Reasons for antiretroviral switching in Colombia: A retrospective cohort study.

INTRODUCTION: Long-term use of antiretroviral therapy (ART) for HIV infection might lead to the necessity of switching regimens. We aimed to analyze the reasons for the ART switch, the time-to-switch of ART, and its associated factors in a Colombian cohort. METHODS: We conducted a retrospective cohort in 20 HIV clinics, including participants ≥18 years old with confirmed HIV infection who underwent an ART switch from January 2017 to December 2019 with at least 6 months of follow-up. A time-to-event analysis and an exploratory Cox model were performed. RESULTS: 796 participants switched ART during the study period. The leading cause of ART switch was drug intolerance (n = 449; 56.4%) with a median time-to-switch of 12.2 months. The longest median time-to-switch was due to regimen simplification (42.4 months). People ≥50 years old (HR = 0.6; 95% CI (0.5-0.7) and CDC stage 3 at diagnosis (HR = 0.8; 95% CI (0.6-0.9) had less hazard for switching ART over time. CONCLUSIONS: In this Colombian cohort, drug intolerance was the main cause of the ART switch, and the time-to-switch is shorter than reports from other countries. In Colombia, it is crucial to apply current recommendations for ART initiation to choose regimens with a better tolerability profile.

Does Inspiratory Muscle Training Affect Static Balance in Soccer Players? A Pilot Randomized Controlled Clinical Trial.

Inspiratory muscle training (IMT) is effective in improving postural stability and balance in different clinical populations. However, there is no evidence of these effects in soccer players. A single-blind, two-arm (1:1), randomized, placebo-controlled pilot study on 14 soccer players was performed with the main aim of assessing the effect of IMT on static balance, and secondarily, of examining changes in the respiratory muscle function. The experimental group (EG) received an IMT program with progressive intensity, from 20% to 80%, of the maximal inspiratory pressure (MIP). The sham group (SG) performed the same program with a fixed load of 20% of the MIP. Static balance and respiratory muscle function variables were assessed. A two-factor analysis of variance for repeated measures was used to assess differences after training. Statistical significance was set at p < 0.05. Significant increases were observed in the EG on length of sway under eyes open (from 2904.8 ± 640.0 to 3522.4 ± 509.0 mm, p = 0.012) and eyes closed (from 3166.2 ± 641.3 to 4173.3 ± 390.8 mm, p = 0.004). A significant increase in the maximal voluntary ventilation was observed for both groups (EG p = 0.005; SG p = 0.000). No significant differences existed between the groups. IMT did not improve the static balance in a sample of soccer players. Conducting a high-scale study is feasible and could refine the results and conclusions stemming from the current pilot study.

Cardiovascular risk factors and comorbidities in people living with HIV: A cross-sectional multicenter study from Colombia comorbidities in a Colombian PLWHIV population.

INTRODUCTION: HIV is an independent risk factor for cardiovascular diseases (CVD). There is insufficient information regarding comorbidities and cardiovascular risk factors in the Colombian HIV population. The aim of this study is to describe the prevalence of cardiovascular risk factors and comorbidities in patients from the HIV Colombian Group VIHCOL. METHODS: This is a multicenter, cross-sectional study conducted in the VIHCOL network in Colombia. Patients 18 years or older who had at least 6 months of follow-up were included. A stratified random sampling was performed to estimate the adjusted prevalence of cardiovascular risk factors and comorbidities. RESULTS: A total of 1616 patients were included. 83.2% were men, and the median age was 34 years. The adjusted prevalence for dyslipidemia, active tobacco use, hypothyroidism, and arterial hypertension was 51.2% (99% CI: 48.0%-54.4%), 7.6% (99% CI: 5.9%-9.3%), 7.4% (99% CI: 5.7%-9.1%), and 6.3% (99% CI: 4.8%-7.9%), respectively. CONCLUSIONS: In this Colombian HIV cohort, there is a high prevalence of modifiable CVD risk factors such as dyslipidemia and active smoking. Non-pharmacological and pharmacological measures for the prevention and management of these risk factors should be reinforced.

The Mézières Method as a Novel Treatment for Elite Spanish Second-Division Soccer League Players With Low Back Pain: A Randomized Controlled Trial.

OBJECTIVES: To evaluate the efficacy of 24 weeks of treatment with Mézières method in a Spanish elite second-division soccer team with low back pain (LBP), analyzing their state of back health, flexibility, pain, and steps speed. DESIGN: Double-blind randomized controlled trial. METHODS: A total of 20 players with LBP from the second soccer division league were allocated equally to the experimental and control groups (n = 10) as per selection criteria and participated in 2 different rehabilitation programs. The postural Mézières method was implemented in the experimental group, whereas the standard European treatment protocol for LBP was implemented in the control group. Both treatments had a twice weekly session of 40 minutes duration for 24 weeks consecutively with a follow-up in the fourth, 12th, and 24th weeks. RESULTS: Multivariate analysis of covariance with the baseline assessment as a covariance showed a significant difference between groups at the 12th and 24th weeks of the treatment for pain and back functionality. A relevant difference between the experimental and control groups was shown only at the 24th week of the treatment (P < .05) for back flexibility. A significant difference between groups was reported for the quality of life scale and steps speed at the 24th week of the treatment (P > .05). CONCLUSION: The Mézières method showed a positive effect in the elite soccer athletes with nonspecific chronic LBP and can be used as an alternative treatment.

Atención Domiciliaria y Pandemia Covid-19: Experiencia Desde Enfermeria / Home care and the COVID-19 pandemic: Experiences from a nursing perspective / Assistência Domiciliar e Pandemia da Covid-19: Experiência de Enfermagem

Introducción: La atención domiciliaria busca brindar una solución a los problemas de salud en el domicilio con el apoyo de profesionales, técnicos del área de la salud y la participación de la familia, en tiempos de pandemia por COVID-19 se deben ajustar las dinámicas a este nuevo contexto Objetivo: Comprender el significado de la experiencia de enfermería brindando cuidado en atención domiciliaria en época de pandemia Materiales y Métodos: Estudio fenomenológico hermenéutico que incluyó a 15 enfermeros que laboran en una institución de hospitalización domiciliaria. Se realizaron entrevistas en profundidad, se analizó la información y se generaron las categorías que representan la experiencia Resultados: El análisis fenomenológico arrojó las siguientes categorías existenciales. El distanciamiento social un cambio en la cotidianidad, La prevención del contagio es responsabilidad de todos y desafíos para el paciente y familia en el domicilio. Conclusión: El personal de enfermería debe ser responsable del cumplimento de los protocolos de bioseguridad y por el bien de ellos mismos, sus pacientes y familiares, el trabajo en equipo y la educación permanente con la escucha activa hacen que esta pandemia por la que atraviesa el mundo no deteriore el cuidado de los pacientes que requieren cuidado en los domicilios.

Introduction: Home-based care seeks to provide a solution to home health care issues supported by healthcare professionals, practitioners and the participation of the family, whose dynamics in COVID-19 times should be adjusted to this new context. Objective: To understand the significance of the nursing experience providing care in home-based care settings in pandemic times. Materials and Methods: A hermeneutic-phenomenological study was conducted with 15 nurses who work in a home care service provider. In-depth interviews were conducted from which the information was analyzed and classified into categories representing the experiences. Results: The following categories were obtained from the phenomenological analysis: social distancing as a change in daily life, preventing COVID-19 infection is everyone's responsibility and home care challenges for patients and families. Conclusions: Nursing professionals must ensure compliance with biosafety protocols and for the good of themselves, their patients and families, teamwork and continuing education with active listening ensure that home care of patients does not deteriorate in these pandemic times

Introdução: A atenção domiciliar busca dar uma solução aos problemas de saúde no domicílio com o apoio de profissionais, técnicos da área da saúde e a participação da família, em tempos de pandemia pela COVID-19, a dinâmica deve ser ajustada a este novo contexto. Objetivo: Compreender o significado da experiência da enfermagem no cuidado na atenção domiciliar em tempos de pandemia. Materiais e Métodos: Estudo fenomenológico hermenêutico que incluiu 15 enfermeiras que trabalham em uma instituição de internação domiciliar. Foram realizadas entrevistas em profundidade, analisadas as informações e foram geradas as categorias que representam a experiência. Resultados:A análise fenomenológica gerou as seguintes categorias existenciais. O distanciamento social uma mudança no cotidiano, a prevenção do contágio é responsabilidade de todos e desafios para o paciente e família em casa. Conclusão: A equipe de enfermagem deve se responsabilizar pelo cumprimento dos protocolos de biossegurança e para o bem de si próprios, de seus pacientes e familiares, o trabalho em equipe e a educação permanente com escuta ativa fazem com que essa pandemia na qual o mundo atravessa não prejudique o atendimento aos pacientes que necessitam de cuidados domiciliares.

Effects of respiratory muscle training in soccer players: a systematic review with a meta-analysis.

Respiratory muscle training can improve strength and reduce respiratory muscle fatigue during high-intensity exercise. Little is known about the existing evidence in soccer players. A systematic review with a meta-analysis was performed to analyse the existing evidence on the effects of respiratory muscle training in soccer players. Two independent researchers reviewed 17 databases until July 2019. Inclusion criteria were controlled clinical trials (randomised or not), soccer players (professional or recreational), females and/or males, and respiratory muscle training compared with simulated or regular training groups. The methodological quality and quality of evidence were evaluated with the Cochrane Collaboration Tool and GRADE score, respectively. Statistical analysis was performed using the integral meta-analysis 3.3.070. Nine studies met the eligibility criteria. The meta-analysis was performed for eight variables related to respiratory muscle function, lung function and sports performance. Respiratory muscle training provided a significant improvement compared with simulated or regular training in maximal inspiratory buccal pressure (6 studies, SDM = 0.89; 95 % CI = 0.42, 1.35) and maximum consumption of oxygen (3 studies, SDM = 0.92; 95 % CI = 0.24; 1.61). No significant improvements were observed for other variables. The quality of the evidence was rated as low or very low.

Relationship between Respiratory Muscle Function and Postural Stability in Male Soccer Players: A Case-Control Study.

The important role of postural stability in exercise performance has been determined by several authors. Despite this, few studies have analyzed the relationship between respiratory muscles' strength and postural stability in athletes. For this reason, the aim of this study was to investigate the relationship between postural stability and respiratory muscles' function in male soccer players. A case-control study was conducted over twenty-eight healthy men (18 soccer players; 10 non-athletes). Inspiratory muscle strength (MIP) and respiratory resistance (MVV) were obtained through a digital spirometer. Stability variables were obtained in standing position on a stabilometric platform and in open and closed eyes conditions. The area and length of the center of pressures and displacements in the X and Y range were analyzed. Pearson's coefficient was used to measure the linear correlation between MIP, MVV and stabilometric variables. In the soccer players' group, MIP and MIP % predictive were inversely correlated with length (r = -0.535 and r = -0.585; p < 0.05) and X range (r = -0.527 and r = -0.560; p < 0.05), whereas MVV was directly correlated with length (r = 0.606; p < 0.01) and Y range (r = 0.558; p < 0.05). Our results show that the greater the inspiratory muscle strength, the less displacement of the pressure center, while at higher respiratory rates there is greater displacement.

Efectos del entrenamiento muscular inspiratorio sobre la función respiratoria y el equilibrio en supervivientes de ictus: un ensayo clínico controlado aleatorizado / Effects of inspiratory muscle training on respiratory function and balance in stroke survivors: a randomized controlled trial

INTRODUCCIÓN: Tras un ictus, los pacientes con hemiparesia y/o hemiplejía van a presentar una asimetría notable del tronco y la pelvis, y una disminución de la estabilidad postural y el equilibrio, lo que afecta, como consecuencia, a la función respiratoria. OBJETIVO: Analizar los efectos del entrenamiento muscular inspiratorio (EMI) sobre la función pulmonar, la fuerza muscular inspiratoria, el control postural y del tronco y el equilibrio en supervivientes de ictus. MATERIALES Y MÉTODOS: Dieciséis pacientes supervivientes de ictus en fase subaguda participaron en un ensayo clínico controlado aleatorizado (experimental = 8; placebo = 8). El grupo experimental recibió un programa de EMI, cinco días a la semana, una vez al día, durante ocho semanas, con una intensidad progresiva del 15 al 60% de la PImáx. El grupo placebo realizó el mismo programa, pero con una carga fija de 7 cmH2O. Se evaluaron la fuerza muscular inspiratoria presión inspiratoria máxima (PImáx), la función pulmonar (capacidad vital forzada, volumen espirado en el primer segundo, flujo espiratorio máximo y ventilación voluntaria máxima), el control del tronco (test de control del tronco), y el control postural y el equilibrio Postural Scale for Stroke Patients (PASS) y escala de Berg. RESULTADOS: Los grupos experimental y placebo presentaron incrementos significativos en la PImáx, con diferencia entre grupos. Existió una correlación negativa y moderada entre el valor de la PImáx inicial y el porcentaje de cambio (PImáx) (r = 0,572; p = 0,021). Se observaron incrementos significativos en la ventilación voluntaria máxima (L/m) en el grupo experimental, e incrementos en la PASS en ambos grupos, pero sin diferencias significativas entre grupos. CONCLUSIONES: El entrenamiento muscular inspiratorio, aunque de baja intensidad, es efectivo para mejorar la fuerza muscular inspiratoria en pacientes supervivientes de ictus. Sin embargo, los efectos sobre el control postural y el equilibrio permanecen inciertos

INTRODUCTION: After a stroke, patients with hemiparesis and / or hemiplegia will present a notable asymmetry of the trunk and pelvis, and decreased postural stability and balance, affecting, consequently, respiratory function. OBJECTIVE. The objective of this study is to analyze the effects of inspiratory muscle training (IMT) on lung function, inspiratory muscle strength, postural and trunk control and balance in stroke survivors in the subacute phase. MATERIALS AND METHODS: 16 survivors of stroke in the subacute phase participated in RCT (experimental = 8; placebo = 8). The experimental group received IMT program, 5 days a week, once a day, for 8 weeks, with a progressive intensity from 15% to 60% of the PImax. The placebo group performed the same program, but with a fixed load of 7cmH20. Inspiratory muscle strength (PImax), lung function (FVC, FEV1, PEF, VMV), trunk control (TCT), and postural control and balance (PASS and Berg Scale) were evaluated. RESULTS: Experimental and placebo groups showed significant increases in PImax, with a difference between groups. There was a moderate and negative correlation between the initial PImax value and the percentage change (PImax) (r = 0.572; p = 0.021). Significant increases in VMV (l/m) were observed in the experimental group, and increases in PASS in both groups, but without significant differences between groups. CONCLUSIONS: Inspiratory muscle training, although low intensity, is effective in improving inspiratory muscle strength in stroke survivors. However, the effects on postural control and balance remain uncertain

Selección de proveedores de insumos críticos en términos de sostenibilidad, a través de la metodología multicriterio, en una empresa del sector azucarero / Suppliers' selection of critical supplies in terms of sustainability, through the use of multi-criteria methodology, in sugar sector Company / Selecção de fornecedores de inputs críticos em termos de sustentabilidade, através da metodologia multicritério, numa empresa do sector do açúcar

RESUMEN Se presentan aquí, los resultados de una investigación teórico-práctica, en la cual se abarcó el eslabón de suministro, en una cadena de abastecimiento, en una empresa del sector azucarero en el Valle del Cauca. Para la selección de proveedores de insumos críticos, se aplicó la metodología multicriterio, considerando criterios que iban más allá del costo, tomando como referencia una clasificación de insumos de acuerdo a su criticidad en términos de sostenibilidad, para el proceso productivo. Inicialmente, se hizo una caracterización y una selección de los insumos críticos, en términos de sostenibilidad. Igualmente, se identificaron los proveedores para los insumos seleccionados. Luego, y en consenso con un comité escogido al interior de la empresa, se seleccionó y aplicó el método de jerarquía analítica AHP (Analytic Hierarcgy Process). Finalmente, se tomó la decisión más acorde a los requerimientos reales de la organización, los cuales consideraban como criterio principal la sostenibilidad, para alcanzar la competitividad y el desarrollo sostenible. Esto contribuirá con el tiempo, a que la organización sea económicamente viable, ambientalmente soportable y socialmente equitativa. CLASIFICACIÓN JEL 181

ABSTRACT We undertake a theoretical-practical investigation in which we study the supply function carried out by a company in the sugar sector at the Valle del Cauca. For the selection of critical input suppliers, we apply a multi-criteria methodology in which we take into account other criteria besides cost by considering a supplies' classification based on how critical these supplies are for the production process in terms of sustainability Initially we classify and select supplies that are more critical in regards to sustainability. Likewise, the suppliers for the selected inputs were identified. Then, in agreement with a committee chosen within the company we select and apply the analytical hierarchy method AHP (Analytic Hierarchy Process). Finally according to the real requirements of the organization, the most appropriate decision is made, which considers sustainability as the main criterion to achieve competitiveness and sustainable development. This will contribute to an economically feasible, environmentally bearable, and socially equitable company JEL CLASSIFICATION 181

RESUMO São aqui apresentados os resultados de uma investigação teórico-prática, que abrangeu o elo de abastecimento de uma cadeia de abastecimento de uma empresa do sector do açúcar no Valle del Cauca. Para a selecção de fornecedores de inputs críticos foi aplicada a metodologia multicritérios, considerando critérios que iam além do custo, tomando como referência uma classificação dos inputs de acordo com a sua criticidade em termos de sustentabilidade, para o processo produtivo. Inicialmente, foi feita uma caracterização e selecção de inputs críticos em termos de sustentabilidade. Do mesmo modo, foram identificados os fornecedores dos factores de produção seleccionados. Em seguida, e em consenso com um comité escolhido na empresa, foi seleccionado e aplicado o método AHP (Analytic Hierarchy Process). Finalmente, foi tomada a decisão mais consentânea com os requisitos reais da organização, que considerou a sustentabilidade como o principal critério para alcançar a competitividade e o desenvolvimento sustentável. Isto contribuirá, com o tempo, para tornar a organização economicamente viável, ambientalmente sustentável e socialmente equitativa. CLASSIFICAÇÃO JEL 181

Cultura dos povos originários da floresta amazônica na gestação e no puerpério: uma revisão de escopo sob o ponto de vista da segurança alimentar e nutricional / Culture of people originating from the Amazon rainforest during pregnancy and the puerperium: a scope review from the point of view of food and nutrition security

RESUMO A desnutrição na população indígena é um problema de saúde pública atual e uma das principais causas de morbimortalidade das crianças desses grupos no Brasil. Para subsidiar ações de promoção da educação alimentar e nutricional, abrangendo povos da floresta do estado do Amazonas, Brasil, cujo território faz fronteira com a Colômbia, além da visita de campo em 2018, fez-se necessário, concomitantemente, mapear na literatura como essa população vive e de que maneira o cuidado é prestado. A revisão de escopo buscou tópicos referentes ao modo de vida das mulheres e crianças na Amazônia, à dieta durante o período gestacional e do puerpério, a práticas de aleitamento, à introdução de alimentos sólidos ao bebê e aos cuidados dos serviços de saúde. Como resultado, foram recuperados 21 estudos multidisciplinares. Encontrou-se que a comida tradicional tem valor nutricional maior do que a industrializada, a culinária local é uma fonte de renda das mulheres indígenas no meio urbano e um elo entre etnias. Conclui-se que as pesquisas devem incorporar o paradigma da promoção da saúde e abranger temas como a aculturação indígena nos centros urbanos amazônicos, a chegada da internet nas aldeias e o papel do cuidado à distância, que necessitam ser investigados para melhor enfrentamento do problema.

ABSTRACT Malnutrition in the indigenous population is a current public health problem and a major cause of morbidity and mortality of children in these groups in Brazil. In order to support actions to promote food and nutrition education, including forest peoples from the state of Amazonas, Brazil, whose territory borders Colombia, in addition to the field visit in 2018, it was necessary, at the same time, to map the literature as this one. Population lives and how care is provided. The scope review sought topics related to the lifestyle of women and children in the Amazon, diet during pregnancy and the postpartum period, breastfeeding practices, the introduction of solid foods to the baby, and the care of health services. As a result, 21 multidisciplinary studies were retrieved. Traditional food has been found to have higher nutritional value than industrialized food, and local cuisine is a source of income for indigenous women in the urban environment and a link between ethnicities. It is concluded that the researches should incorporate the health promotion paradigm and cover themes such as indigenous acculturation in the Amazonian urban centers, the arrival of the internet in the villages and the role of distance care, which needs to be investigated to better address the problem.

Prevalencia y factores de riesgo para infecciones del tracto urinario de inicio en la comunidad causadas por Escherichia coliproductor de betalactamasas de espectro extendido en Colombia / Prevalence and risk factors for extended-spectrum Beta-lactamase-producing Escherichia coli causing community-onset urinary tract infections in Colombia

INTRODUCCIÓN: Las infecciones del tracto urinario (ITU) son frecuentes en la comunidad. Sin embargo, la información de aislamientos resistentes en este contexto es limitada en Latinoamérica. Este estudio tiene como objetivo determinar la prevalencia y los factores de riesgo asociados con ITU de inicio en la comunidad (ITU-IC) causadas por Escherichia coli productor de betalactamasas de espectro extendido (BLEE) en Colombia. MATERIALES Y MÉTODOS: Entre agosto y diciembre de 2011 se realizó un estudio de casos y controles en 3 instituciones de salud de tercer nivel en Colombia. Se invitó a participar a todos los pacientes admitidos a urgencias con diagnóstico probable de ITU-IC, y se les pidió una muestra de orina. En los aislamientos de E.coli se realizaron pruebas confirmatorias para BLEE, susceptibilidad antibiótica, caracterización molecular (PCR en tiempo real para genes bla, repetitive element palindromic PCR [rep-PCR], multilocus sequence typing [MLST] y factores de virulencia por PCR). Se obtuvo información clínica y epidemiológica, y posteriormente se realizó el análisis estadístico. RESULTADOS: De los 2.124 pacientes seleccionados, 629 tuvieron un urocultivo positivo, en 431 de estos se aisló E.coli, 54 fueron positivos para BLEE y 29 correspondieron a CTX-M-15. La mayoría de los aislamientos de E.coli productor de BLEE fueron sensibles a ertapenem, fosfomicina y amikacina. La ITU complicada se asoció fuertemente con infecciones por E.coliproductor de BLEE (OR=3,89; IC95%: 1,10-13,89; p = 0,03). E.coli productor de CTX-M-15 mostró 10 electroferotipos diferentes; de estos, el 65% correspondieron al ST131. La mayoría de estos aislamientos tuvieron 8 de los 9 factores de virulencia analizados. DISCUSIÓN: E.coli portador del gen blaCTX-M-15 asociado al ST131 sigue siendo frecuente en Colombia. La presencia de ITU-IC complicada aumenta el riesgo de tener E.coli productor de BLEE, lo cual debe tenerse en cuenta para ofrecer una terapia empírica adecuada

INTRODUCTION: Urinary tract infections (UTI) are common in the community. However, information of resistant isolates in this context is limited in Latin America. This study aims to determine the prevalence and risk factors associated with community-onset UTI (CO-UTI) caused by extended-spectrum β-lactamase (ESBL)-Producing Escherichia coli in Colombia. MATERIALS AND METHODS: A case-control study was conducted between August and December of 2011 in three Colombian tertiary-care institutions. All patients who were admitted to the Emergency Department with a probable diagnosis of CO-UTI were invited to participate. All participating patients were asked for a urine sample. ESBL confirmatory test, antibiotic susceptibility, and molecular epidemiology were performed in these E.coli isolates (Real Time-PCR for blagenes, repetitive element palindromic PCR [rep-PCR], multilocus sequence typing [MLST] and virulence factors by PCR). Clinical and epidemiological information was recorded, and a statistical analysis was performed. RESULTS: Of the 2124 recruited patients, 629 had a positive urine culture, 431 of which grew E.coli; 54 were positive for ESBL, of which 29 were CTX-M-15. The majority of ESBL isolates were susceptible to ertapenem, phosphomycin and amikacin. Complicated UTI was strongly associated with ESBL-producing E.coli infections (OR=3.89; 95%CI: 1.10-13.89; P=.03). CTX-M-15-producing E.coli showed 10 different pulsotypes, 65% were PT1 or PT4, and corresponded to ST131. Most of these isolates had 8 out of the 9 analysed virulence factors. DISCUSSION: E.coli harbouring blaCTX-M-15 associated with ST131 is still frequent in Colombia. The presence of complicated CO-UTI increases the risk of ESBL-producing E.coli, and must be taken into account in order to provide an adequate empirical therapy

Más allá de la recaída en el paciente con esquizofrenia / Beyond the relapse in patients with schizophrenia / Alèm recìda em pacientes con esquizofrenia

Uno de los desafíos actuales para los profesionales de la salud, específicamente en el área de la salud mental, está relacionado con la \r\nrecuperación y rehabilitación del paciente con esquizofrenia, donde la adherencia farmacológica desempeña un papel importante \r\npara disminuir el riesgo de recaída. Por lo anterior, se hace necesario revisar a profundidad el tema para conocer las posibles causas \r\no factores relacionados que permitan abordar esta problemática más allá de los aspectos biológicos y fisiológicos. Con tal fin, se \r\nrealizó la revisión de literatura científica que aborda la problemática de recaída en pacientes con esquizofrenia y psicosis. Diferentes \r\nestudios han abordado el fenómeno de la recaída en pacientes con esquizofrenia y las posibles causas, entre ellas, el no compro\r\n-\r\nmiso, el rol no activo del paciente y la falta de adherencia al tratamiento, así como de soporte social y familiar. Se ha demostrado \r\nque la administración continua de los antipsicóticos y la terapia cognitiva-conductual son eficaces en la reducción de las recaídas \r\nen personas con esquizofrenia. Se hace énfasis en fortalecer a los equipos de salud en el seguimiento y control del evento

One of the current challenges for health professionals, specif\r\n-\r\nically in the area of mental health, is related to the recovery \r\nand rehabilitation of patients with schizophrenia, where the \r\nmedical adherence plays an important role in reducing the risk \r\nof relapse. Therefore it is necessary to review in depth the issue \r\nin order to know the possible causes and / or related factors \r\nthat will address this issue beyond the biological and physio\r\n-\r\nlogical aspects. For this situation, a review of scientific literature \r\ndealing with the problem of relapse in patients with schizo\r\n-\r\nphrenia and psychosis was made. Therefore, various studies \r\nhave examined the phenomenon of relapse in patients with \r\nschizophrenia and possible causes, including active patient role \r\nin the disease process, treatment adherence, social and family \r\nsupport. It has been shown that continuous administration of \r\nantipsychotics and cognitive-behavioral therapy is effective \r\nin reducing relapses in people with schizophrenia. Emphasis \r\nis made on strengthening health teams in monitoring and \r\ncontrol of the event.\r\nConclusions: it is necessary to develop strategies and action \r\nplans to the population at risk. Strengthen health teams in the \r\nmonitoring and control of the disease, in order to limit relapses \r\nin patients with schizophrenia.

Um dos desafios atuais para os profissionais de saúde, espe\r\n-\r\ncificamente na área de saúde mental, está relacionado à \r\nrecuperação e reabilitação de pacientes com esquizofrenia, \r\nna qual a adesão à medicação desempenha um papel impor\r\n-\r\ntante na redução do risco de recaída. Por isso, é necessário \r\nrever em profundidade a questão, a fim de conhecer as possí\r\n-\r\nveis causas e/ou fatores relacionados que irão abordar esta \r\nquestão para além dos aspectos biológicos e fisiológicos. Para \r\nesta situação, realizou-se a revisão da literatura científica que \r\naborda a questão de recaída em pacientes com esquizofrenia \r\ne psicose. Vários estudos examinaram o fenômeno da recaída \r\nem pacientes com esquizofrenia e as possíveis causas, entre \r\nelas, o não comprometimento, o papel inativo do paciente e \r\na falta de adesão ao tratamento, assim como de apoio social \r\ne familiar. Foi demonstrado que a administração contínua dos \r\nantipsicóticos e da terapia comportamental cognitiva é eficaz \r\nna redução de recaídas em pessoas com esquizofrenia. Por fim, \r\nenfatiza-se o fortalecimento das equipes de saúde no acompa\r\n-\r\nnhamento e controle do evento.

[Prevalence and risk factors for extended-spectrum ß-lactamase-producing Escherichia coli causing community-onset urinary tract infections in Colombia]. / Prevalencia y factores de riesgo para infecciones del tracto urinario de inicio en la comunidad causadas por Escherichia coli productor de betalactamasas de espectro extendido en Colombia.

INTRODUCTION: Urinary tract infections (UTI) are common in the community. However, information of resistant isolates in this context is limited in Latin America. This study aims to determine the prevalence and risk factors associated with community-onset UTI (CO-UTI) caused by extended-spectrum ß-lactamase (ESBL)-Producing Escherichia coli in Colombia. MATERIALS AND METHODS: A case-control study was conducted between August and December of 2011 in three Colombian tertiary-care institutions. All patients who were admitted to the Emergency Department with a probable diagnosis of CO-UTI were invited to participate. All participating patients were asked for a urine sample. ESBL confirmatory test, antibiotic susceptibility, and molecular epidemiology were performed in these E.coli isolates (Real Time-PCR for bla genes, repetitive element palindromic PCR [rep-PCR], multilocus sequence typing [MLST] and virulence factors by PCR). Clinical and epidemiological information was recorded, and a statistical analysis was performed. RESULTS: Of the 2124 recruited patients, 629 had a positive urine culture, 431 of which grew E.coli; 54 were positive for ESBL, of which 29 were CTX-M-15. The majority of ESBL isolates were susceptible to ertapenem, phosphomycin and amikacin. Complicated UTI was strongly associated with ESBL-producing E.coli infections (OR=3.89; 95%CI: 1.10-13.89; P=.03). CTX-M-15-producing E.coli showed 10 different pulsotypes, 65% were PT1 or PT4, and corresponded to ST131. Most of these isolates had 8 out of the 9 analysed virulence factors. DISCUSSION: E.coli harbouring blaCTX-M-15 associated with ST131 is still frequent in Colombia. The presence of complicated CO-UTI increases the risk of ESBL-producing E.coli, and must be taken into account in order to provide an adequate empirical therapy.

Colonización por Staphylococcus aureus resistente a la meticilinaen una unidad de cuidados intensivos de adultos de un hospitalcolombiano: caracterización fenotípica y molecular con detecciónde un clon de circulación en la comunidad / Methicillin-resistant Staphylococcus aureus colonization in a Colombian hospital intensive care unit: phenotypic and molecular characterization

Introducción. Staphylococcus aureus resistente a la meticilina (SARM) causa infecciones adquiridas en la comunidad y en el ámbito hospitalario. El ser portador de SARM se ha descrito como factor de riesgo para desarrollar infección clínica. Objetivo. Caracterizar la colonización por SARM en pacientes adultos de una unidad de cuidados intensivos colombiana, utilizando herramientas de biología molecular.Materiales y métodos. Entre febrero de 2007 y febrero de 2008 se tamizaron mediante hisopado nasofaríngeo, 705 pacientes al ingresar a la unidad de cuidados intensivos, de los cuales, 683 (96,9%) fueron seguidos semanalmente y al egreso de la unidad. Se determinó el perfil de sensibilidad de los aislamientos a 11 antibióticos por el método de dilución en agar; el 62,0% de los aislamientos de SARM fueron caracterizados genética y molecularmente. Resultados. Se tamizaron 705 pacientes al ingreso; 182 (25,8%) estaban colonizados por S. aureus, de los cuales, 51 (7,2%) eran resistentes a la meticilina. Se hizo el seguimiento durante la estancia en la unidad de cuidados intensivos a 683 pacientes, de los cuales, 62 (9,1%) fueron colonizados por SARM en dicha unidad. La prevalencia del clon chileno fue de 76,5% al ingreso y de 88,9% durante la estancia. El 16,0% de los pacientes colonizados desarrollaron algún tipo de infección por SARM. Se encontraron tres pacientes colonizados con SARM adquirido en la comunidad, los cuales fueron positivos para la leucocidina Panton-Valentine (Panton-Valentine leukocidin, PVL). Conclusiones. El 7,2% de los pacientes que ingresaron a la unidad de cuidados intensivos estaban colonizados con SARM. Éste es el primer reporte de colonización por aislamientos de SARM-ST8-SCCmec IVc adquirido en la comunidad y relacionado genéticamente con el clon pandémico USA300-0114 en Colombia.

Introduction. Methicillin-resistant Staphylococcus aureus (MRSA) cause nosocomial and community infections. MRSA colonization in hospitals has been described as an important risk factor during hospitalization. Objective. The colonization characteristics of MRSA was described using the tools of molecular biology. Materials and methods. Between February 2007 and February 2008, 705 patients entering a Colombian intensive care unit (ICU) were screened for MRSA by taking nasopharyngeal samples. For 683 of these patients, a weekly follow-up was provided after they left the ICU. The susceptibility of each S. aureus isolate was tested against 11 antibiotics using agar dilution methods. Sixty two percent (62.0%) of the MRSA isolates were characterized at genetic and molecular level with the detection of resistant genes, SCCmec typing using PCR and the genetic profile with pulsed field gel electrophoresis (PFGE). Results. Of the 705 patients screened at entry to the ICU, 182 (25.8%) were colonized by S. aureus, and of these, 51 (7.2%) were MRSA. Of the 683 patients with follow-up, 62 (9.1%) were infected by MRSA contracted in the hospital ICU. The prevalence of the Chilean clone was 76.5% at entry and 88.9% for follow-up patients. Of the 113 patients colonized with MRSA, nosocomial infection was present in 18 patients (16.0%). Three community-acquired MRSA isolates related to the USA300-0114 pandemic clone were identified. These were also positive for Panton-Valentine leucidin cytotoxin genes of S.aureus. Conclusions. This is the first report in Colombia of patients colonized with CA-MRSA-ST8-SCCmec IVc isolates, and it is a probable source of dissemination of this bacteria in Colombian hospitals.

[Methicillin-resistant Staphylococcus aureus colonization in a Colombian hospital intensive care unit: phenotypic and molecular characterization]. / Colonización por Staphylococcus aureus resistente a la meticilina en una unidad de cuidados intensivos de adultos de un hospital colombiano: caracterización fenotípica y molecular con detección de un clon de circulación en la comunidad.

INTRODUCTION: Methicillin-resistant Staphylococcus aureus (MRSA) cause nosocomial and community infections. MRSA colonization in hospitals has been described as an important risk factor during hospitalization. OBJECTIVE: The colonization characteristics of MRSA was described using the tools of molecular biology. MATERIALS AND METHODS: Between February 2007 and February 2008, 705 patients entering a Colombian intensive care unit (ICU) were screened for MRSA by taking nasopharyngeal samples. For 683 of these patients, a weekly follow-up was provided after they left the ICU. The susceptibility of each S. aureus isolate was tested against 11 antibiotics using agar dilution methods. Sixty two percent (62.0%) of the MRSA isolates were characterized at genetic and molecular level with the detection of resistant genes, SCCmec typing using PCR and the genetic profile with pulsed field gel electrophoresis (PFGE). RESULTS: Of the 705 patients screened at entry to the ICU, 182 (25.8%) were colonized by S. aureus, and of these, 51 (7.2%) were MRSA. Of the 683 patients with follow-up, 62 (9.1%) were infected by MRSA contracted in the hospital ICU. The prevalence of the Chilean clone was 76.5% at entry and 88.9% for follow-up patients. Of the 113 patients colonized with MRSA, nosocomial infection was present in 18 patients (16.0%). Three community-acquired MRSA isolates related to the USA300-0114 pandemic clone were identified. These were also positive for Panton-Valentine leucidin cytotoxin genes of S.aureus. CONCLUSIONS: This is the first report in Colombia of patients colonized with CA-MRSA-ST8-SCCmec IVc isolates, and it is a probable source of dissemination of this bacteria in Colombian hospitals.

Respuesta hemodinámica con el entrenamiento en resistencia y fuerza muscular de miembros superiores en rehabilitación cardiaca / Hemodynamic response to training in resistance and muscular strength of upper limbs in cardiac rehabilitation

Antecedentes: el entrenamiento de la fuerza muscular en pacientes con eventos cardiovasculares, estaba totalmente contraindicado por el riesgo de incrementar las cifras de tensión arterial sistólica y diastólica, así como someter al miocardio a una sobrecarga. Objetivo: valorar la respuesta hemodinámica (frecuencia cardiaca, tensión arterial) durante el entrenamiento de resistencia a la fuerza muscular en los pacientes que asisten a un programa de rehabilitación cardiaca.Diseño: cuasi experimental prospectivo.Excenario: se realizó un entrenamiento de resistencia a la fuerza muscular en miembros superiores a pacientes durante la fase II de rehabilitación cardiaca.Sujetos: se incluyeron 175 pacientes, 135 hombres y 40 mujeres con un promedio de edad de 58,79 años, los cuales presentaron enfermedad coronaria con y sin procedimientos de revascularización, cirugía de cambios valvulares, síncope y corrección quirúrgica de anomalías congénitas...

Background: training of muscular strength in patients with cardiovascular events was totally contraindicated because of the risk of incrementing the systolic and diastolic arterial pressure values, as well as the submission to a myocardial overload. Objective: evaluate the hemodynamic response (heart rate, arterial pressure) during the resistance to muscular strength training in patients assisting to a heart rehabilitation program. Design: quasi experimental prospective study. Setting: resistance training to muscular strength in upper limbs to patients during stage II of cardiac rehabilitation was realized. Subjects: 175 patients were included. 135 men and 40 women with mean age 58.79 years with coronary disease, with or without revascularization procedures, valvular surgery, syncope and surgical correction of congenital heart disease. Procedure: previous aerobic training (treadmill or static bicycle), muscular strength evaluation was realized through maximal repetition and the strength training was initiated at 30%-50% of this, in a three different exercise circuit in upper limbs, 10 repetitions in three series with a twice a week frequency. Besides, monitoring of heart frequency, electrocardiogram by telemetry (V5), arterial pressure recording before, during and after the session, and subjective perception of the effort by the Borg scale were made, and signs and symptoms of intolerance to the activity or decompensation were observed. For the statistical analysis, measures of central tendency with the cardiovascular changes were used and in order to compare the change in muscular strength, a paired t test with significance level 0.05 was utilized. Results: mean muscular strength with maximal repetition evidenced a significant increase of 1.92 ± 2.49 lb (p<0.001) in the general population, with an increment of 2.03 ± 2.57 lb (p<0.001) in men and of 1.46 ± 2.1 lb...

[Molecular characterization of an outbreak caused by CTX-M-12-producing Klebsiella pneumoniae in a Colombian hospital's neonatal intensive care unit]. / Caracterización molecular de un brote por Klebsiella pneumoniae productora de CTX-M-12 en la unidad de cuidado intensivo neonatal de un hospital Colombiano.

INTRODUCTION: Molecular characterisation of Klebsiella pneumoniae strains is a tool that assits in the reduction of the disemination of drug resistance and the control of nosocomial infections that are caused by this pathogen. Objective. Molecular description of an outbreak of nosocomial infection caused by Klebsiella pneumoniae in a neonatal intensive care unit in a tertiary level hospital in Bogotá. METHODS: Eleven Klebsiella pneumoniae isolates were analysed. Production of Extended Spectrum Beta-Lactamases was verified by agar diffusion tests. Isoelectric points of the enzymes were determined by isoelectric focusing. The bla(CTX-M-12) gene was detected by PCR and pulsed field gel electrophoresis genotyping was done. RESULTS: All the isolates were Extended Spectrum Beta-Lactamase producers. Pulsed field gel electrophoresis and BOX-PCR genotyping grouped two isolates from hospital objects and eight infection-causing isolates into a single epidemic clone. The isolate from a thermometer was not grouped into the epidemic clone and showed a different resistance pattern. Isoelectric focusing revealed simultaneous beta-lactamase production having different isoelectric points. PCR amplification revealed the presence of the bla(CTX-M-12) gene in the 11 isolates studied. CONCLUSION: This is the first report of a molecularly characterised outbreak of CTX-M-12-producing Klebsiella pneumoniae from Colombia. The results of this study provide additional evidence of the global dissemination of CTX-M ESBL and the need for epidemiological follow-up in our hospitals.

Caracterización molecular de un brote por Klebsiella pneumoniae productora de CTX-M-12 en la unidad de cuidado intensivo neonatal de un hospital colombiano / Molecular characterization of an outbreak caused by CTX-M-12-producing Klebsiella pneumoniae in a Colombian hospital´s neonatal intensive care unit

Introducción. La caracterización molecular de cepas de Klebsiella pneumoniae es una herramienta que contribuye a disminuir la diseminación de la resistencia y al control de las infecciones nosocomiales causadas por este patógeno. Objetivo. Describir molecularmente un brote de infección nosocomial por Klebsiella pneumoniae en la Unidad de Cuidado Intensivo Neonatal de un hospital de tercer nivel de Bogotá. Materiales y métodos. Se analizaron once aislamientos. Se verificó la producción de betalactamasas de espectro extendido mediante pruebas de difusión en agar. Se determinaron los puntos isoeléctricos de las betalactamasas mediante isoelectroenfoque. Se detectó el gen blaCTX-M-12 por PCR y se realizó genotipificación mediante BOX- PCR y electroforesis en gel con campos pulsados (PFGE). Resultados. Los aislamientos fueron productores de beta-lactamasas de espectro extendido. La genotipificación por PFGE y por BOX-PCR, agrupó a dos aislamientos provenientes de objetos hospitalarios y a los ocho aislamientos causantes de infección en un grupo clonal epidémico. El aislamiento proveniente de un termómetro no fue agrupado en el grupo clonal epidémico y mostró un patrón de resistencia diferente. Se observó la producción simultánea de beta-lactamasas con diferentes puntos isoeléctricos. La PCR reveló el gen blaCTX-M-12 en los 11 aislamientos estudiados. Conclusión: Este es el primer informe en Colombia de un brote por Klebsiella pneumoniae productora de CTX-M-12, caracterizado molecularmente. Este estudio da evidencia adicional de la diseminación global de BLEE de tipo CTX-M y alerta sobre la necesidad de actividades especificas de prevención para cortar la cadena de transmisión y del seguimiento de tipo epidemiológico en nuestros centros hospitalarios

Introduction. Molecular characterisation of Klebsiella pneumoniae strains is a tool that assits in the reduction of the disemination of drug resistance and the control of nosocomial infections that are caused by this pathogen. Objective. Molecular description of an outbreak of nosocomial infection caused by Klebsiella pneumoniae in a neonatal intensive care unit in a tertiary level hospital in Bogotá. Methods: Eleven Klebsiella pneumoniae isolates were analysed. Production of Extended Spectrum Beta-Lactamases was verified by agar diffusion tests. Isoelectric points of the enzymes were determined by isoelectric focusing. The blaCTX-M-12 gene was detected by PCR and pulsed field gel electrophoresis genotyping was done. Results. All the isolates were Extended Spectrum Beta-Lactamase producers. Pulsed field gel electrophoresis and BOX-PCR genotyping grouped two isolates from hospital objects and eight infection-causing isolates into a single epidemic clone. The isolate from a thermometer was not grouped into the epidemic clone and showed a different resistance pattern. Isoelectric focusing revealed simultaneous beta-lactamase production having different isoelectric points. PCR amplification revealed the presence of the blaCTX-M-12 gene in the 11 isolates studied. Conclusion. This is the first report of a molecularly characterised outbreak of CTX-M-12-producing Klebsiella pneumoniae from Colombia. The results of this study provide additional evidence of the global dissemination of CTX-M ESBL and the need for epidemiological follow-up in our hospitals.

Impacto del seguimiento sobre la modificación de factores de riesgo en pacientes con enfermedad arterial coronaria / Follow-up impact on the modification of risk factors in patients with coronary artery disease

Se realizó un estudio observacional descriptivo de corte longitudinal prospectivo, con el fin de describir la disminución en la prevalencia de nuevos eventos coronarios en 344 pacientes que asistieron de enero de 2001 a enero de 2003, a un programa de rehabilitación cardiaca y con una consulta y al menos un control en la clínica de factores de riesgo, donde se hace seguimiento de la modificación de hábitos nutricionales, promoción y realización de actividad física, cese del tabaquismo y cumplimiento del tratamiento farmacológico.Resultados: se observaron cambios significativos en todos los componentes de prevención, en el grupo de pacientes que asistieron a mayor número de controles en factores de riesgo. Más del 75.85 porciento de la población continuaba con tratamiento farmacológico betabloqueador, 91.97 porciento con ácido acetilsalicílico (AAS), 87.9 porciento con estatinas y 55.67 porciento con terapia antihipertensiva. Se evidenciaron valores de LDL entre 98.9 y 122 mg porciento, y HDL entre 38.3 y 41.1 porciento. Los rangos de presión arterial registrados fueron de 117.0 a 132.2 mm Hg y de 76.5 a 82.7 mm Hg para la presión arterial sistólica y diastólica respectivamente. Más del 80 porcient de los pacientes que permanecieron en control, realizaban una actividad fìsica mayor a tres veces por semana. Se evidenció que más del 75 porciento de los pacientes que ingresaron al programa y asistieron a los controles programados, manifestaron no haber vuelto a fumar.No se registraron nuevos eventos coronarios en el grupo de pacientes que asistió a más de dos controles en factores de riesgo.Conclusiones: el seguimiento de factores de riesgo mostró modificación en los hábitos de vida, como incremento en la actividad física, continuidad en el tratamiento farmacológico, cese del tabaquismo y disminución en el riesgo para nuevos eventos coronarios. La prevención para enfermedad cardiovascular, debe iniciarse lo más temprano posible en todo paciente con riesgo y/o sín...

Impacto del entrenamiento intervalado como preparación pre-competencia atlética en fase III de rehabilitación cardíaca / Impact of the training interval as preparation athletic pre-competition in phase the IIIrd of cardiac rehabilitation

Se trata de un estudio descriptivo de corte longitudinal, prospectivo, en donde se realizó un entrenamiento supervisado de tipo intervalado, manteniendo la frecuencia cardiaca en límites de seguridad mediante caminata y/o trote en 21 hombres con rango de edad de 30 a 73 años, con previo evento cardiaco, que se encontraban en fase III de un programa de rehabilitación cardiaca, con el fin de participar en un evento atlético competitivo. Además, se describieron y compararon los cambios en las variables cardiovasculares en reposo (frecuencia cardiaca y presión arterial) y los cambios en la composición corporal antes y después del entrenamiento.Cada semana, el programa de entrenamiento intervalado tenía una intensidad diferente, oscilando entre 70 porciento y 75 porciento de la frecuencia cardiaca máxima teórica calculada, durante 35 a 45 minutos.Al comparar las variables cardiovasculares, de peso y composición corporal analizadas mediante la prueba t de student, se evidenció una disminución en el peso corporal, el índice de masa corporal, el porcentaje de grasa y el perímetro de cintura, lo cual estadísticamente significativo (p< 0.005). Al analizar el comportamiento de la frecuencia cardiaca durante el ejercicio con la prueba ANOVA de una vía, se evidenció que los promedios de porcentaje de frecuencia cardiaca máxima oscilaron entre 61.7 porciento y 75.47 porciento. Es de destacar que el 76 porciento de estos pacientes tomaban betabloqueadores.