Características clínicas y microbiológicas de pacientes con aislamiento por Raoultella spp. en Bogotá, Colombia / Clinical and microbiological characteristics of patients with Raoultella spp. isolation in Bogotá, Colombia

Introducción: Raoultella spp. es un bacilo gramnegativo con importancia clínica creciente por el desarrollo de multirresistencia y porque se ha reportado como causa de infección invasiva. El riesgo de infección aumenta si se presentan comorbilidades como diabetes mellitus y neoplasias.MétodosEstudio descriptivo de las características clínicas y microbiológicas en pacientes adultos con aislamiento de Raoultella spp., atendidos en un hospital de cuarto nivel de Bogotá, Colombia, entre 2015 y 2020.ResultadosSe identificaron 61 pacientes con aislamiento de Raoultella spp., 51 se consideraron infección y 10, colonización. Las comorbilidades asociadas fueron hipertensión arterial (n=26, 42,6%), fallo cardiaco (n=19, 31,1%) y diabetes mellitus (n=18, 29,5%). Se encontraron patrones de resistencia AmpC en 10 muestras (16,4%) y KPC en 3 (4,9%).ConclusionesEs una infección emergente de importancia clínica por su aislamiento en pacientes inmunocomprometidos con múltiples comorbilidades y por el aumento de cepas multirresistentes.

Clinical and microbiological characteristics of patients with Raoultella spp. isolation in Bogotá, Colombia. / Características clínicas y microbiológicas de pacientes con aislamiento por Raoultella spp. en Bogotá, Colombia.

INTRODUCTION: Raoultella spp. is a gram-negative bacillus with increasing clinical importance due to the development of multi-drug resistance and because it has been reported as a cause of invasive infection. The risk of infection increases if comorbidities present such as diabetes mellitus and malignancies. METHODS: Descriptive study of clinical and microbiological characteristics in adult patients with Raoultella spp. isolation, treated at a fourth-level hospital in Bogotá, Colombia, between 2015 and 2020. RESULTS: 61 patients with isolation of Raoultella spp., 51 were considered infection and 10, colonization. The associated comorbidities were hypertension (n=26, 42.6%), heart failure (n=19, 31.1%) and diabetes mellitus (n=18, 29.5%). AmpC resistance patterns were found in 10 samples (16.4%) and KPC in 3 (4.9%). CONCLUSIONS: Raoultella spp. is of clinical importance due to its isolation in immunocompromised patients with multiple comorbidities and due to the increase in multi-resistant strains.

Detección rápida de Enterobacterias productoras de carbapenemasas en hisopados rectales de pacientes neonatos colonizados / Rapid detection of carbapenemase-producing Enterobacteriaceae in rectal swabs of colonized neonatal patients

Resumen Objetivo: Detectar la presencia de Enterobacterias productoras de carbapenemasas en hisopados rectales de neonatos mediante técnica de nefelometría láser y caracterización del tipo de carbapenemasa mediante test inmunocromatográfico. Materiales y Métodos: Estudio descriptivo de corte transversal. Fueron incluidos 57 neonatos, tamizados al ingreso a UCI, mediante hisopado rectal, procesado por nefelometría laser HB&L Carbapenemase (Alifax®) y caracterización del tipo de carbapenemasa por inmunocromatografía rápida RESIST-3 (Coris BioConcept®). Resultados: Encontramos un alto porcentaje de colonización rectal (22.9%) correspondiente a 13 hisopados positivos y 44 (77.1%) fueron negativos por nefelometría láser. Por VITEK 2® se obtuvo identificación de Klebsiella pneumoniae resistente a carbapenémicos en los 13 aislamientos y el test inmunocromatográfico reveló la presencia de carbapenemasas blaKPC en estos aislamientos. Discusión: Estudios evidencian el aumento de la colonización por microorganismos productores de carbapenemasas en neonatos. Los resultados de este estudio demuestran que un porcentaje significativo de neonatos que ingresan a las Unidades de Cuidado Neonatal se encuentran colonizados con Enterobacterias productoras de carbapenemasas en tracto intestinal. Lo anterior constituye un riesgo potencial para su diseminación y posterior desarrollo de brotes, en donde surge la importancia de implementar estrategias de vigilancia activa como la tamización rectal para la detección oportuna de neonatos colonizados.

Abstract Objective: To detect the presence of carbapenemase-producing Enterobacteriaceae in rectal swabs of neonates by means of laser nephelometry technique and characterization of the type of carbapenemase by immunochromatographic test. Materials and Methods: Descriptive cross-sectional study. 57 neonatal patients were included; They underwent rectal screening upon admission to the ICU, using swabs which were processed by HB&L Carbapenemase laser nephelometry (Alifax®) and characterization of the type of carbapenemase by RESIST-3 rapid immu nochromatography (Coris BioConcept®). Results: We found a high percentage of rectal colonization (22.9%) corresponding to 13 positive swabs and 44 samples (77.1%) were negative by laser nephelome try. Identification of carbapenem-resistant Klebsiella pneumoniae was obtained by VITEK 2® in the 13 isolates and the immunochromatographic test revealed the presence of blaKPC carbapenemases in these isolates. Discussion: Studies show increased colonization by carbapenemase-producing microorganisms in neonates. The results of this study demonstrate that a significant percentage of neonates who enter Neonatal Care Units are colonized with Enterobacteriaceae that produce carbapenemases in the intestinal tract. This constitu tes a potential risk for its spread and subsequent development of outbreaks, where the importance of implementing active surveillance strategies such as rectal screening for the timely detection of colonized neonates arises.

Bacteriemia por Vibrio cholerae (no-O1/no O139): reporte de caso / Vibrio cholerae bacteremia (non-O1/non-O139): case report

RESUMEN Vibrio cholerae (no-O1/no-O139) es un patógeno poco común que causa infecciones en humanos y que se encuentra en vida libre en ríos y en el mar, donde coloniza peces y moluscos, fuente principal de contagio para los humanos. Se presenta el caso de un paciente de 78 años con antecedente de diabetes mellitus y sospecha de neoplasia pancreática, quien consultó por síndrome febril asociado a dolor abdominal y se documentó bacteriemia por V. cholerae, por lo que se inició manejo antibiótico con posterior resolución del cuadro clínico. Como el caso se relacionó con el consumo de agua contaminada, se notificó a la autoridad competente para realizar el control de la fuente infecciosa, intervención que permitirá evitar la infección de la población que tiene contacto con ese pozo de agua.

ABSTRACT Vibrio cholerae (non-O1/non-O139) is an uncommon pathogen that causes infection in humans, it is a free-living microorganism in river and sea waters, where it colonizes fish and shellfish, which are the main transmission sources. We present the case of a 78-year old man with a history of diabetes mellitus and suspected pancreas malignancy; who was brought because of fever disease with abdominal pain, and Vibrio cholerae bacteremia was documented, so antibacterial therapy was started, and his clinical condition resolved. Since this case was related to the ingestion of contaminated water, we notified the authorities so the infectious source may be controlled, and this intervention will prevent the occurrence of infections in persons in contact with this particular water source.

Phase Dependent Vectorial Current Control in Symmetric Noisy Optical Ratchets.

In this work, we demonstrate single microparticle transport in a symmetric noisy optical ratchet made with a linear array of 20 optical potentials, where each potential is a spatially symmetric low power (<2.5 mW) three-dimensional trap. Both the external force F(t) and the depth V_{0i}(t) of the optical potentials are dynamic and change at the same frequency ν=2 Hz. The depths of the individual optical potentials are random (uncorrelated noise) distributed around a mean value V_{0}, ⟨V_{0i}(t)⟩=V_{0}, while the external force is periodic and unbiased ⟨F(t)⟩=0. The system is completely symmetric for times t≫1/ν. Directed transport is possible as a result of the symmetry being broken at times on the order of 1/ν. We find that the direction and speed of motion (current) are coupled to the phase difference between the noise in the optical potentials and the external periodic force.

Tamoxifen Resistance: Emerging Molecular Targets.

17ß-Estradiol (E2) plays a pivotal role in the development and progression of breast cancer. As a result, blockade of the E2 signal through either tamoxifen (TAM) or aromatase inhibitors is an important therapeutic strategy to treat or prevent estrogen receptor (ER) positive breast cancer. However, resistance to TAM is the major obstacle in endocrine therapy. This resistance occurs either de novo or is acquired after an initial beneficial response. The underlying mechanisms for TAM resistance are probably multifactorial and remain largely unknown. Considering that breast cancer is a very heterogeneous disease and patients respond differently to treatment, the molecular analysis of TAM's biological activity could provide the necessary framework to understand the complex effects of this drug in target cells. Moreover, this could explain, at least in part, the development of resistance and indicate an optimal therapeutic option. This review highlights the implications of TAM in breast cancer as well as the role of receptors/signal pathways recently suggested to be involved in the development of TAM resistance. G protein-coupled estrogen receptor, Androgen Receptor and Hedgehog signaling pathways are emerging as novel therapeutic targets and prognostic indicators for breast cancer, based on their ability to mediate estrogenic signaling in ERα-positive or -negative breast cancer.

Mango (Mangifera indica L.) cv. Kent fruit mesocarp de novo transcriptome assembly identifies gene families important for ripening.

Fruit ripening is a physiological and biochemical process genetically programmed to regulate fruit quality parameters like firmness, flavor, odor and color, as well as production of ethylene in climacteric fruit. In this study, a transcriptomic analysis of mango (Mangifera indica L.) mesocarp cv. "Kent" was done to identify key genes associated with fruit ripening. Using the Illumina sequencing platform, 67,682,269 clean reads were obtained and a transcriptome of 4.8 Gb. A total of 33,142 coding sequences were predicted and after functional annotation, 25,154 protein sequences were assigned with a product according to Swiss-Prot database and 32,560 according to non-redundant database. Differential expression analysis identified 2,306 genes with significant differences in expression between mature-green and ripe mango [1,178 up-regulated and 1,128 down-regulated (FDR ≤ 0.05)]. The expression of 10 genes evaluated by both qRT-PCR and RNA-seq data was highly correlated (R = 0.97), validating the differential expression data from RNA-seq alone. Gene Ontology enrichment analysis, showed significantly represented terms associated to fruit ripening like "cell wall," "carbohydrate catabolic process" and "starch and sucrose metabolic process" among others. Mango genes were assigned to 327 metabolic pathways according to Kyoto Encyclopedia of Genes and Genomes database, among them those involved in fruit ripening such as plant hormone signal transduction, starch and sucrose metabolism, galactose metabolism, terpenoid backbone, and carotenoid biosynthesis. This study provides a mango transcriptome that will be very helpful to identify genes for expression studies in early and late flowering mangos during fruit ripening.

Molecular modeling and expression analysis of a MADS-box cDNA from mango (Mangifera indica L.).

MADS-box genes are a large family of transcription factors initially discovered for their role during development of flowers and fruits. The MADS-box transcription factors from animals have been studied by X-ray protein crystallography but those from plants remain to be studied. In this work, a MADS-box cDNA from mango encoding a protein of 254 residues was obtained and compared. Based on phylogenetic analysis, it is proposed that the MADS-box transcription factor expressed in mango fruit (MiMADS1) belongs to the SEP clade of MADS-box proteins. MiMADS1 mRNA steady-state levels did not changed during mango fruit development and were up-regulated, when mango fruits reached physiological maturity as assessed by qRT-PCR. Thus, MiMADS1 could have a role during development and ripening of this fruit. The theoretical structural model of MiMADS1 showed the DNA-binding domain folding bound to a double-stranded DNA. Therefore, MiMADS1 is an interesting model for understanding DNA-binding for transcriptional regulation.

El Capitalismo Organizacional como factor de riesgo Psicosocial:: Efectos psicológicos colaterales de las nuevas condiciones de trabajo en hospitales y universidades de naturaleza pública. Resultados Santander, Colombia / The Organizacional Capitalism as a Psychosocial risk factor: psychological collateral effects of the new working conditions in hospitals and universities of public nature. Results in Santander, Colombial

En esta investigación se analiza la subjetivación laboral del capitalismo organizacional a partir de las construcciones de significado de los trabajadores de hospitales y universidades públicas desarrolladas según: a) percepciones del entorno laboral, b) experiencia y sentido del trabajo, c) impacto psicosocial percibido en la calidad de vida laboral y el bienestar psicológico, y d) estrategias y prácticas de afrontamiento individual y colectivo de las demandas organizacionales. El estudio se desarrolló a través de una investigación de tipo cualitativo en la que se utilizó el análisis del discurso. Paralelamente, se aplicaron técnicas cuantitativas a efectos de realizar una triangulación de métodos como estrategia de investigación. Se desarrollaron entrevistas sobre las experiencias laborales actuales de los profesionales, acompañadas de la aplicación del Cuestionario de calidad de vida laboral (Blanch, 2008). Algunos resultados destacan como aspectos positivos: el compañerismo y mejoramiento de materiales; y entre los aspectos negativos, la sobrecarga laboral, el tipo de contratación, inestabilidad laboral y baja remuneración salarial.

This research analyzes the labor subjectification of organizational capitalism, considering the construction of meaning of workers in hospitals and universities in the public sector, developed according to: a) perceptions of the working environment, b) experience and meaning of work, c) perceived psychosocial impact on the quality of working life and psychological well-being, and d) strategies and practices of facing collective and individual organizational requirements. The study was developed through a qualitative research, by using discourse analysis. In parallel, we applied quantitative techniques, performing a triangulation of the methods as a research strategy. We conducted interviews in-depth, about current work experiences of professionals, along with the application of the questionnaire entitled Calidad de Vida Laboral (Blanch, 2008). Some of the results point out positive aspects like fellowship and the improvement of materials, and, as negative aspects, the excessive workload, the type of contract, job instability and wage compensation.

Reacción en cadena de la polimerasa y diagnóstico molecular / Polymerase chain reaction and molecular diagnostics

La PCR, acrónimo de la reacción en cadena de la polimerasa, revolucionó el campo del diagnóstico molecular, hasta el punto de que en la actualidad representa el segmento de mayor crecimiento en los laboratorios clínicos del mundo entero, en los que se ha convertido en herramienta de invaluable utilidad. El presente escrito describe los fundamentos de la metodología, así como algunas de sus múltiples aplicaciones en la diagnosis, desde sus albores hasta el presente.

PCR, acronym of polymerase chain reaction, has revolutionized the field of molecular diagnostics to the point that it currently represents the fastest-growing segment in clinical laboratories worldwide, where it has become an invaluable tool. This paper describes the fundamentals of PCR and its developments in some of its many applications in the diagnosis, from its beginnings to the present.

Succession pattern of cadaverous entomofauna in a semi-rural area of Bogotá, Colombia.

The main objective of this work was to examine the succession of insects colonizing three pig (Sus scrofa) cadavers in a semi-rural area of Bogotá. The 12kg pigs were shot and put into metallic mesh cages to allow access by insects. Arthropods were then sampled at different intervals depending on the corresponding stage of decomposition. In total 5981 arthropods were collected during decomposition, 3382 adults and 2599 immature stages, belonging to 10 orders and 27 families. Sarconesia magellanica and Compsomyiops verena (Diptera: Calliphoridae) were the first species to colonize the corpses. Egg masses and 1st stage Calliphoridae larvae were associated with the fresh stage of decomposition, 1st and 2nd stage larvae of Calliphoridae and Sarcophagidae during chromatic and emphysematous stages, immature Chrysomya albiceps (Diptera: Calliphoridae), Ophyra sp. (Diptera: Muscidae) and Oxellytrum discicolle (Coleoptera: Silphidae) during the colliquative stage and mainly Coleoptera during the skeletization phase (plus some adult Diptera). The data obtained in the present investigation could be used for the estimation of postmortem interval (PMI) in real cases when the conditions to which a cadaver has been exposed are similar to those recorded during this work.

Comparación de hemodiafiltración “mid-dilucional” respecto a hemodiafiltración pre y postdilucional / Comparison of “mid-dilution” haemodiafiltration with pre- and post-dilution haemodiafiltration

La hemodiafiltración permite varias alternativas según se incorpore el líquido de reinfusión: pre-dilucional (antes del dializador), post-dilucional (después del dializador) y mixta (pre y post-dilución). Una alternativa a esta última es un dializador diseñado para realizar la mid-dilución, dónde la sangre entra por un haz de fibras centrales y regresa, en sentido contrario, por fibras periféricas. El líquido de reinfusión se incorpora en la mitad de los dos tramos del dializador, así en el primer tramo se produce una hemodiafiltración post-dilucional y en el segundo tramo una hemodiafiltración pre-dilucional. El objetivo de este estudio fue comparar el modo de infusión mid-dilucional con los modos pre y post-dilucional, evaluando la depuración de varias moléculas de diferente peso molecular. Cada paciente fue sometido a tres sesiones de diálisis con una técnica diferente cada vez, respetando las características de la diálisis a excepción del volumen de infusión. La hemodiafiltración on-line con el modo de infusión mid-dilucional parece ser una buena alternativa que permite altos volúmenes convectivos con una mayor depuración de β2-microglobulina, prolactina, mioglobina y proteína transportadora de retinol en comparación con el modo postdilucional, y más llamativa en comparación con la hemodiafiltración predilucional (AU)

Various alternative forms of haemodia filtration are possible depending on when the reinfusion liquid isincorporated: pre-dilution (before the dialyser), postdilution (after the dialyser) and mixed (pre- and post-dilution). An alternative to the latter is a dialyser designed for mid-dilution, where the blood passes through a membrane of central fibres and returns, in the opposite direction, through peripheral fibres. The reinfusion liquid is incorporated in half of the two sections of the dialyser. Thus, in the first section post-dilution haemodia filtration takes place, and in the second section, pre-dilution haemodiafltration. The aim of this study was to compare the forms of mid-dilution infusion with pre- and post-dilution, evaluating the removal of various molecules with different molecular weight. Each patient underwent three dialysis sessions, using a different technique each time, respecting the characteristics of the dialysis except for the infusion volume. Mid-dilution on-line haemodiafiltration seems to a be a good alternative that permits high convective volumes with a greater purification of β2-microglobulin,prolactin, myoglobin and retinol binding protein compared to post-dilution haemodiafiltration, and more marked compared to pre-dilution haemodiafiltration (AU)

Deficiencia de glucosa 6 fosfato deshidrogenasa: analisis enzimatico y molecular en una población de Bogota / Glucose-6-phosphate dehydrogenase deficiency: enzimatic and molecular analysis in a Bogotß population

Objetivo: Determinar qué tan frecuente es la deficiencia de glucosa 6 fosfato deshidrogenasa (G6PD) y realizar analisis molecular para identificar las variantes A+, A- y mediterrßnea en una población de residentes en Bogota. Métodos: Se analizaron 348 personas que residen en Bogotß, pertenecientes a la Policía Nacional y a la Universidad del Rosario. La actividad enzimßtica se determinó en muestras de sangre mediante espectrofotometría con el kit Trinity Biotech (Cat 345-B). Los valores de hemoglobina (Hg) y hematócrito (Hto) se determinaron con el método de Drabkin y sedimentación, respectivamente. La determinación de las variantes moleculares se realizó mediante amplificación por reacción en cadena de la polimerasa (PCR) y analisis de fragmentos de restricción de longitud polimórfica (RFLP) con las enzimas NlaIII, Fok I y MboII para A+, A- y mediterrßnea, respectivamente. Se hicieron analisis estadísticos para comparar la concentración de Hg en personas sanas y deficientes, la actividad de G6PD por géneros y los datos de frecuencia a nivel mundial. Resultados y conclusiones: La frecuencia de deficiencia de G6PD para la población en estudio fue 3.1%. En 1.4% de los casos se observó actividad deficiente, en 1.7% actividad intermedia y en 0.6% actividad aumentada. No se encontraron las variantes moleculares A+, A- y mediterranea en ningún afectado. La actividad de G6PD no tuvo diferencias por género. Se encontró diferencia significativa en el valor de hemoglobina entre las personas sanas y deficientes de G6PD. Los individuos deficientes eran asintomßticos lo que indica mecanismos de compensación de estrés oxidativo. Las mujeres deficientes son heterocigotos con una inactivación preferencial del cromosoma X anormal y al ser portadoras tienen riesgo de 50% de tener hijos afectados con la enfermedad. La identificación de mujeres y hombres deficientes permite establecer medidas preventivas ante posibles crisis hemolíticas desencadenadas por infecciones y drogas.

Objective: To determine the frequency of G-6PD and molecular analysis for identification of A+, A- and Mediterranean in healthy persons in Bogota. Methods: Quantitative spectrophotometric assays for enzyme activity of G-6PD were carried out on the red cells of 348 asymptomatic and healthy adult males and females. Through molecular analysis of DNA from G-6PD deficients the relevant exons were amplified for PCR and then analysed with the restriction enzymes NlaIII, Fok I and MboII, for the detection of A+, A- and Mediterranean variants. Results and conclusions: Among 348 samples, 1.4% exhibited total deficiency and 1.7% had intermediate deficiency while 96.3% were normal. The combined prevalence was 3.7%. In enzymatic activity no statistically significance was seen between males and females. No variant was found among these patients and any of the subjects studied displayed any sign of hemolysis and other clinical manifestations. Although it is not yet clearly understood other mechanisms must exist to offer protection from the oxidative stresses. The finding of severe enzyme deficiency in some heterozygote females is due to extreme degree of X inactivation of the normal chromosome.

Platón y el consentimiento informado contemporáneo / Plato and the contemporary informed consent

El consentimiento informado es un concepto ético consustancial a la práctica y la investigación médica contemporáneas. En reconocimiento de su importancia, se examina la influencia de las ideas de Platón, tanto sobre su planteamiento como sobre sus alcances, en especial en lo que se refiere a la asociación entre el carácter del hombre libre y su derecho a tomar decisiones acerca de su salud.

Informed consent is an ethical concept inherent to contemporary medical practice and research. In recognition of its importance, some Plato’s ideas are examined, on the basis of the influence upon its definition and reaches, especially what refers to the connection between the quality of a free person and his right to make decisions about his health.

Glucosa-6-fosfato deshidrogenasa (G6PD): respuesta de los hematíes y otras células humanas a la disminución en su actividad / Glucose-6-phosphate dehydrogenase (G6PD): response of the human erythrocyte and another cells to the decrease in their activity

La glucosa-6-fosfato deshidrogenasa (G6PD) es la primera enzima de la vía pentosa fosfato y la principal fuente intracelular de nicotidamina adenina dinucleótido fosfato reducido (NADPH), compuesto comprometido en diversos procesos fisiológicos, por ejemplo defensa antioxidante (sobre todo células como los eritrocitos), modulación del crecimiento endotelial, eritropoyesis, vascularización y fagocitosis. La deficiencia de G6PD es la enzimopatía ligada al cromosoma X más común en el ser humano. Si bien se puede presentar en cualquier tipo de célula, su carencia absoluta es incompatible con la vida. Según la OMS, en el mundo hay más de 400 millones de personas afectadas por la deficiencia de la enzima, y para Colombia calculan una prevalencia de la deficiencia severa entre 3% y 7%, pero no se conocen los datos relativos a las alteraciones leves y moderadas, que también tienen efectos clínicos. El presente artículo revisa los aspectos biomoleculares más importantes de la enzima, su clasificación de acuerdo con la actividad y la movilidad electroforética, y también se mencionan algunos aspectos clínicos relacionados con la alteración de su actividad.

Glucose-6-phosphate dehydrogenase is the first enzyme in the pentose phosphate pathway and the main intracellular source of reduced nicotidamineadenine nucleotidephosphate (NADPH), involved in diverse physiological processes such as antioxidant defense, (for instance in the erythrocyte) endothelial growth modulation, erithropoyesis, vascularization and phagocitosis. G6PDH deficiency is the most common X-chromosome-linked enzymopathy in human beings. Although it is present in any type cell, its absolute deficiency is incompatible with life. According to WHO, 400 million people are affected by G6PD deficiency in the world but in Colombia, the severe form prevalence is about 3% to 7%. There are no data related to slight and moderate alterations, that also have clinical effects. This paper reviews some G6PD biomolecular aspects, its classification according to activity and electrophoretic mobility, as well as some main clinical aspects related to its activity alteration.

Cambios en el uso de tabaco y factores relacionados en estudiantes del sexto al noveno grado, Estado Lara, Venezuela, años 2000 y 2003 / Changes in tobacco use and related factors in Junior High School students, Lara State, Venezuela, 2000-2003

La Encuesta Mundial sobre Tabaquismo en Jóvenes (EMTAJOVEN), sistema de vigilancia basado en la escuela elemental, fue realizada en el Estado Lara, Venezuela, por una coalición de organizaciones. El instrumento incluye: actitudes, conocimientos, conductas; acceso a productos, propaganda y exposición al humo de tabaco en el ambiente. Participación 85,7 por ciento (2000) y 79,3 por ciento (2003). Prevalencias ( por ciento) 2000 vs. 2003 de: "primer contacto con tabaco": sin cambios (22,8 por ciento y 22,8 por ciento); "Fumar su primer cigarrillo antes los 10 años": disminuyó en varones (21,5 por ciento y 16,7 por ciento); "Fumadores actuales": sin cambio (8,4 por ciento y 8,3 por ciento); "Fumadores que desean dejarlo": aumentó en varones (62,6 por ciento y 84,7 por ciento); "Expuestos al humo de tabaco en el ambiente en lugares públicos": aumentó (43,9 por ciento y 50,7 por ciento); "Apoya prohibir fumar en lugares públicos": sin cambios(> 80 por ciento ambos),; "Recibieron cigarrillos promocionales gratis": aumentó (9,5 por ciento a 13,4 por ciento). "No tuvieron problema al comprar": disminuyó en varones (97 por ciento y 74,3 por ciento) y mujeres (95,9 por ciento y 90,3 por ciento). El tabaquismo se mantiene sin cambios lo que puede imputarse al mercadeo y a la falta de efectividad de las leyes. Los datos presentados permiten examinar políticas y programas actuales a fin de ajustarlos a la realidad.

[Changes in tobacco use and related factors in Junior High School students, Lara State, Venezuela, 2000-2003]. / Cambios en el uso de tabaco y factores relacionados en estudiantes del sexto al noveno grado, Estado Lara, Venezuela, años 2000 y 2003.

The Global Youth Tobacco Survey (GYTS) is a school-based surveillance system. In Lara State, Venezuela, it was conducted by a coalition of organizations. The instrument includes: attitudes, knowledge, behaviors, exposure to environmental tobacco smoke, mass media, and marketing. Participation was 85.7% in 2000 and 79.3% in 2003. Comparing prevalence (%) from 2000 to 2003: "first contact": unchanged (22.8%); "males having first cigarette before the age of 10": decreased (21.5% to 16.7%); "current cigarette smoker": unchanged (8.4% to 8.3%); "male smokers wanted to quit": increased (62.6% to 84.7%); "exposure to environmental tobacco smoke": increased (43.9% a 50.7%), "support ban on smoking in public places": unchanged (> 80%), "received free promotional cigarettes": increased (9.5% a 13.4%), and "no problem buying cigarettes": decreased in males (97% to 74.3%) and in females (95.9% to 90.3%). Tobacco use has remained unchanged, a situation attributed in part to marketing, including free cigarettes, and lack of law enforcement. GYTS provides evidence to support the design, implementation, and monitoring of policies and programs aimed at the prevention and control of tobacco use among adolescents.

Heart failure in rupture of a sinus of valsalva aneurysm.

We report a 22-year-old man who developed shortness of breath after lifting weights and then developed acute heart failure due to rupture of an aneurysm of the right sinus of Valsalva into the right ventricle. The patient developed dyspnea, and clinical findings included tachycardia, wide pulse pressure, bounding carotid and peripheral pulses, pulmonary crackles, and prominent continuous precordial murmur with thrill. Transesophageal echocardiogram with Doppler examination confirmed the diagnosis. The patient underwent surgery with cardioplegia directly infused into the coronary arteries with excision of redundant tissue and closure of the defect with a Dacron patch. He has been asymptomatic since surgery. This condition must to be included in the differential diagnosis for young patients with heart failure.

Review of clinical characteristics and management of patients with ST segment elevation myocardial infarction at atertiary care center.

BACKGROUND: Information from recent multiple trials on the pathophysiology and outcome of ST-segment elevation myocardial infarction (STEMI) has changed its clinical perspective and strategic management, leading to a revision of the 1999 ACC/AHA practice guidelines for that condition. OBJECTIVE: Analyze the clinical characteristics, management strategies, the timing of therapeutic interventions and outcome of patients with STEMI referred to the Cardiovascular Center of Puerto Rico (CVCPR). METHODS: Retrospective review of medical records of all patients admitted to the CVCPR with a diagnosis of STEMI from January 1, 2003 to December 31, 2003. RESULTS: A total of 184 medical records were reviewed. Seventy-six percent of patients were men, mean age was 62.1 +/- 11.8 years. A high prevalence of coronary risk factors was present: systemic hypertension (64%), diabetes mellitus (40%), dyslipidemia (35%), smoking (33%) and previous CAD (32%). Less than 1/4 of referral forms contained data indicative of whether patients had received antiplatelet therapy, beta-blockers, ACE inhibitors or statins. Fifty percent of patients arrived to the CVCPR more than 48 hours after diagnosis. Only forty-two patients (23%) arrived within 12 hours. Thrombolytic therapy had been used in 27% of them. 179 (97%) patients underwent coronary angiography, 69.2% of which had multivessel disease. 114 (62%) patients underwent percutaneous coronary interventions (PCI) with stenting. Patients submitted to PCI and stenting of the culprit lesion had a better outcome and survival than the ones not exposed to those procedures (p = 0.02). Approximately two-third of patients received secondary prevention medications upon discharge. CONCLUSIONS: Relevant findings of this review were that in spite of high prevalence of CAD major risk factors, the use of medications of proven benefit for prevention and treatment of CAD at referral centers was less than that recommended by current guidelines, a significant delay in the transfer of patients to the tertiary care facility (in most cases that period exceeded more than 48 hours after diagnosis) and a reduced utilization of thrombolytic therapy. Intensification of the education of physicians throughout the island regarding these matters is to be encouraged. Additional measures should include, development of written protocols at referral centers to assure a more expedite clinical assessment of patients, an enhancement of their capability for utilizing fibrinolytic agents in suitable candidates and the timely transfer to PCI-capable facilities of patients that may still benefit from catheter reperfusion.

Biocirugía: utilización de larvas de insectos necrófagos en la curación de heridas. La terapia larval / Biosurgery: use of larvae of necrophage insects in wound healing. The larval therapy

La terapia larval es una técnica que permite aplicar las larvas de algunas especies de dípteros sobre heridas crónicas o sobre focos de infección localizados, con la finalidad de restaurar el tejido afectado. La velocidad y la eficacia del tratamiento, sumadas a la casi nula pérdida de tejido sano durante el proceso de reparación tisular, han hecho de la terapia larval o biocirugía una alternativa viable para la curación de heridas asociadas con entidades como pie diabético, úlceras venosas, úlceras crónicas de la piel y quemaduras, así como de ciertos tipos de tumores beningos, abscesos y osteomielitis.Aunque la medicina moderna ha sido, en muchos casos, reticente a la aplicación de terapias de esta índole, eventos como la resistencia a los antibióticos y las alteraciones en el proceso de cicatrización en las heridas crónicas han permitido modificar la posición inicial de muchos médicos al respecto.