Attitudes towards childcare practices in rural and urban caregivers with high rates of multidimensional poverty

Objective: To analyse the relationship between poverty and attitudes towards childcare practices in rural and urban areas of Colombia. Method: This article presents a cross-sectional correlational study conducted in the department of Atlántico, northern Colombia. Attitudes towards childcare and living conditions were assessed among 1189 caregivers of preschool children. The multidimensional poverty index and the participants' area of origin (urban or rural) were considered. Results: No direct relationship was found between attitudes towards childcare and the multidimensional poverty index. However, it was observed that urban participants from deprived areas had a higher poverty index and less positive attitudes towards childcare, especially regarding cognitive, sleep and health care. There was a moderating effect of area on attitudes towards childcare. Conclusions: The study highlights the influence of poverty and social vulnerability on attitudes towards childcare, particularly in urban areas. These findings underline the importance of considering socio-economic and geographical conditions when addressing childcare practices. It also highlights the need to implement specific strategies to promote positive childcare practices in more vulnerable contexts to improve early childhood development in Colombia.

Objetivo: Analizar la relación entre la pobreza y las actitudes hacia las prácticas de cuidado infantil en áreas rurales y urbanas de Colombia. Método: El presente artículo es un estudio transversal correlacional en el departamento del Atlántico, al norte de Colombia. Se indagó sobre las actitudes hacia el cuidado infantil y las condiciones de vida en 1189 cuidadores de niños en edad preescolar. Se tuvo en cuenta el índice de pobreza multidimensional y el área de procedencia de los participantes (urbana o rural). Resultados: No se encontró una relación directa entre las actitudes hacia el cuidado infantil y el índice de pobreza multidimensional. Sin embargo, se observó que los participantes de áreas urbanas provenientes de zonas vulnerables presentaron un mayor índice de pobreza y mostraron actitudes menos positivas hacia el cuidado infantil, especialmente en el cuidado cognitivo, del sueño y de la salud. Se evidenció un efecto moderador del área sobre las actitudes de cuidado. Conclusiones: El estudio destaca la influencia de la pobreza y la vulnerabilidad social en las actitudes de cuidado infantil, especialmente en áreas urbanas. Estos hallazgos subrayan la importancia de considerar las condiciones socioeconómicas y geográficas al abordar el cuidado infantil. Además, se resalta la necesidad de implementar estrategias específicas para promover prácticas de cuidado positivas en contextos más vulnerables, con el fin de mejorar el desarrollo de la primera infancia en Colombia.

Hematological and blood chemistry parameters of a Podocnemis vogli and P. unifilis captive population in Colombia.

The Podocnemididae family is seriously affected by anthropogenic factors, which is why almost all of their family members are threatened, according to the IUCN red list. The biology and ecology of these species, as well as the hematological and serum chemistry reference intervals that allow clinical action and decision-making conservation programs, are poorly known. Based on this, the objective of this study was to establish the hematological and blood chemistry parameters of the Savannah side-necked turtle (Podocnemis vogli) and Yellow-spotted river turtle (Podocnemis unifilis) maintained in captivity at the Estación de Biología Tropical Roberto Franco (Villavicencio-Colombia). Forty-nine captive turtles of the species P. vogli (n = 28) and P. unifilis (n = 21) were sampled to determine hematological and serum chemistry parameters. Blood samples were taken from the jugular veins of both male and female turtles across both species. Student's t-test and Mann-Whitney-Wilcoxon tests were used to compare values between the parameters evaluated against genders and sizes. Reference intervals were calculated for the hematological and biochemical values of each species. Some assessed parameters demonstrated significant differences between the males and females of both species. Most of the analyzed parameters exhibited similar reference intervals in both species. In this study, we report values and propose the hematological and serum chemistry reference intervals for P. vogli and P. unifilis, which can be used in the clinical diagnosis of these reptiles and in future research.

Virus de la hepatitis E

Resumen El virus de la hepatitis E (VHE) es uno de los principales agentes etiológicos de hepatitis entérica en el mundo. En países en vía de desarrollo, la seroprevalencia oscila entre 20 y 50% y en países desarrollados entre 4,4 y 21%. Clínicamente los casos de infección por VHE en individuos inmunocompetentes cursan como una hepatitis viral aguda auto limitada; por el contrario, en mujeres embarazadas, individuos receptores de trasplantes de órganos e individuos que conviven con el virus de la inmunodeficiencia humana (VIH), la infección puede manifestarse como una hepatitis crónica y grave. En América Latina, sólo Brasil y Argentina reportan cifras en individuos que conviven con el VIH. Se requieren más estudios en nuestra región que permitan determinar la prevalencia del VHE en individuos inmunosuprimidos, donantes de sangre y población general para adoptar medidas que garanticen un diagnóstico oportuno, acceso a la atención y el control de la transmisión.

Abstract The hepatitis E virus (HEV) is one of the main etiological agents of enteric hepatitis in the world. In developing countries its sero-prevalence ranges from 20 to 50% and in developed countries from 4.4% to 21%. Clinically, cases of HEV infection in immunocompetent individuals present as self-limited acute viral hepatitis; conversely, in pregnant women, transplanted individuals, and individuals living with the human immunodeficiency virus (HIV), the infection can manifest as chronic and severe hepatitis. In Latin America, only Brazil and Argentina report figures for individuals living with HIV. More studies are required in our region to determine the prevalence of HEV in immunosuppressed individuals, blood donors, and the general population to adopt measures that guarantee timely diagnosis, access to care, and control of transmission.

Comparative Effectiveness Study of Home-Based Interventions to Prevent CA-MRSA Infection Recurrence.

Recurrent skin and soft tissue infections (SSTI) caused by Community-Associated Methicillin-Resistant Staphylococcus aureus (CA-MRSA) or Methicillin-Sensitive Staphylococcus aureus (CA-MSSA) present treatment challenges. This community-based trial examined the effectiveness of an evidence-based intervention (CDC Guidelines, topical decolonization, surface decontamination) to reduce SSTI recurrence, mitigate household contamination/transmission, and improve patient-reported outcomes. Participants (n = 186) were individuals with confirmed MRSA(+)/MSSA(+) SSTIs and their household members. During home visits; Community Health Workers/Promotoras provided hygiene instructions; a five-day supply of nasal mupirocin; chlorhexidine for body cleansing; and household disinfecting wipes (Experimental; EXP) or Usual Care Control (UC CON) pamphlets. Primary outcome was six-month SSTI recurrence from electronic health records (EHR). Home visits (months 0; 3) and telephone assessments (months 0; 1; 6) collected self-report data. Index patients and participating household members provided surveillance culture swabs. Secondary outcomes included household surface contamination; household member colonization and transmission; quality of life; and satisfaction with care. There were no significant differences in SSTI recurrence between EXP and UC in the intent-to-treat cohort (n = 186) or the enrolled cohort (n = 119). EXP participants showed reduced but non-significant colonization rates. EXP and UC did not differ in household member transmission, contaminated surfaces, or patient-reported outcomes. This intervention did not reduce clinician-reported MRSA/MSSA SSTI recurrence. Taken together with other recent studies that employed more intensive decolonization protocols, it is possible that a promotora-delivered intervention instructing treatment for a longer or repetitive duration may be effective and should be examined by future studies.

Implementación de la Informatización del Servicio de Préstamo de Literatura Docente / Implementation of computerization in the textbook lending service

RESUMEN Introducción: el servicio de préstamos de libros del almacén de literatura docente constituye uno de los servicios más importantes dentro de las universidades de las Ciencias Médicas. En estos centros, no existe una aplicación que gestione los procesos de esta área. El préstamo se hace mediante tarjetas individuales por usuarios, su procesamiento enlentece el proceso en los tiempos de mayor flujo de usuarios. La presente investigación, implementación, es continuación de la Informatización del Servicio de Préstamo de Literatura Docente en la Universidad de Ciencias Médicas de Pinar del Río. Objetivo: implementar la informatización del Servicio de Préstamo de Literatura Docente en la Universidad de Ciencias Médicas de Pinar del Río. Métodos: se utilizaron métodos teóricos como: el histórico-lógico y análisis de los documentos relacionados con el proceso de gestión de la literatura docente. Resultados: se implementó y probó una Aplicación, previamente diseñada, que brinda las funcionalidades necesarias para gestionar el préstamo y control de la literatura docente en el almacén. Su uso mejora la calidad del servicio de préstamos, permite tener un control riguroso la literatura existente y brindar respuestas rápidas y precisas a todas las informaciones solicitadas por el nivel superior. Conclusiones: se obtuvo un producto novedoso ya que no existen antecedentes en la universidad de Ciencias Médicas. Con su realización se logró informatizar el proceso de préstamo de literatura docente en la Universidad de Ciencias Médicas de Pinar del Río y su aplicación mejora la calidad del servicio que reciben estudiantes y profesores.

ABSTRACT Introduction: lending service from the textbook store constitutes one of the most important processes within the University of Medical Sciences. In these centers, no applications have been designed to manage the processes of book-lending. It is made through individual cards by users; this slows down the process in the times of greater flow of users. The present research establishes the implementation of computerization, and the continuance of Informatization in the textbook- lending service at Pinar del Rio University of Medical Sciences. Objective: to implement the computerization in the textbook-lending service at Pinar del Rio University of Medical Sciences. Methods: theoretical methods: historical-logical and analysis of documents related to the process of management of the textbooks. Results: a previously designed application was implemented and tested, which provides the necessary functions to manage and control the textbooks in the book store. Its implementation improves the quality of the lending service and allows having an accurate control of all the textbooks, providing at the same time faster and accurate responses to all the information requested by the higher level. Conclusions: a novel product was obtained since there is no background in the University of Medical Sciences. With its implementation the process of management of the textbooks at Pinar del Río University of Medical Sciences was computerized, and its application improves the quality of the service for both students and professors.

Early-Onset of Transthyretin Amyloidosis in a Young Afro-Caribbean Woman With Thr60Ala Mutation.

Transthyretin amyloidosis involves the deposition of transthyretin amyloid fibrils in the body. We report an unusual case of a young Afro-Caribbean woman harboring a Thr60Ala mutation who presented with clinical signs of heart failure and polyneuropathy confirmed with genetic testing and results of an abdominal fat pad biopsy. (Level of Difficulty: Intermediate.).

Respuestas evocadas visuales mediante estimulación con diodos emisores de luz montados en gafas / Visual evoked responses to light-emitting diodes in goggles

Introducción: El potencial evocado visual es una técnica que permite la evaluación de la integridad funcional de la vía visual; su aplicación en niños pequeños resulta de gran dificultad. Objetivo: Caracterizar desde el punto de vista fisiológico el potencial evocado visual en niños menores de 5 años. Métodos: Estudio descriptivo transversal, donde se registran respuestas visuales obtenidas con diodos (montados en gafas) en 112 niños sanos (65 varones, 47 hembras) con rango de edad entre 3 meses y 5 años. Se calcularon los valores medios y desviación estándar de latencias y amplitudes de cada componente de la respuesta y se estimaron sus dinámicas madurativas en función de la edad. Se utilizó un análisis de componentes principales para explicar la variabilidad morfológica (complejo N1-P1-N2) y, se calculó una ecuación discriminante (con indicadores de replicación y relación señal/ruido), para evaluar la contribución en su mejor detección. Resultados: La morfología típica encontrada resultó consistente, replicable y mostró un nivel de detección visual > 90 por ciento (para cada componente), con 85 por ciento de acierto global (clasificaciones correctas) mediante la ecuación discriminante. El complejo N1-P1-N2, consigue explicar > 70 por ciento de la varianza de esta respuesta. Se demostró un acortamiento significativo de latencia con la edad (regresión, p≤ 0,05) para los componentes N1, P1 (marginal, N2). Los valores de amplitud resultaron de mayor dispersión y su tendencia al incremento no alcanzó significación. Conclusiones: El registro del potencial evocado visual mediante diodos/gafas demuestra la obtención de respuestas fisiológicas consistentes y replicables (alta detectabilidad) con una variabilidad morfológica controlable(AU)

Introduction: The Visual Evoked Potentials is a neurophysiological technique to provide an objective assessment of the functional integrity of the visual pathway. However, the young children population is a particularly difficult (uncooperative) group to obtain visual responses. Objective: The purpose of this study was to describe electrophysiological characteristics of the visual response in children. Methods: Descriptive, cross-sectional study. Transient visual evoked potentials with goggles were recorded from 112 healthy children (65 males, 47 females) aged between 3 months to 5 years old. The mean (and standard deviations) for latencies and amplitudes of each component was calculated and both statistical significance in function of age was analyzed (linear regression model). Principal component analysis is use to explain the visual waveform variability. A discriminant equation (with indicators of reliability and noise/signal ratio) is calculate to evaluate contribution in detectability. Results: The typical waveform of (N1, P1, N2, components) is consistent and reliable and showed a visual detection level >90 percent (for each component) and 85 percent of global success (good classifications) with the discriminant equation. N1-P1-N2 complex is able to explain >70 percent of the visual response variance. A significant reduction of N1, P1 (N2, marginal) latencies with increasing age is demonstrated (linear regression, p≤0.05). There was no significant difference for age-dependent increased pattern of amplitude data (high variability). Conclusions: The visual evoked potentials/goggles obtained in infants and young children are consistent and reliable physiological responses (high detectability) with recognizable morphological variability(AU)

Respuestas evocadas auditivas obtenidas mediante un estímulo chirp de banda ancha / Auditory evoked responses obtained by a broad-band chirp stimulus

Introducción: La estimación de la audición con Potenciales Evocados Auditivos de Tallo Cerebral obtenidos mediante estímulos tipo chirp constituye una alternativa de reciente aplicación. Varios autores han demostrado que, este tipo de estimulación compensa el retardo de la onda sonora en la codificación de frecuencias, generándose Potenciales Evocados Auditivos de Tallo Cerebral con componentes de amplitudes mayores. Objetivos: Diseñar y generar un estímulo chirp (banda ancha) para implementar en el sistema AUDIX (La Habana, Neuronic SA) y, realizar una serie de controles para evaluar su viabilidad en el registro de Potenciales Evocados Auditivos de Tallo Cerebral en sujetos con audición normal. Métodos: Las formulaciones que se utilizaron en la generación del estímulo fueron implementadas como una función en Matlab®, y luego, insertada en el sistema AUDIX con las siguientes especificaciones técnicas, frecuencia de muestreo: 48 kHz, composición de frecuencias (ascendente): 350-11300 Hz, y duración total: 4,95 ms. Se obtuvieron registros de PEATC mediante estímulos chirp y click a un nivel de intensidad fija (60 dB nHL) en 9 sujetos adultos (18 oídos) con audición normal. Resultados: El estímulo chirp diseñado tuvo un comportamiento funcional similar a lo reportado en la literatura. Cuando se compara con los Potenciales Evocados Auditivos de Tallo Cerebral -click, la onda V de Potenciales Evocados Auditivos de Tallo Cerebral -chirp mostró valores de amplitud significativamente mayores (relación de amplitud chirp/click: 1,62), con una ganancia promedio de 54 por ciento (p< 0,001, n= 18, prueba de rangos de Wilcoxon). Conclusiones: El estímulo chirp (banda ancha) diseñado resulta más eficiente que el estímulo click para obtener registros de Potenciales Evocados Auditivos de Tallo Cerebral. Con respecto a la amplitud de la onda V, el sistema muestra un funcionamiento lineal (mejor sincronía neural). Este tipo de estimulación pudiera resultar de mucha utilidad en programas de pesquisa auditiva neonatal pues la obtención de una onda V de mayor amplitud permitiría su fácil y rápida detección, y posible automatización(AU)

Introduction: Estimation of audition through brainstem auditory evoked potentials obtained by chirp stimuli is an alternative of recent application. It has been shown by several authors that this type of stimulation compensates for retardation of the sound wave in the coding of frequencies, generating auditory evoked responses with components of higher amplitudes. Objectives: Design and develop a broad-band chirp stimulus to be implemented in the AUDIX system and conduct a control series evaluation of its viability to register brainstem auditory evoked potentials in normal-hearing subjects. Methods: The formulations used to generate the stimulus were implemented as a function on Matlab® and then incorporated into the AUDIX system with the following technical specifications: sampling frequency: 48 kHz, frequency composition (rising): 350-11 300 Hz, and total duration: 4.95 ms. BAEP registries were obtained with chirp and click stimuli at a fixed intensity level (60 dB nHL) in nine normal-hearing adult subjects (18 ears). Results: The chirp stimulus designed had a functional behavior similar to the one reported in the literature. When compared with the click-BAEP, the V wave of chirp-BAEP displayed significantly higher amplitude values (chirp/click amplitude ratio: 1.62), with an average gain of 54 percent (p< 0.001, n= 18, Wilcoxon rank test). Conclusions: The broad band chirp stimulus designed proved to be more efficient than the click stimulus to obtain registries of Brainstem Auditory Evoked Potentials. Regarding V wave amplitude, the system was found to function linearly (better neural synchrony). This type of stimulation could be very useful in neonatal hearing screening programs, since a higher amplitude V wave could facilitate its fast and easy detection and possible automation(AU)

Management and outcome of obstructive ureteral stones in the emergency department: Emphasis on urine tests and antibiotics usage.

BACKGROUND: Kidney stone related complaints in the Emergency Department (ED) are common. Current guidelines recommend antibiotic therapy for infected obstructive stones and stone removal in a timely fashion, but there is no clear recommendation for prophylactic antibiotic use for bacteriuria or pyuria in the setting of obstructive ureteral stones. OBJECTIVES: The aim of this study is to evaluate the current management of patients with obstructive ureteral stones in a single ED with emphasis on urine tests and antibiotics use. METHODS: The picture archiving and communication system (PACS) was used to filter the list of patients who received a computed tomography (CT) scan of the abdomen and pelvis that positively identified obstructive ureteral stones. Demographics and clinical data were also recorded and analyzed. RESULTS: Of the patients discharged, 278 patients did not receive antibiotics in the ED or a prescription. Of these, 8 patients had positive culture, 4 patients followed up, and one developed and was treated for a urinary-tract infection. One hundred ninety two patients were not given antibiotics in the ED but received an antibiotics prescription, and 4 patients had positive cultures grow. Two followed up and had no infection-related complications. Fourteen patients were discharged without a prescription after receiving a single dose of antibiotics in the ED, with no positive urine cultures and 9 patients following up without complication. CONCLUSION: Antibiotics were given at the discretion of the provider without clear pattern. A high rate of infectious complication did not occur in the followed up patient group.

Consenso Colombiano para la estratificación, diagnostico, Tratamiento y Prevención de la Infección por citomegalovirus en Pacientes Adultos con trasplante renal / Colombian consensus for stratification, diagnosis, treatment and prevention of cytomegalovirus infection in adults patients with renal transplant

El citomegalovirus es una de las principales causas de infección y enfermedad en receptores de trasplante renal, con un notorio impacto en términos de morbilidad, mortalidad y costos. Sin embargo, no existe en Colombia una práctica clínica estandarizada entre los centros de trasplante, por lo cual, es de suma importancia disponer de guías con el fin de orientar la estratificación, el diagnóstico de laboratorio, el tratamiento y la prevención de la infección y enfermedad por citomegalovirus en pacientes adultos con trasplante renal. A través de la metodología ADAPTE para la evaluación de calidad y transculturización de guías de práctica clínica a nuestro medio, un grupo multidisciplinario realizó una revisión sistemática de la literatura: se seleccionaron las guías internacionales, las cuales fueron evaluadas con el instrumento AGREE II en términos de calidad. Con la guía base seleccionada se buscó la evidencia existente para contestar a las preguntas, de acuerdo con el método de desarrollo de recomendaciones GRADE. Se realizaron recomendaciones para la estratificación, el diagnóstico, el tratamiento y la prevención de la infección y enfermedad por citomegalovirus en pacientes adultos con trasplante renal en Colombia.

Cytomegalovirus is a primary cause of infection and illness in patients who have had renal transplantation, with a significant impact on morbidity, mortality and economic costs. However, there is no standardized clinical practice in transplant centers in Colombia, and it is important to have guidelines to stratify, diagnose, treat and prevent cytomegalovirus infection and disease. Through ADAPTE's methodology for the quality evaluation and adaptation of clinical practice guidelines in our setting, a multidisciplinary group carried out a systematic review of the medical literature, selecting international guidelines that were evaluated with the AGREE-II instrument in terms of quality. With each selected guideline, an evidence table was constructed and the GRADE strategy was performed to develop recommendations. Recommendations related to stratification, laboratory diagnosis, treatment and prevention of infections and disease caused by cytomegalovirus in adult transplant patients were developed.

Diseminación de cepas Staphylococcus aureus sensible a meticilina (SASM) relacionadas genéticamente, pertenecientes al CC45, entre portadores nasales sanos de hogares infantiles de Medellín, Colombia / Spread of genetically related methicillin-susceptible Staphylococcus aureus belonging to CC45, in healthy nasal carriers in Child Day Care Centers of Medellin, Colombia

INTRODUCCIÓN: La colonización por Staphylococcus aureus desempeña un papel importante en la epidemiología y patogénesis de las infecciones que causa. La población infantil es una de las más susceptibles a colonizarse; sin embargo, en Colombia los estudios en comunidad y en población infantil son escasos. OBJETIVO: Determinar la relación clonal de aislamientos colonizantes de S. aureus en menores de 8 hogares infantiles de Medellín y describir las características epidemiológicas presentes en esta población. MÉTODOS: Se realizó un estudio observacional transversal donde se seleccionó una muestra de 200 menores entre los 6 meses y los 5 años de edad, provenientes de 8 hogares infantiles de Medellín, Colombia, durante 2011. Las muestras fueron tomadas de fosas nasales. Los aislamientos de S. aureus y la resistencia a meticilina se confirmaron molecularmente, empleando los genes nuc y mec. La genotipificación incluyó tipificación del SCCmec, tipificación de spa, PFGE y MLST. La información epidemiológica fue obtenida de los padres y analizada en SPSS® 21.0. RESULTADOS: La frecuencia de colonización en los hogares varió entre el 16,7% (n = 3) y el 53,6% (n = 15). En el interior de 4 hogares infantiles se identificaron aislamientos de S. aureus relacionados entre sí. Adicionalmente, el 50% de todos los aislamientos de S. aureus sensible a meticilina se agruparon en 3 clúster, que pertenecían a los complejos clonales CC45, CC30 y CC121. CONCLUSIÓN: La tipificación molecular de los aislamientos de los menores colonizados y el análisis realizado en el interior de los hogares permitió describir la diseminación de las cepas colonizantes en el interior de los hogares infantiles de la ciudad de Medellín, principalmente del CC45, un clon exitoso en colonización

INTRODUCTION: Colonization plays a major role in the epidemiology and pathogenesis of Staphylococcus aureusinfections. The child population is one of the most susceptible to colonization; however, community and children studies are limited in Colombia. OBJECTIVE: To assess the clonal relationship of S. aureus strains isolated from colonized children in eight day care centers (DCCs) from Medellin and to determine the presence of epidemiological characteristics in these populations. METHODS: An observational cross-sectional study was conducted on a sample of 200 children aged from 6 months to 5 years attending eight DCCs in Medellin, Colombia, during 2011. Nasal samples were collected from each nostril. The isolates species and methicillin resistance were molecularly confirmed using nuc and mec genes. Genotypic analysis included SCCmec typing, spa typing, PFGE and MLST. Epidemiological information was obtained from the parents and analyzed using the statistics program SPSS 21.0 RESULTS: The colonization frequency in DCCs ranged from 16.7% (n = 3) to 53.6% (n = 15). Genetically related isolates were identified inside four DCCs. Half (50%) of the isolates were grouped in 3 clusters, which belonged to the clonal complexes CC45, CC30, and CC121. CONCLUSION: Molecular typing of isolates from colonized children and comparison among DCCs showed the spread of colonizing strains inside DCCs in Medellin; predominantly the CC45 clone, a successful child colonizer

[Spread of genetically related methicillin-susceptible Staphylococcus aureus belonging to CC45, in healthy nasal carriers in Child Day Care Centers of Medellin, Colombia]. / Diseminación de cepas Staphylococcus aureus sensible a meticilina (SASM) relacionadas genéticamente, pertenecientes al CC45, entre portadores nasales sanos de hogares infantiles de Medellín, Colombia.

INTRODUCTION: Colonization plays a major role in the epidemiology and pathogenesis of Staphylococcus aureus infections. The child population is one of the most susceptible to colonization; however, community and children studies are limited in Colombia. OBJECTIVE: To assess the clonal relationship of S.aureus strains isolated from colonized children in eight day care centers (DCCs) from Medellin and to determine the presence of epidemiological characteristics in these populations. METHODS: An observational cross-sectional study was conducted on a sample of 200 children aged from 6 months to 5 years attending eight DCCs in Medellin, Colombia, during 2011. Nasal samples were collected from each nostril. The isolates species and methicillin resistance were molecularly confirmed using nuc and mec genes. Genotypic analysis included SCCmec typing, spa typing, PFGE and MLST. Epidemiological information was obtained from the parents and analyzed using the statistics program SPSS 21.0 RESULTS: The colonization frequency in DCCs ranged from 16.7% (n=3) to 53.6% (n=15). Genetically related isolates were identified inside four DCCs. Half (50%) of the isolates were grouped in 3 clusters, which belonged to the clonal complexes CC45, CC30, and CC121. CONCLUSION: Molecular typing of isolates from colonized children and comparison among DCCs showed the spread of colonizing strains inside DCCs in Medellin; predominantly the CC45 clone, a successful child colonizer.

Comportamientos sexuales en mayores de 18 años con diagnóstico VIH/SIDA en tres ciudades de Colombia 2011 / Comportamentos sexuais em mais de 18 anos com diagnóstico de HIV / AIDS em três cidades na Colômbia 2011 / Sexual behaviors in over 18 years old with a diagnosis of HIV/AIDS in three cities of Colombia 2011

Objetivo: Describir los comportamientos sexuales en personas VIH positivas en tres ciudades de Colombia antes y después de conocer el diagnóstico e identificar cambios en estos comportamientos. Metodología: Estudio descriptivo, de corte trasversal, en el que participaron 85 individuos de tres ciudades colombianas, entrevistados durante el año 2011. Se cumplió con los parámetros éticos para investigaciones con personas. Para el análisis estadístico se utilizó el software SPSS 18.0. Resultados: Se encontraron diferencias significativas al comparar el comportamiento sexual antes y después de conocer el diagnóstico VIH positivo. el 23% de los entrevistados manifestó no haber iniciado actividades sexuales después del diagnóstico, el 62.5% empezó a usar el condón en todas sus relaciones sexuales. Las relaciones sexuales con personas VIH positivo aumentaron a un 35.4%. Las infecciones de transmisión sexual disminuyeron a un 12.3%. El consumo de alcohol previo al inicio de relaciones sexuales disminuyó a un 31.8%. Conclusiones: Se encontraron cambios en los comportamientos de riesgo de las personas después de recibir el diagnóstico; sin embargo, dichas modificaciones no son suficientes por tratarse de la trasmisión de una infección mortal y de elevados costos socioeconómicos.

Objective: To describe sexual behaviors of HIV positive patients in three cities of Colombia, before and after learning diagnosis and to identify changes. Methodology: Quantitative, descriptive, cross-sectional study, with participation of 85 individuals from three cities of Colombia who were interviewed during 2011. Ethical standards for research involving individuals were met during the study. The SPSS software version 18.0 was used for statistical analysis. Results: Significant differences were found when comparing their sexual behavior before and after knowing HIV positive diagnosis, 23.0% of respondents said that they had not resumed sexual activity, 62.5% of the patients began to use the condom in all sexual relations. Sex with HIV-positive people increased a 35.4%. Sexually transmitted infections were reduced to a 12.3%. The consumption of alcohol prior to the onset of sexual intercourse decreased to 31.8%. Conclusions: Changes were found regarding risky behaviors of people after knowing the diagnosis; however, such modifications are not enough regarding the transmission of a deadly infection and with high social and economic costs.

Objetivo: Descrever o comportamento sexual em pessoas HIV-positivas em três cidades na Colômbia antes e depois de conhecer o diagnóstico e identificar mudanças no esses comportamentos. Metodologia: Estudo descritivo de transversal, em que 85 indivíduos participaram em três cidades colombianas, entrevistado em 2011. Eles se conheceram os padrões éticos para a investigação com as pessoas. Para análise estatística foi utilizado SPSS 18.0 software. Resultados: Diferenças significativas na comparação entre o comportamento sexual foram encontrados antes e depois de aprender sobre o diagnóstico de HIV positivo. 23% dos entrevistados disseram que a atividade sexual não ter iniciado após o diagnóstico, 62,5% começaram a usar preservativos em todas as relações sexuais. Sexo com pessoas HIV positivas aumentou para 35,4%. infecções sexualmente transmissíveis diminuiu para 12,3%. O consumo de álcool antes do início do sexo diminuiu para 31,8%. Conclusões: foram encontradas alterações nos comportamentos de risco de pessoas depois de receber o diagnóstico; No entanto, estas alterações não são suficientes, porque é a transmissão de uma infecção fatal e custos socioeconómicos elevados.

[Systematic review of antimicrobial resistance in Enterobacteriaceae isolates from Colombian hospitals]. / Revisión sistemática de la farmacorresistencia en enterobacterias de aislamientos hospitalarios en Colombia.

INTRODUCTION: Bacterial resistance is a public health problem worldwide that seriously compromises the possibility to treat infections. OBJECTIVE: To identify levels of resistance to antibiotic markers in Enterobacteriaceae isolates from Colombian hospitals. MATERIALS AND METHODS: A systematic literature survey was done including articles indexed in Medline, Embase and LILACS. A manual search was made of Colombian scientific journals and other publications on infectious disease that were not available electronically. RESULTS: In total, 43 observational studies and epidemiological reports were identified with information about resistance among Enterobacteriaceae isolates in Colombian hospitals, mainly from Bogotá, Cali and Medellín. The resistance rate of Escherichia coli ranges from 3 to 11%, 5 to 20% and from 0.2 to 0.8% for piperacillin-tazobactam, third generation cephalosporins and carbapenems, respectively. For Klebsiella pneumoniae resistance rates ranges from 21.8 to 48.1% to piperacillin-tazobactam, 20 to 35% to broad-spectrum cephalosporins and 3 to 8% to carbapenems, with significant variations by cities, levels of care and clinical settings. CONCLUSIONS: The spread of bacterial resistance in Enterobacteriaceae isolated in Colombian hospitals is a growing problem that calls for priority action to cut the chains of transmission.

Revisión sistemática de la farmacorresistencia en enterobacterias de aislamientos hospitalarios en Colombia / Systematic review of antimicrobial resistance in Enterobacteriaceae isolates from Colombian hospitals

Introducción. La resistencia bacteriana es un problema de salud pública a nivel mundial que compromete seriamente la capacidad de tratar las infecciones. Objetivo. Describir el perfil de resistencia a los antimicrobianos marcadores en enterobacterias identificadas en hospitales colombianos. Materiales y métodos. Se hizo una revisión bibliográfica sistemática de las publicaciones indexadas en Medline, Embase y Lilacs, además de la búsqueda manual de todos los números de revistas colombianas reconocidas en el campo de la infectología y otros afines para identificar referencias no disponibles electrónicamente. Resultados. Se identificaron 43 estudios y reportes de vigilancia epidemiológica con información sobre la resistencia de las enterobacterias en hospitales, principalmente de Bogotá, Cali y Medellín. La tasa de resistencia en Escherchia coli oscila entre 3 y 11 %, 5 y 20 % y 0,2 a 0,8 % para piperacilina-tazobactam, cefalosporinas de tercera generación y carbapenémicos, respectivamente. En aislamientos de Klebsiella pneumoniae , la resistencia oscila entre 21,8 y 48,1 % frente a piperacilina-tazobactam, 20 y 35 % frente a cefalosporinas de amplio espectro y 3 y 8 % frente a carbapenémicos, con variaciones importantes por ciudades, niveles de atención y circunstancias clínicas. Conclusiones. La diseminación de la resistencia bacteriana en enterobacterias aisladas en hospitales colombianos es un problema creciente que requiere medidas prontas para cortar las cadenas de transmisión.

Introduction: Bacterial resistance is a public health problem worldwide that seriously compromises the possibility to treat infections. Objective: To identify levels of resistance to antibiotic markers in Enterobacteriaceae isolates from Colombian hospitals. Materials and methods: A systematic literature survey was done including articles indexed in Medline, Embase and LILACS. A manual search was made of Colombian scientific journals and other publications on infectious disease that were not available electronically. Results: In total, 43 observational studies and epidemiological reports were identified with information about resistance among Enterobacteriaceae isolates in Colombian hospitals, mainly from Bogotá, Cali and Medellín. The resistance rate of Escherichia coli ranges from 3 to 11%, 5 to 20% and from 0.2 to 0.8% for piperacillin-tazobactam, third generation cephalosporins and carbapenems, respectively. For Klebsiella pneumoniae resistance rates ranges from 21.8 to 48.1% to piperacillin-tazobactam, 20 to 35% to broad-spectrum cephalosporins and 3 to 8% to carbapenems, with significant variations by cities, levels of care and clinical settings. Conclusions: The spread of bacterial resistance in Enterobacteriaceae isolated in Colombian hospitals is a growing problem that calls for priority action to cut the chains of transmission.