The Socioecology of Parental Adjustment to Pediatric Cancer: The Roles of Individual and Neighborhood Socioeconomic Status in Parental Social Support and Depressive Symptoms.

OBJECTIVE: Parents of children with cancer are at risk for depressive symptoms, and previous research has linked their level of distress to various demographic, social, and economic factors. However, little research has examined associations between parental depressive symptoms and multiple socioecological factors at once. The current study examined how socioeconomic status (SES) at the individual and neighborhood level is related to parental depressive symptoms and social support satisfaction in Latinx and non-Latinx parents of children recently diagnosed with cancer, and whether social support satisfaction mediated associations between SES and depressive symptoms. METHODS: Parents (N = 115; 82% female; 30% Latinx) completed questionnaires reporting their demographic information, social support satisfaction, and depressive symptoms. Neighborhood SES was coded by block group level based on participants' home addresses. RESULTS: Individual, but not neighborhood, SES was positively associated with social support satisfaction, and higher social support satisfaction was associated with lower depressive symptoms. There was a significant indirect effect of individual (but not neighborhood) SES on depressive symptoms through social support satisfaction. Latinx parents reported lower individual SES, but not lower social support satisfaction or depressive symptoms than non-Latinx parents. CONCLUSIONS: These results highlight the important role of social support in the adjustment of parents who have a child with pediatric cancer. Findings suggest that families may benefit from services that target multiple levels of their social ecology.

Role of perilipin 2 in microvascular obstruction in patients with ST-elevation myocardial infarction.

AIMS: Coronary microvascular obstruction (MVO) occurs frequently in patients with ST-elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI). However, mechanisms are multiple and not yet fully understood. Perilipin 2 (PLIN2) is involved in lipid metabolism of macrophages resident in atherosclerotic plaques, along with a role in enhancing plaque inflammation. We studied the association between PLIN2 and MVO in STEMI patients undergoing primary PCI, and we assessed the role of PLIN2 to predict major adverse cardiovascular events (MACEs). METHODS AND RESULTS: STEMI patients undergoing primary PCI were enrolled. PLIN2 was evaluated in peripheral blood monocytes; MVO was assessed using coronary angiogram. MACEs, as a composite of cardiac death, non-fatal myocardial infarction, re-admission for heart failure, and target vessel revascularization were investigated at follow-up. Among 100 STEMI patients, 33 (33.0%) had MVO. Patients with MVO had higher levels of PLIN2 (1.03 ± 0.28 vs. 0.90 ± 0.16, P = 0.019). Age [odds ratio (OR) (95% confidence interval, CI), 1.045 (1.005-1.087), P = 0.026] and PLIN2 [OR (95% CI), 16.606 (2.027-136.030), P = 0.009] were associated with MVO at univariate analysis, although only PLIN2 [OR (95% CI), 12.325 (1.446-105.039), P = 0.022] was associated with MVO at multivariate analysis. After a mean follow-up of 182.2 ± 126.6 days, 13 MACEs occurred. MVO [hazard ratio (HR) (95% CI), 6.791 (2.053-22.462), P = 0.002], hypercholesterolaemia [HR (95% CI), 3.563 (1.094-11.599), P = 0.035], and PLIN2 [HR (95% CI), 82.991 (9.857-698.746), P < 0.001] were predictors of MACEs at univariate analysis, although only PLIN2 [HR (95% CI), 26.904 (2.461-294.100), P = 0.007] predicted MACEs at multivariate analysis. CONCLUSIONS: In STEMI patients undergoing primary PCI, PLIN2 was independently associated with MVO and was an independent predictor of MACEs at follow-up, suggesting to further explore PLIN2 as a target for future cardioprotection therapies.

Local anesthesia enhanced with increasing high-frequency ultrasound intensity.

The effect of local anesthetics, particularly those which are hydrophilic, such as tetrodotoxin, is impeded by tissue barriers that restrict access to individual nerve cells. Methods of enhancing penetration of tetrodotoxin into nerve include co-administration with chemical permeation enhancers, nanoencapsulation, and insonation with very low acoustic intensity ultrasound and microbubbles. In this study, we examined the effect of acoustic intensity on nerve block by tetrodotoxin and compared it to the effect on nerve block by bupivacaine, a more hydrophobic local anesthetic. Anesthetics were applied in peripheral nerve blockade in adult Sprague-Dawley rats. Insonation with 1-MHz ultrasound at acoustic intensity greater than 0.5 W/cm2 improved nerve block effectiveness, increased nerve block reliability, and prolonged both sensory and motor nerve blockade mediated by the hydrophilic ultra-potent local anesthetic, tetrodotoxin. These effects were not enhanced by microbubbles. There was minimal or no tissue injury from ultrasound treatment. Insonation did not enhance nerve block from bupivacaine. Using an in vivo model system of local anesthetic delivery, we studied the effect of acoustic intensity on insonation-mediated drug delivery of local anesthetics to the peripheral nerve. We found that insonation alone (at intensities greater than 0.5 W/cm2) enhanced nerve blockade mediated by the hydrophilic ultra-potent local anesthetic, tetrodotoxin. Graphical abstract.

Prolonged Duration Topical Corneal Anesthesia With the Cationic Lidocaine Derivative QX-314.

PURPOSE: Topical corneal local anesthetics are short acting and may impair corneal healing. In this study we compared corneal anesthesia and toxicity of topically applied N-ethyl lidocaine (QX-314) versus the conventional local anesthetic, proparacaine (PPC). METHODS: Various concentrations of QX-314 and 15 mM (0.5%) PPC were topically applied to rat corneas. Corneal anesthesia was assessed with a Cochet-Bonnet esthesiometer at predetermined time points. PC12 cells were exposed to the same solutions to assess cytotoxicity. Repeated topical corneal administration in rats was then used to assess for histologic evidence of toxicity. Finally, we created uniform corneal epithelial defects in rats and assessed the effect of repeated administration of these compounds on the defect healing rate. RESULTS: QX-314 (15 mM) and PPC (15 mM) caused similar total duration (114 ± 17 and 87 ± 16 minutes, respectively; P = 0.06) of anesthesia. The depth of anesthesia was similar between these low-dose groups at 15 minutes after application (1.8 ± 0.3- and 2.0 ± 0.8-cm filament lengths). QX-314 (100 mM) provided more prolonged corneal anesthesia (174 ± 13 minutes; P < 0.0001), with improved depth at 15 minutes (0.7 ± 0.3-cm filament length; P = 0.007). All tested concentrations of QX-314 demonstrated similar or less toxicity than 0.5% PPC. CONCLUSIONS: Topical administration of QX-314 is effective for corneal anesthesia and demonstrates no histologic signs of local toxicity in a rodent model. In higher concentrations, QX-314 provides more than twofold the duration of anesthetic effect than does 0.5% PPC. TRANSLATIONAL RELEVANCE: Our study reveals a clinically relevant compound providing prolonged duration topical corneal anesthesia.

Prolonged Duration Local Anesthesia by Combined Delivery of Capsaicin- and Tetrodotoxin-Loaded Liposomes.

BACKGROUND: Capsaicin, the active component of chili peppers, can produce sensory-selective peripheral nerve blockade. Coadministration of capsaicin and tetrodotoxin, a site-1 sodium channel blocker, can achieve a synergistic effect on duration of nerve blocks. However, capsaicin can be neurotoxic, and tetrodotoxin can cause systemic toxicity. We evaluated whether codelivery of capsaicin and tetrodotoxin liposomes can achieve prolonged local anesthesia without local or systemic toxicity. METHODS: Capsaicin- and tetrodotoxin-loaded liposomes were developed. Male Sprague-Dawley rats were injected at the sciatic nerve with free capsaicin, capsaicin liposomes, free tetrodotoxin, tetrodotoxin liposomes, and blank liposomes, singly or in combination. Sensory and motor nerve blocks were assessed by a modified hotplate test and a weight-bearing test, respectively. Local toxicity was assessed by histologic scoring of tissues at the injection sites and transmission electron microscopic examination of the sciatic nerves. Systemic toxicity was assessed by rates of contralateral nerve deficits and/or mortality. RESULTS: The combination of capsaicin liposomes and tetrodotoxin liposomes achieved a mean duration of sensory block of 18.2 hours (3.8 hours) [mean (SD)], far longer than that from capsaicin liposomes [0.4 hours (0.5 hours)] (P < .001) or tetrodotoxin liposomes [0.4 hours (0.7 hours)] (P < .001) given separately with or without the second drug in free solution. This combination caused minimal myotoxicity and muscle inflammation, and there were no changes in the percentage or diameter of unmyelinated axons. There was no systemic toxicity. CONCLUSIONS: The combination of encapsulated tetrodotoxin and capsaicin achieved marked prolongation of nerve block. This combination did not cause detectable local or systemic toxicity. Capsaicin may be useful for its synergistic effects on other formulations even when used in very small, safe quantities.

Polymer-tetrodotoxin conjugates to induce prolonged duration local anesthesia with minimal toxicity.

There is clinical and scientific interest in developing local anesthetics with prolonged durations of effect from single injections. The need for such is highlighted by the current opioid epidemic. Site 1 sodium channel blockers such as tetrodotoxin (TTX) are extremely potent, and can provide very long nerve blocks but the duration is limited by the associated systemic toxicity. Here we report a system where slow release of TTX conjugated to a biocompatible and biodegradable polymer, poly(triol dicarboxylic acid)-co-poly(ethylene glycol) (TDP), is achieved by hydrolysis of ester linkages. Nerve block by the released TTX is enhanced by administration in a carrier with chemical permeation enhancer (CPE) properties. TTX release can be adjusted by tuning the hydrophilicity of the TDP polymer backbone. In vivo, 1.0-80.0 µg of TTX released from these polymers produced a range of durations of nerve block, from several hours to 3 days, with minimal systemic or local toxicity.

Long-acting liposomal corneal anesthetics.

Eye drops producing long-acting ocular anesthesia would be desirable for corneal pain management. Here we present liposome-based formulations to achieve very long ocular anesthetic effect after a single eye drop instillation. The liposomes were functionalized with succinyl-Concanavalin A (sConA-Lip), which can bind corneal glycan moieties, to significantly prolong the dwell time of liposomes on the cornea. sConA-Lip were loaded with tetrodotoxin and dexmedetomidine (sConA-Lip/TD), and provided sustained release for both. A single topical instillation of sConA-Lip/TD on the cornea could achieve 105 min of complete analgesia and 608 min of partial analgesia, which was significantly longer than analgesia with proparacaine, tetrodotoxin/dexmedetomidine solution or unmodified liposomes containing tetrodotoxin and dexmedetomidine. sConA-Lip/TD were not cytotoxic in vitro to human corneal limbal epithelial cells or corneal keratocytes. Topical administration of sConA-Lip/TD provided prolonged corneal anesthesia without delaying corneal wound healing. Such a formulation may be useful for the management of acute surgical and nonsurgical corneal pain, or for treatment of other ocular surface diseases.

Hollow Silica Nanoparticles Penetrate the Peripheral Nerve and Enhance the Nerve Blockade from Tetrodotoxin.

The efficacy of tetrodotoxin (TTX), a very potent local anesthetic, is limited by its poor penetration through barriers to axonal surfaces. To address this issue, we encapsulated TTX in hollow silica nanoparticles (TTX-HSN) and injected them at the sciatic nerve in rats. TTX-HSN achieved an increased frequency of successful blocks, prolonged the duration of the block, and decreased the toxicity compared to free TTX. In animals injected with fluorescently labeled HSN, the imaging of frozen sections of nerve demonstrated that HSN could penetrate into nerve and that the penetrating ability of silica nanoparticles was highly size-dependent. These results demonstrated that HSN could deliver TTX into the nerve, enhancing efficacy while improving safety.

Drug delivery systems for prolonged duration local anesthesia.

Numerous drug delivery systems have been applied to the problem of providing prolonged duration local anesthesia (PDLA). Here we review the rationale for PDLA, the desirable features for and important attributes of such systems, and specific examples that have been developed.

Tetrodotoxin, Epinephrine, and Chemical Permeation Enhancer Combinations in Peripheral Nerve Blockade.

BACKGROUND: Chemical permeation enhancers (CPEs) have the potential to improve nerve blockade by site 1 sodium channel blockers such as tetrodotoxin (TTX). Here, we investigated the efficacy and toxicity of CPE-enhanced nerve blockade across a range of TTX concentrations using 2 CPEs (sodium octyl sulfate and octyl trimethyl ammonium bromide). We also tested the hypothesis that CPEs could be used to reduce the concentrations of TTX and/or of a second adjuvant drug (in this case, epinephrine) needed to achieve prolonged local anesthesia METHODS:: Sprague-Dawley rats were injected at the sciatic nerve with combinations of TTX and CPEs, with and without epinephrine. Sensory and motor nerve blockade were assessed using a modified hot plate test and a weight-bearing test, respectively. Systemic and local toxicities of the different combinations were assessed. RESULTS: Addition of increasing concentrations of TTX to fixed concentrations of CPEs produced a marked concentration-dependent improvement in the rate of successful nerve blocks and in nerve block duration. CPEs did not affect systemic toxicity. At some concentrations, the addition of sodium octyl sulfate increased the duration of block from TTX plus epinephrine, and epinephrine increased that from TTX plus CPEs. The addition of epinephrine did not cause an increase in local toxicity, and it markedly reduced systemic toxicity. CONCLUSIONS: CPEs can prolong the duration of nerve blockade across a range of concentrations of TTX. CPEs could also be used to reduce the concentration of epinephrine needed to achieve a given degree of nerve block. CPEs may be useful in enhancing nerve blockade from site 1 sodium channel blockers.

Ultrasensitive Phototriggered Local Anesthesia.

An injectable local anesthetic producing repeatable on-demand nerve block would be desirable for pain management. Here we present a phototriggerable device to achieve repeatable and adjustable on-demand local anesthesia in superficial or deep tissues, consisting of gold nanorods attached to low temperature sensitive liposomes (LTSL). The particles were loaded with tetrodotoxin and dexmedetomidine. Near-infrared light (NIR, 808 nm, continuous wave) could heat gold nanorods at low fluence (short duration and low irradiance), leading to rapid release of payload. In vivo, 1-2 min of irradiation at ≤272 mW/cm2 produced repeatable and adjustable on-demand infiltration anesthesia or sciatic nerve blockade with minimal toxicity. The nerve block intensity and duration correlated with the irradiance and duration of the applied light.

A Supramolecular Shear-Thinning Anti-Inflammatory Steroid Hydrogel.

Shear-thinning and self-healing steroid-drug-based hydrogels are presented, which exhibit rapid and complete recovery of their mechanical properties within seconds following stress-induced flow. The hydrogels release steroid drug in vivo with no visible residue when release is complete.

Extended Release of Native Drug Conjugated in Polyketal Microparticles.

Polyketals, which can be biodegradable, have good biocompatibility, and are pH-sensitive, could have broad applicability in drug delivery and other biomedical applications. However, facile synthesis of high molecular weight polyketals is challenging, and short durations of drug release from polyketal particulate formulations limit their application in drug delivery. Here we report the synthesis of a di-isopropenyl ether monomer and its use to synthesize high molecular weight estradiol-polyketal conjugates by addition polymerization. Microparticles were prepared from the estradiol-polyketal conjugate, where estradiol was incorporated into the polymer backbone. The particles had high drug loading and significantly prolonged drug release. Release of estradiol from the drug-polyketal conjugate microparticles was acid-responsive, as evidenced by faster drug release at low pH and with co-incorporation of PLGA. Tissue reaction to the microparticles was benign in vivo. Polyketal drug conjugates are promising candidates for long-acting drug delivery systems to treat chronic diseases.

Phototriggered Local Anesthesia.

We report a phototriggerable formulation enabling in vivo repeated and on-demand anesthesia with minimal toxicity. Gold nanorods (GNRs) that can convert near-infrared (NIR) light into heat were attached to liposomes (Lip-GNRs), enabling light-triggered phase transition of their lipid bilayers with a consequent release of payload. Lip-GNRs containing the site 1 sodium channel blocker tetrodotoxin and the α2-adrenergic agonist dexmedetomidine (Lip-GNR-TD) were injected subcutaneously in the rat footpad. Irradiation with an 808 nm continuous wave NIR laser produced on-demand and repeated infiltration anesthesia in the rat footpad in proportion to the irradiance, with minimal toxicity. The ability to achieve on-demand and repeated local anesthesia could be very beneficial in the management of pain.

Participación y liderazgo estudiantil: una apuesta por la ciudadanía activa / Student involvement and leadership: a commitment to active citizenship

El liderazgo asumido como postura ética con corresponsabilidad hacia la acción plantea un reto complejo en su alcance,por múltiples aspectos inherentes a los seres humanos y sus procesos evolutivos. Es necesario emprender caminos y aventurarse a tejer formas y experiencias que lleven a este. La Escuela de Enfermería de la Universidad del Valle, interpretando la misión universitaria y basada en su Plan Estratégico 2005-2015; toma como propia la responsabilidad de promover espacios e iniciativas que fomenten el liderazgo en los estudiantes a través del desarrollo de dos estrategias: Formación y Promoción del Liderazgo, a partir del acompañamiento en iniciativas y representaciones de los estudiantes del Programa de Enfermería. Este artículo recoge diferentes voces de estudiantes que han sido participes de iniciativas generadas a partir del Proyecto de Liderazgo y del desarrollo de sus estrategias, con el propósito de rescatar y revelar la riqueza de susposibilidades, lo mismo que las dificultades que entraña una propuesta movilizadora democrática y humanista que comprende diversas formas de asumir la vida individual y proyectarse en el horizonte de lo colectivo. Reflexion final: La experiencia en la Escuela de Enfermería de la Universidad del Valle, sobre liderazgo y participación estudiantil, aporta la necesidad de fomentar un liderazgo cimentado en lo colectivo, pero centrado en potencialidades individuales, crecimiento personal y profesional de estudiantes y docentes, para lo cual se requiere, conjugar esfuerzos desde lo humano, económico, académico y administrativo.

Assuming leadership from an ethical stance with responsibility for action proposes a complex challenge to achieve,because of the many aspects inherent to human beings and their evolutionary processes. It is necessary to undertake ways and ventures to weave forms and experiences that lead to it. The School of Nursing at Universidad del Valle, interpreting the university mission and based on its 2005-2015 Strategic Plan, assumes the responsibility of promoting opportunities and initiatives that foster leadership in students through the development of two strategies: promotion of Leadership andTraining, through accompanying initiatives and representations of the Nursing Program students. This article describes different voices of students who have been participating in initiatives generated from the Leadership Project and the development of their strategies to recover and reveal the richness of its possibilities, as well as the difficulties of mobilizing a proposal involving democratic and humanist views on various forms of individual life and projected onto the horizon of the collective. Final reflection: The experience at the School of Nursing at Universidad del Valle about leadership and student participation provides the necessity to promote leadership based on the collective, but focusing on individual potential, as well as the personal and professional growth of students and teachers, which requires the conjunction of human, economic,academic and administrative efforts.

El desarrollo disciplinar: razón de ser, sentipensar y hacer en enfermería / Disciplinary development: the reason for being, sensing, thinking, and doing in nursing

Introducción: Durante seis décadas y media, la Escuela de Enfermería de la Universidad del Valle ha movilizado múltiples búsquedas en la perspectiva de construir y proyectar un ejercicio de la profesión comprometido socialmente. El presente artículo pretende exponer los procesos, reflexiones y acciones conectados con el desarrollo disciplinar como preocupación central de la Escuela así como también, enunciar las responsabilidades hacia el futuro que presenta complejo se ineludibles desafíos. El desafío del desarrollo disciplinar en la Escuela de Enfermería: Se propuso encaminar el desarrollo conceptual en enfermería a través de la producción y validación de conocimientos propios de la disciplina y de la práctica profesional sustentada en el cuidado humano, a través del desarrollo de tres áreas: la formación de docentes, estudiantes, y profesionales de asistencia; el desarrollo de investigación en alianza con los servicios asistenciales para facilitar la innovación en el cuidado de enfermería y la implementación de modelos de servicio de enfermería fundamentados en el cuidado humano. Cómo se visualiza el futuro: La gestión de este proyecto, ha llevado a comprender que el proceso de reflexión disciplinar va más allá de un proyecto y entraña una apuesta más ambiciosa que un plan de escuela; esto es, tendrá que convertirse enun plan de Gobierno sin olvidar que lo importante es el cuestionamiento de la disciplina y que esto implica un impacto realen el cuidado que se ofrece en los servicios de salud por parte de enfermería.

Introduction: For six and a half decades, the School of Nursing at Universidad del Valle has been involved in multiple searches on the perspective of constructing and projecting a socially committed exercise in the profession. This article seeks to expose the processes, reflections, and actions having to do with the discipline’s development as a central concern of the School, as well as to also declare the future responsibilities presented by complex and inescapable challenges.The challenge of the disciplinary development in the School of Nursing: We sought to guide the conceptual development in Nursing through the production and validation of knowledge appertaining to the discipline and of the professional practice substantiated on Human Care, via the development of three areas: formation of professors, students, and healthcare professionals; development of research inalliance with healthcare services to facilitate innovation in Nursing Care, and the implementation of Nursing Service Models based on Human Care. How is the future perceived: Management of this project has led to understanding that the process of disciplinary reflection goes beyond a project and involves a more ambitious wager than a School Plan; i.e., it will have to become a Government Plan without overlooking that what is important is to challenge the discipline and that this implies a real impact on the care offered in health services by Nursing professionals.

Resecciones pulmonares en cuña para estudio histopatológico: experiencia de Bucaramanga / Lung wedge resections for histopathologic study: experience in Bucaramanga, Colombia

Introducción. En la gran mayoría de los casos de enfermedad pulmonar intersticial difusa y de nódulos pulmonares indeterminados, se requiere la obtención de tejido pulmonar para llegar a un diagnóstico preciso. El presente estudio presenta la experiencia con las resecciones pulmonares en cuña en una sola institución. Materiales y métodos. Se llevó a cabo un estudio retrospectivo de los pacientes sometidos a resecciones pulmonares en cuña entre 2004 y 2009, en la Fundación Oftalmológica de Santander-Clínica Carlos Ardilla Lülle.Resultados. Se estudiaron 52 pacientes operados durante este periodo. Veintiocho (53,9%) eran hombres; la media de edad fue de 60,5 años. La indicación fue: nódulos en 29 (55,8%) y enfermedad pulmonar intersticial difusa en 23 (44,2%). Los pacientes con nódulos con mayor frecuencia no presentaban ningún síntoma ni hallazgos en el examen físico (p=0,008). El 88,5% de los pacientes fue operado mediante toracoscopia y 76,9% tuvieron una sola resección.La mediana del tiempo quirúrgico fue de 90 minutos fue menor cuando la técnica fue toracoscópica p=0,04) y cuando no se dejó tubo de tórax p=0,0006). No se dejó tubo de tórax en 23,1% de os casos. La media de estancia hospitalaria fue de dos días. La morbilidad y la mortalidad a 30 días fue de 5,8%. En 92% de los casos se estableció un diagnóstico preciso.Conclusiones. La resección pulmonar en cuña en los casos de enfermedad pulmonar intersticial difusa y nódulos indeterminados es segura y puede realizarse con una corta estancia hospitalaria. Puede omitirse el tubo de tórax. En más de 90% de los casos se establece un diagnóstico preciso.

Introduction: In most cases of interstitial lung disease (ILD) and indeterminate pulmonary nodules, lung tissue is needed to achieve a precise a diagnosis. This study seeks to present the experience with lung wedge resections at a single institution. Materials and methods: Retrospective study of patients undergoing lung wedge resections for histopathologic study in the period 2004-2009 at Fundación Oftalmológica de Santander – Clínica Carlos Ardilla Lülle in the city of Bucaramanga, Colombia,.Results: Fifty-two patients were operated on during this period. Twenty-eight (53.9%) were male; mean age was 60.5 years. Indications for surgery were nodules in 29 (55.8%) and ILD in 23 (44.2%). Patients with nodules presented more frequently without symptoms or findings at physical examination (p=0.008). In 88.5% and 76.9% of cases, the thoracoscopic technique was utilized and the number of resections was just one, respectively. Median operative time was 90min and it was shorter when the thoracoscopic technique was employed (p=0.04) and when a chest tube was not left in the pleural space (p=0.0006). A chest tube was not installed in 23.1% of cases. Median hospital length of stay was 2 days. Both morbidity and mortality were 5.8%, respectively. A precise diagnosis was achieved in 92% of patients. Conclusions: Lung wedge resection for ILD and indeterminate nodules is a safe procedure and can be done with a short length of stay. A chest tube can be omitted at the end of the procedure. In more than 90% of cases a precise diagnosis is achieved.

Accidentes biológicos en médicos residentes de Bucaramanga, Colombia / Biological accidents in hospital resident physicians in the city of Bucaramanga, Colombia

Introducción. El riesgo biológico es el más frecuente en el ambiente laboral de los trabajadores del área de la salud. Los médicos residentes son particularmente vulnerables debido a su relativa inexperiencia y a que se encuentran expuestos a muchos pacientes y jornadas laborales largas. Objetivos. Determinar la prevalencia, caracterización y factores asociados a los accidentes biológicos en los médicos residentes.Materiales y métodos. Se realizó un estudio de corte transversal con los médicos residentes de las especializaciones médicas y quirúrgicas en la Universidad Industrial de Santander. Resultados. De 79 médicos residentes, respondieron la encuesta 73 (92,4%). De éstos, 49,3% utilizaban rutinariamente protección completa (guantes, tapabocas y gafas); 35 (48%) reportaron haber sufrido al menos un accidente biológico en su vida y 29 (39,8%) reportaron haber sufrido al menos uno durante la residencia. El 31% no reportó el último accidente. Como factores asociados, se encontró que cursar un programa de residencia quirúrgico comparado con un médico ofrece una razón de prevalencia de 3,17 (IC95% 1,27-7,94; p=0,014); por otra parte, el hecho de haber sufrido un accidente biológico como estudiante de medicina en pregrado da una razón de prevalencia de 2,55 (IC95% 1,53-4,27; p<0,001). Conclusiones. Los accidentes biológicos, especialmente los quirúrgicos y dentro de las salas de cirugía, son frecuentes en los médicos residentes. Se necesitan estrategias que reduzcan el número de accidentes biológicos de manera sistemática y que faciliten su reporte.

Introduction : Biological risk is most frequent among health care workers. Resident physicians are particularly susceptible due to their relative inexperience and exposure to high volume of patients and long workdays. Objectives : To determine the prevalence, characterization and associated factors of biological accidents among hospital resident physicians. Materials and methods : Cross-sectional study on resident physicians in surgical and medical services at Universidad Industrial de Santander (Bucaramanga, Colombia). Results : Of 79 resident physicians, 73 (92.4%) answered the survey. Of these, 49.3% routinely used complete protection (gloves, face mask and protective eyewear); 35 (48%) reported having sustained at least one accident in their lifetimes, and 29 (39.8%) reported at least one accident during the course of their residencies. The last accident was not reported by 31%.Factors found to be associated with a biological accident during residency were a surgical residency, which compared to a medical residency yields a PR=3.17 (CI 95% 1.27 – 7.94; p=0.014); also, having sustained abiological accident as an undergraduate medical student yields a PR=2.55 (CI 95% 1.53 – 4.27; p<0.001). Conclusions: Biological accidents are frequent among resident physicians, especially those on surgical residencies and most occur inside the operating room. Strategies aimed at reducing the number of biological accidents carried out in a systematic way and measures to make reporting easier are needed.

Perforación de íleon terminal y ciego causada por tuberculosis intestinal en un paciente positivo para VIH / Perforation of the terminal ileum and cecum caused by tuberculosis in an HIV positive patient

La tuberculosis es una de las enfermedades infecciosas más prevalentes y su presentación pulmonar es la más frecuente. Sin embargo, debido al aumento en la infección por el virus de la inmunodeficiencia humana (VIH), el envejecimiento de la población, el mayor uso de fármacos inmunosupresores, la inmigración desde áreas endémicas y la aparición de cepas resistentes de Mycobacterium tuberculosis, ha habido un aumento de las presentaciones extrapulmonares. Entre éstas, la tuberculosis abdominal y la gastrointestinal son raras y suelen presentarse clínicamente de manera inespecífica, por lo cual el diagnóstico sólo se logra por medio de imágenes o métodos invasivos para la obtención de tejido. La perforación como complicación de la tuberculosis intestinal es aún menos frecuente. Presentamos el caso de un paciente de 51 años, positivo para VIH, con tuberculosis con compromiso intestinal, quien presentó como complicación la perforación del íleon terminal y el ciego que resultó en su muerte.

Tuberculosis is one of the most prevalent infectious diseases, most frequent in its pulmonary presentation. However, due to the increase in HIV infection, the population getting older, the increase in the use of immunosuppressive drugs, immigration from endemic areas, and the appearance of resistant strains of M. tuberculosis, there has been a rise in the rate of extrapulmonary presentations. Among the extrapulmonary presentations, abdominal and gastrointestinal tuberculosis are rare and usually present with nospecific symptoms, and diagnosis is then achieved through imaging and invasive methods that allow tissue sampling. Perforation as a complication of intestinal tuberculosis is even less frequent. We report the case of a 51-year-old HIV-positive male patient with intestinal tuberculosis who developed perforation of the terminal ileum and cecum resulting in his death.