contexto, el ayuno intermitente (AI) se ha popularizado debido a las posibilidades de pérdida de peso que ofrece. Esta dieta consiste en alternar períodos de ayuno con alimentación sin restricciones; sin embargo, su eficacia y consecuencias son desconocidas para la mayoría de los usuarios. Esta revisión narrativa analiza si el ayuno intermitente contribuye a la mejora de la composición corporal y metabólica. El objetivo de la revisión fue examinar los datos disponibles sobre la contribución del ayuno intermitente a la mejora de la composición corporal y metabólica, con el fin de aportar información y definir los parámetros que condicionan la consecución segura de sus beneficios. Se ha encontrado que las alteraciones metabólicas van de la mano con la alteración de los ritmos circadianos; si AI contribuye a este efecto, puede ayudar a tratar y prevenir la obesidad y las enfermedades asociadas. Sin embargo, también existen desventajas, como la pérdida de masa muscular magra por atrofia y el aumento de la hipoglucemia(AU)

Retos de ser mujer trans en Colombia: aspectos asociados a sus condiciones de vida / Challenges of being a trans woman in Colombia: aspects associated with living conditions

Colombia es un país cisnormativo en el cual durante los últimos años ha cobrado relevancia las discusiones y acciones en pro del bienestar y la salud de las mujeres trans. De esta manera, en el presente artículo presentamos los retos de las mujeres trans asociados a sus condiciones de vida a partir de una revisión bibliográfica en Colombia de la literatura publicada entre 2010 y 2020. Los hallazgos dan cuenta de escasos estudios sobre las mujeres trans, así como las cualidades y procesos cotidianos de reproducción social que interfieren en el goce y protección de sus derechos asociados a las situaciones de estigma, discriminación y violencias que enfrentan por su identidad de género no hegemónica. Esto impacta negativamente en sus condiciones de vida, su salud y bienestar, y perpetúa las inequidades e injusticias que tienen que enfrentar y han enfrentado de manera estructural e histórica. (AU)

Colombia is a cisnormativecountry in which discussions and actions for the welfare and health of trans women have gained relevance in recent years. In this way, this article presents the challenges of trans women associated with their living conditions based on a bibliographic review in Colombia of the literature published in the last five years. The findings reveal the scarcity of studies on trans women, as well as the qualities and daily processes of social reproduction that interfere in the enjoyment and protection of their rights associated with situ-ations of stigma, discrimination, and violence they face because of their non-hegemonic gender identity. This has a negative impact on their living conditions, health, and well-being, and perpetuates the inequities and injustices they have to face and have faced structurally and historically. (AU)

Cheese Whey Milk Adulteration Determination Using Casein Glycomacropeptide as an Indicator by HPLC.

Raw milk adulteration with cheese whey is a major problem that affects the dairy industry. The objective of this work was to evaluate the adulteration of raw milk with the cheese whey obtained from the coagulation process, with chymosin enzyme using casein glycomacropeptide (cGMP) as an HPLC marker. Milk proteins were precipitated with 24% TCA; with the supernatant obtained, a calibration curve was established by mixing raw milk and whey in different percentages, which were passed through a KW-802.5 Shodex molecular exclusion column. A reference signal, with a retention time of 10.8 min, was obtained for each of the different percentages of cheese whey; the higher the concentration, the higher the peak. Data analysis was adjusted to a linear regression model, with an R2 of 0.9984 and equation to predict dependent variable (cheese whey percentage in milk) values. The chromatography sample was collected and analyzed by three tests: a cGMP standard HPLC analysis, MALDI-TOF spectrometry, and immunochromatography assay. The results of these three tests confirmed the presence of the cGMP monomer in adulterated samples with whey, which was obtained from chymosin enzymatic coagulation. As a contribution to food safety, the molecular exclusion chromatography technique presented is reliable, easy to implement in a laboratory, and inexpensive, compared with other methodologies, such as electrophoresis, immunochromatography, and HPLC-MS, thus allowing for the routine quality control of milk, an important product in human nutrition.

Multidisciplinary Treatment of Deep Non-Carious Cervical Lesion With a CAD/CAM Chairside Restoration in Combination With Periodontal Surgery: A 60-Month Follow-Up Technique Report.

INTRODUCTION: Restoring function and esthetics are essential aspects of periodontology and restorative dentistry. Depending on their extension and the tissues involved, the treatment of non-carious cervical lesions (NCCLs) associated with gingival recessions may require a multidisciplinary approach, and different periodontal and restorative techniques have been described. CASE PRESENTATION: This case report presents an innovative approach to treat a deep NCCL combined with a gingival recession in a canine region of a female patient. A Computer Aided Design - Computer Aided Manufacturing (CAD/CAM) chairside ceramic restoration in combination with mucogingival surgery procedures is described. A comprehensive analysis of the selected approach and its clinical implications is presented based on a 60-month follow-up. Conclusions After 60-month follow-up, clinical condition maintained stable, and a successful esthetic outcome was accomplished. Complete root coverage was achieved and kept throughout the whole period of tracing.

Different Crises, Different Patterns of Trauma. The Impact of a Social Crisis and the COVID-19 Health Pandemic on a High Violence Area.

BACKGOUND: Santiago, Chile underwent two separate periods of crisis over the past year. The first period, the 'social crisis,' extended over thirteen weeks in late 2019 into early 2020 due to protests over income inequality and the government response to social unrest. The second period, the 'health crisis,' began in March 2020 with Chile's first case of COVID-19 and escalated rapidly to include 'stay at home orders,' traffic restrictions, and the shuttering of most businesses. We wished to evaluate the impact of these crisis periods on trauma epidemiology. METHODS: We performed a retrospective review of the South-East Metropolitan Health Service Trauma Registry. Trauma admissions, operative volume, and in-hospital mortality were evaluated during the crisis period and the year prior. RESULTS: The social crisis saw increased levels of trauma, both blunt and penetrating, relative to the time period immediately preceding. The health crisis saw an increase in penetrating trauma with a concomitant decline in blunt trauma. Both crisis periods had decreased levels of trauma, overall, compared to the year prior. There were no statistically significant differences in in-hospital trauma mortality. CONCLUSION: Different crises may have different patterns of trauma. Crisis periods that include extended periods of lockdown and curfew may lead to increasing penetrating trauma volume. Governments and health officials should anticipate the aggregate impact of these measures on public health and develop strategies to actively mitigate them. LEVEL OF EVIDENCE: III.

Calidad de vida relacionada a la salud de las personas con esclerosis múltiple en la Región de Magallanes, Chile / Health-related quality of life of individuals with multiple sclerosis from the Magallanes Region of Chile

INTRODUCCIÓN: La esclerosis múltiple (EM) es una enfermedad autoinmune, crónica, inflamatoria y desmielinizante que afecta al sistema nervioso central (SNC) y la calidad de vida de las personas afectadas. Este último aspecto tiene especial relevancia por su impacto, ya que afecta a individuos jóvenes en etapa productiva. OBJETIVO: Describir las características demográficas y calidad de vida relacionada a la salud de personas con diagnóstico de EM de la región de Magallanes y Antártica Chilena. Materiales y métodos: Mediante un estudio descriptivo de pacientes con diagnóstico de EM, se registraron los antecedentes demográficos y se evaluó la Calidad de Vida Relacionada a la Salud (CVRS) con el cuestionario de salud SF-36 v.2. RESULTADOS: Se evaluaron 40 pacientes entre 21 y 65 años de edad (57,5% mujeres) con una evolución de EM de 7,59 ± 7,38 años. En la SF-36 v.2, los menores puntajes promedios fueron en las dimensiones Vitalidad (53,75 puntos) y Salud General (61,00 puntos), y los mayores fueron en las dimensiones Función Social (72,50 puntos) y Función Física (71,63 puntos). No hubo diferencias en la calidad de vida de las personas según el sexo. CONCLUSIÓN: La EM deteriora de manera gradual y diversa diferentes funciones neurológicas; esto determina una disminución de la calidad de vida, principalmente en las dimensiones de Vitalidad y Concepción General del estado de salud.

INTRODUCTION: Multiple sclerosis (MS) is an autoimmune, chronic, inflammatory and demyelinating disease that affects the central neuro system (CNS) and patients' quality of life. This is particularly relevant as MS impacts young individuals, during their productive years. AIM: To describe the demographic characteristics and health-related quality of life of individuals with MS in the Magallanes and Chilean Antarctic Region. Materials and methods: A descriptive study of individuals with MS was conducted; demographic information was collected, and health-related quality of life was assessed with the SF-36 v.2 instrument. RESULTS: A total of 40 patients, between 21 to 65 years of age (57.5% women) were evaluated. They had MS for an average of 7.59 ± 7.38 years. In the SF-36 v.2, the lowest average scores were in the dimensions of Vitality (53.75 points) and General Health (61.00 points), while the highest scores were in Social Functioning (72.50 points) and Physical Functioning (71.63 points). There was no sex-based difference in quality of life. CONCLUSIONS: MS produces a gradual and varied decline of neurological functions, leading to a reduction of quality of life, mainly in the dimensions of Vitality and General Health perception

Trastorno de espectro autista y psicosis / Autism spectrum disorder and psychosis

Paciente Felipe S. S., 24 años. Soltero. Escuela especial hasta los 15 años. Antecedentes psiquiátricos familiares (+). A 2 años, el diagnóstico de Autismo. Escuela especial hasta los 15 años. 18 años: conducta disruptiva, irritable, agresivo, intento de suicido. Examen mental en contexto hospitalario: Contacto autista, asintónico. Hipomímico, con escasos movimientos complementarios. Con signos catatónicos de presentación intermitente (imantación, pseudoflexibilidad cérea). Además, presenta frecuentemente ecolalia. Presencia de alucinaciones auditivas (impresionan del mundo externo, a veces personificadas y otras anónimas), visuales y cinestésicas. Presenta constantes desajustes conductuales, con inquietud psicomotora transitoria y reiteradas agresiones hacia personal. Tratamiento farmacológico: Clozapina 500 mg. al día. Olanzapina 30 mg al día. Ácido Valproico 750 mg al día.

Felipe S. S., 24 years old. Single. Special school up to 15 years. Family psychiatric history (+). At 2 years, the diagnosis of Autism. Special school up to 15 years. 18 years: disruptive, irritable, aggressive behavior, attempted suicide. Mental examination in hospital context: Autistic, asyntonic contact. Hipomimic, with few complementary movements. With catatonic signs of intermittent presentation (magnetization, waxy pseudoflexibility). In addition, he frequently presents echolalia. Presence of auditory hallucinations (impressions of the external world, sometimes personified and others anonymous), visual and kinesthetic. He presents constant behavioral imbalances, with transient psychomotor restlessness and repeated aggressions towards personnel. Pharmacological treatment: Clozapine 500 mg. up to date. Olanzapine 30 mg daily. Valproic Acid 750 mg daily.

Iris Melanoma Outcomes Based on the American Joint Committee on Cancer Classification (Eighth Edition) in 432 Patients.

PURPOSE: The American Joint Committee on Cancer (AJCC) classification was updated to the eighth edition in January 2017, providing staging for iris melanoma. This study evaluated outcomes of iris melanoma per the AJCC classification, eighth edition. DESIGN: Retrospective case series. PARTICIPANTS: Four hundred thirty-two patients with iris melanoma. METHODS: Management including tumor resection, plaque radiotherapy, or enucleation. MAIN OUTCOME MEASURES: Local tumor recurrence, melanoma-related systemic metastasis, and melanoma-related death. RESULTS: Of 432 patients with iris melanoma, AJCC classification was category T1 (n = 324 [75%]), T2 (n = 83 [19%]), T3 (n = 2 [<1%]), and T4 (n = 23 [5%]). There was no difference in age, race, gender, eye, or iris color among T categories. Overall, Kaplan-Meier analysis of outcomes (at 5 and 10 years) revealed visual acuity reduction by 3 lines or more (42% and 54%, respectively), secondary glaucoma (29% and 33%, respectively), local recurrence (8% and 17%, respectively), secondary enucleation (12% and 19%, respectively), lymph node metastasis (1% and 1%, respectively), melanoma-related systemic metastasis (5% and 10%, respectively), and melanoma-related death (3% and 4%, respectively). Compared with T1 category, the hazard ratio (HR) for local recurrence in nonenucleated eyes was 1.31 for T2, not evaluable (NE) for T3 (because of small cohort), and 6.61 for T4; the HR for metastasis was 3.41 for T2, NE for T3 (because of small cohort), and 25.6 for T4; the HR for death was 7.51 for T2, NE for T3 (because of small cohort), and 26.5 for T4; and the odds ratio for enucleation was 1.23 for T2, 3.63 for T3, and 4.72 for T4. Features predictive of melanoma-related metastasis (multivariate analysis) included secondary glaucoma (P < 0.001; HR, 4.51), T2 category (vs. T1; P = 0.01; HR, 4.09), and T4 category (vs. T1; P < 0.001; HR, 30.8). Features predictive of melanoma-related death (multivariate analysis) included older age (P = 0.008; HR, 2.16 per 10-year increase), T2 category (vs. T1; P = 0.005; HR, 8.07), and T4 category (vs. T1; P < 0.001; HR, 20.3). CONCLUSIONS: The AJCC eighth edition classification provides prognostic stratification of iris melanoma. By multivariate analysis, the ratio for melanoma-related metastasis was 4 times greater in category T2 and 31 times greater in T4 compared with T1. The ratio for melanoma-related death was 8 times greater in category T2 and 20 times greater in T4 compared with T1. The cohort size for T3 was too small to provide useful information.

Estigma y discriminación ante la tuberculosis por profesionales de la salud de la costa pacífica colombiana / Stigma and discrimination facing tuberculosis in health workers in the colombian pacific coast / Estigma e discriminação ante a tuberculose por profissionais da saúde do litoral pacífico colombiano

Resumen Objetivo: Caracterizar los conocimientos, las actitudes y las prácticas de profesionales de la salud que reflejan estigma y discriminación frente a la tuberculosis (TB) en municipios prioritarios de la Costa Pacífica colombiana. Materiales y Métodos: Se realizó un estudio cualitativo descriptivo con 13 profesionales de la salud, vinculados a los programas de TB de 4 municipios prioritarios en la Costa Pacífica nariñense de Colombia. Se realizaron entrevistas en profundidad y grupos focales. Resultados: Los profesionales de la salud tienen adecuados conocimientos sobre la enfermedad y el tratamiento, pero sus creencias sobre las causas de la enfermedad y algunas actitudes frente a las personas con TB reflejan estigma. Sus prácticas fueron poco discriminatorias hacia los pacientes y sus familias, incluso tienen prácticas de riesgo para su salud como no usar las medidas de bioseguridad para evitar hacer sentir discriminados a los pacientes. La mayoría de los profesionales reportaron ser discriminados por su labor, la cual implica un contacto diario y un alto riesgo de infección, proviniendo estas actitudes por parte de sus familiares y de otros profesionales del sector salud. Conclusiones: Los resultados de este estudio señalan focos importantes de atención en las acciones de prevención del estigma y la discriminación frente a las personas con TB, que no han sido visibilizados por estudios cuantitativos en el país.

Abstract Objective: To characterize the knowledge, attitudes and practices of health professionals that reflect stigma and discrimination facing tuberculosis (TB) in critical municipalities of the Colombian Pacific Coast. Materials and Methods: A qualitative descriptive study was conducted with 13 health professionals, linked to TB programs in 4 critical municipalities in the Colombian Pacific Coast in the Department of Nariño. In-depth interviews and focus groups were conducted. Results: Health professionals have adequate knowledge about the disease and its treatment, but their beliefs about some TB causes and some attitudes towards patients with the disease reflect stigma. Their practices were not very discriminatory towards TB patients and their families, and they even have risk practices for their health such as not using biosecurity measures in order to avoid making patients feel discriminated. The majority of the professionals reported being discriminated against for their work which implies daily contact with patients and high risk of infection, attitudes that arise from their relatives and other professionals in the health sector. Conclusions: The results of this study point out important attention focus to be attended in the actions of prevention of stigma and discrimination against people with TB which have not been reported by quantitative studies in the country.

Resumo Objetivo: Caracterizar os conhecimentos, as atitudes e as práticas de profissionais da saúde que reflitam estigma e discriminação frente à tuberculose (TB) em municípios prioritários do Litoral Pacífico colombiano. Materiais e Métodos: Realizou se um estudo qualitativo descritivo com 13 profissionais da saúde, vinculados aos programas de TB de 4 municípios prioritários no Litoral Pacífico nariñense "Nariño cidade da Colômbia". Realisou se entrevistas em profundidade e grupos focais. Resultados: Os profissionais da saúde têm adequados conhecimentos sobre a doença e o tratamento, mas suas crenças sobre as causas da doença e algumas atitudes frente às pessoas com TB reflitam estigma. Suas práticas foram pouco discriminatórias para os pacientes e suas famílias, incluso tem práticas de risco para sua saúde como não usar as medidas de biossegurança para evitar fazer sentir discriminados os pacientes. A maioria dos profissionais reportou ser discriminada por seu labor, a qual implica um contato diário e um alto risco de infecção, provindo estas atitudes por parte de seus familiares e de outros profissionais do sector saúde. Conclusões: Os resultados de este estudo apontam focos importantes de atenção nas ações de prevenção do estigma e a discriminação frente ás pessoas com TB, que não tem sido visibilizados por estudos quantitativos no país.

Roles y desafíos de mujeres jefas de hogar con VIH/Sida / Roles and challenges of female heads of household with HIV/AIDS

Objetivo Caracterizar los roles y desafíos que enfrentan las mujeres con VIH, líderes de hogar, del Valle del Cauca, Colombia. Método Cualitativo exploratorio, basado en la Teoría Fundada. Los datos fueron recolectados a través de entrevistas en profundidad a 13 mujeres con VIH, jefas de hogar con edades entre los 19 y los 46 años que viven en las ciudades de Cali y Buenaventura. Resultados Los principales roles asumidos por las mujeres son el cuidado de sus hijos, el sostenimiento del hogar, las expresiones de afecto, el apoyo frente a diferentes situaciones de la vida y los procedimientos administrativos relacionados con el acceso a los servicios de salud. Entre los desafíos se mencionan aquellos aspectos relacionados con la crianza, ser modelo de autocuidado, acompañar y liderar el diagnóstico y la adherencia al tratamiento de quienes tienen menores VIH positivos, dar a conocer el diagnóstico, proveer las mejores condiciones de vida, y el proveer acceso a bienes y servicios. Conclusiones Los resultados del estudio resaltan los desafíos y roles que enfrentan las mujeres al vivir con una enfermedad crónica y que aún sigue estando cargados de estigma y discriminación. Se evidencian los aspectos sociales, económicos, culturales y en salud relacionados con las inequidades y desigualdades en salud, asociadas al género y al acceso a los servicios en salud, al trabajo decente y educación.(AU)

Objective To characterize the roles and challenges that female heads of households with HIV in Valle del Cauca, Colombia assume. Method A qualitative exploratory method, based on Grounded Theory was conducted. Data were collected through in depth interviews to 13 women with HIV, heads of household with ages between 19 and 46,who live in the cities of Cali and Buenaventura. Results The main roles assumed by women are taking care of their children and their homes, expressing affection, providing support during different life events and administrative procedures related to health care services access. The challenges expressed by these women include aspects related to parenting, being a self-care role model, accompanying and leading the diagnosis and adherence to the treatment children with HIV, revealing the diagnosis, providing the best living conditions, and providing access to goods and services. Conclusions The results of the study highlight the challenges that women living with a chronic illness, that is still loaded with stigma and discrimination, have to face. The social, economic, cultural and health aspects related to the inequities and inequalities in health, to gender and access to health services, to decent work and to education are made clear in this work.(AU)

[Roles and challenges of female heads of household with HIV/AIDS]. / Roles y desafíos de mujeres jefas de hogar con VIH/Sida.

Objective To characterize the roles and challenges that female heads of households with HIV in Valle del Cauca, Colombia assume. Method A qualitative exploratory method, based on Grounded Theory was conducted. Data were collected through in depth interviews to 13 women with HIV, heads of household with ages between 19 and 46,who live in the cities of Cali and Buenaventura. Results The main roles assumed by women are taking care of their children and their homes, expressing affection, providing support during different life events and administrative procedures related to health care services access. The challenges expressed by these women include aspects related to parenting, being a self-care role model, accompanying and leading the diagnosis and adherence to the treatment children with HIV, revealing the diagnosis, providing the best living conditions, and providing access to goods and services. Conclusions The results of the study highlight the challenges that women living with a chronic illness, that is still loaded with stigma and discrimination, have to face. The social, economic, cultural and health aspects related to the inequities and inequalities in health, to gender and access to health services, to decent work and to education are made clear in this work.

Percepción de la calidad y la importancia de sus componentes en la formación universitaria de kinesiología / Quality perception and importance of its components in the university formation of kinesiology

El estudio se interesa en conocer la percepción que, estudiantes de diferentes niveles de formación universitaria en kinesiología, tienen sobre la importancia de diversos aspectos de la calidad de su preparación profesional. Un grupo de 149 estudiantes participaron voluntariamente en este estudio que utilizó un diseño no experimental transversal descriptivo. El instrumento mide la importancia de 10 aspectos de la calidad tales como los recursos, la perfección, cultura, procesos y prestigio, entre otros. Permite conocer la puntuación directa de importancia atribuida a cada uno de ellos, así como la jerarquización de estos. Los resultados indican aquellos aspectos a los que se les asigna importancia en un nivel manifiesto no son los mismos que en un nivel implícito. Los resultados son discutidos en torno a la relación entre los diferentes aspectos de la calidad, las condiciones contextuales y las diferencias de atribución causal(AU)

The study was aimed at identifying the perceptions of students at the various levels of kinesiology at the university about the importance of several aspects of the professional preparation quality. A group of 149 students willingly participated in this study that used a non-experimental cross-sectional and descriptive design. The instrument measures the importance of ten quality aspects such as resources, perfection, culture, processes and prestige, among others. It also allows knowing the direct scoring of importance attached to each of them as well as their hierarchization. The results pointed to those aspects to which manifest importance is given, which are not the same as those given implicit importance. The results were discussed in terms of their relationship among the various aspects of quality, contextual conditions and causal attribution(AU)

American Joint Committee on Cancer Classification of Uveal Melanoma (Anatomic Stage) Predicts Prognosis in 7,731 Patients: The 2013 Zimmerman Lecture.

PURPOSE: To analyze the clinical features and prognosis of posterior uveal melanoma based on the American Joint Committee on Cancer (AJCC) (7th edition) tumor staging. DESIGN: Retrospective interventional case series. PARTICIPANTS: A total of 7731 patients. METHODS: Uveal melanoma management. MAIN OUTCOME MEASURES: Melanoma-related metastasis and death. RESULTS: Of 7731 patients with posterior uveal (ciliary body and choroidal) melanoma, the AJCC tumor staging was stage I in 2767 (36%), stage II in 3735 (48%), stage III in 1220 (16%), and stage IV in 9 (<1%). Based on tumor staging (I, II, III, and IV), features that showed significant increase with tumor staging included age at presentation (57, 58, 60, 60 years) (P < 0.001), tumor base (8, 12, 17, 17 mm) (P < 0.001), tumor thickness (2.9, 6.0, 10.1, 10.2 mm) (P < 0.001), distance to optic disc (3, 5, 5, 5 mm) (P < 0.001), distance to foveola (3, 5, 5, 5 mm) (P < 0.001), mushroom configuration (6%, 24%, 34%, 33%) (P < 0.001), plateau configuration (3%, 4%, 7%, 11%) (P < 0.001), tumor pigmentation (48%, 53%, 69%, 78%) (P < 0.001), and extraocular extension (0%, 1%, 11%, 22%) (P < 0.001). After therapy, Kaplan-Meier estimates of metastasis at 1, 5, 10, and 20 years were <1%, 5%, 12%, and 20% for stage I, 2%; 17%, 29%, and 44% for stage II; 6%, 44%, 61%, and 73% for stage III, and 100% by 1 year for stage IV. Kaplan-Meier estimates of death at 1, 5, 10, and 20 years were <1%, 3%, 6%, and 8% for stage I; <1%, 9%, 15%, and 24% for stage II; 3%, 27%, 39%, and 53% for stage III, and 100% by 1 year for stage IV. Compared with stage I, the hazard ratio for metastasis/death was 3.1/3.1 for stage II and 9.3/10.1 for stage III. CONCLUSIONS: Compared with uveal melanoma classified as AJCC stage I, the rate of metastasis/death was 3 times greater for stage II, 9 to 10 times greater for stage III, and further greater for stage IV. Early detection of posterior uveal melanoma, at a point when the tumor is small, can be lifesaving.