[Superficial mycoses in patients from Anzoátegui state, Venezuela, period 2002-2012]. / Micosis superficiales en pacientes del estado Anzoategui, Venezuela, periodo 2002-2012.

Superficial fungal diseases that affect the skin and its appendages are frequently seen in basic triage and in dermatology services. These diseases are distributed in Venezuela with an incidence of 92.9%. The aim of this study was to determine the genera and species that cause dermatomycoses in residents of Anzoátegui state, Venezuela, during the period 2002-2012. A total of 4257 patients with a presumptive diagnosis of superficial mycoses were studied, with ages from 7 months to 79 years. The overall prevalence was 30.9%. The most frequent were dermatophytosis (44.7%). M. canis produced 148 cases of tinea capitis. Three dermatophytic agents represented 95% of all cases, with a significant predominance of T. mentagrophytes with 50%. Candidosis occurred in 28.4%. C. albicans, and the C. parapsilosis complex, were responsible for 80% of the cases. The other species identified were C. tropicalis (n = 41, 11.0%), C. glabrata (n = 10, 2.7%), C. guilliermondii (n = 6, 1.6%), C. krusei (n = 4, 1.1%). Pityriasis versicolor occurred in 22.4% of the cases studied, and less frequently were present onychomycosis produced by a non dermatophytic mold: Fusarium oxysporum (n = 34, 65.4%), Aspergillus terreus (n=16, 30.8%) and Scytalidium dimidiatum (n=2; 3.8%). Rare cases of Trichosporon onychomycosis (0.5%) and one case of black tinea were also found. Health education in the population is recommended to promote measures to prevent transmission of these fungi and prevent the spread of this silent public health problem.

Evaluation of Spin in Systematic Reviews and Meta-Analyses of Minimally Invasive Surgical Techniques and Standard Microdiscectomies for Treating Lumbar Disc Herniation.

STUDY DESIGN: Systematic review. OBJECTIVES: Spin in scientific literature is defined as bias that overstates efficacy and/or underestimates harms of procedures undergoing review. While lumbar microdiscectomies (MD) are considered the gold standard for treating lumbar disc herniations (LDH), outcomes of novel procedures are being weighed against open MD. This study identifies the quantity and type of spin in systematic reviews and meta-analyses of LDH interventions. METHODS: A search was conducted on the PubMed, Scopus, and SPORTDiscus databases for systematic reviews and meta-analyses evaluating the outcomes of MD against other LDH interventions. Each included study's abstract was assessed for the presence of the 15 most common types of spin, with full texts reviewed during cases of disagreement or for clarification. Full texts were used in the assessment of study quality per AMSTAR 2. RESULTS: All 34 included studies were observed to have at least 1 form of spin, in either the abstract or full text. The most common type of spin identified was type 5 ("The conclusion claims the beneficial effect of the experimental treatment despite a high risk of bias in primary studies"), which was observed in ten studies (10/34, 29.4%). There was a statistically significant association between studies not registered with PROSPERO and the failure to satisfy AMSTAR type 2 (P < .0001). CONCLUSION: Misleading reporting is the most common category of spin in literature related to LDH. Spin overwhelmingly tends to go in the positive direction, with results inappropriately favoring the efficacy or safety of an experimental intervention.

Prediction models of COVID-19 fatality in nine Peruvian provinces: A secondary analysis of the national epidemiological surveillance system.

There are initiatives to promote the creation of predictive COVID-19 fatality models to assist decision-makers. The study aimed to develop prediction models for COVID-19 fatality using population data recorded in the national epidemiological surveillance system of Peru. A retrospective cohort study was conducted (March to September of 2020). The study population consisted of confirmed COVID-19 cases reported in the surveillance system of nine provinces of Lima, Peru. A random sample of 80% of the study population was selected, and four prediction models were constructed using four different strategies to select variables: 1) previously analyzed variables in machine learning models; 2) based on the LASSO method; 3) based on significance; and 4) based on a post-hoc approach with variables consistently included in the three previous strategies. The internal validation was performed with the remaining 20% of the population. Four prediction models were successfully created and validate using data from 22,098 cases. All models performed adequately and similarly; however, we selected models derived from strategy 1 (AUC 0.89, CI95% 0.87-0.91) and strategy 4 (AUC 0.88, CI95% 0.86-0.90). The performance of both models was robust in validation and sensitivity analyses. This study offers insights into estimating COVID-19 fatality within the Peruvian population. Our findings contribute to the advancement of prediction models for COVID-19 fatality and may aid in identifying individuals at increased risk, enabling targeted interventions to mitigate the disease. Future studies should confirm the performance and validate the usefulness of the models described here under real-world conditions and settings.

Ferric iron uptake genes are differentially expressed in the presence of copper sulfides in Acidithiobacillus ferrooxidans strain LR.

Acidithiobacillus ferrooxidans is one of the most widely used microorganisms in bioleaching operations to recover copper from low-grade copper sulfide ores. This work aimed to investigate the relative expression of genes related to the iron uptake system when A. ferrooxidans LR was maintained in contact with chalcopyrite or bornite as the sole energy source. Real-time quantitative PCR analysis revealed that the presence of bornite had no effect on the expression of seven genes related to the siderophore-mediated Fe(III) uptake system, while in the presence of chalcopyrite the expression of the genes was up-regulated. Bioinformatic analysis of the genomic region where these genes were found revealed the existence of three new putative DNA-binding sequences for the ferric iron uptake transcriptional regulator (Fur). Electrophoretic mobility shift assays demonstrated that a purified A. ferrooxidans His-tagged Fur protein was able to bind in vitro to each of these putative Fur boxes, suggesting that Fur regulated the expression of these genes. The expression of fur and two known Fur-regulated genes, mntH and dsrK, was also investigated in the presence of chalcopyrite. While the expression of fur and mntH was up-regulated, the expression of dsrK was down-regulated. The low amount of ferrous iron in the medium was probably responsible for the up-regulation of fur and the genes related to the siderophore-mediated Fe(III) uptake system when A. ferrooxidans LR was kept in the presence of chalcopyrite. A homology model of the A. ferrooxidans Fur was constructed and revealed that the putative DNA-binding surface presents conserved positively charged residues, supporting a previously suggested mode of interaction with DNA. The up-regulation of fur and the siderophore-mediated Fe(III) uptake genes, and the down-regulation of dsrK suggest that in the presence of chalcopyrite Fur acts as a transcription inducer and repressor.

Gene expression modulation by chalcopyrite and bornite in Acidithiobacillus ferrooxidans.

Acidithiobacillus ferrooxidans is a mesophilic, acidophilic, chemolithoautotrophic bacterium that obtains energy from the oxidation of ferrous iron (Fe2+), elemental sulfur and reduced sulfur compounds. The industrial interest in A. ferrooxidans resides in its capacity to oxidize insoluble metal sulfides into soluble metal sulfates, thus allowing the recovery of the desired metals from low-grade sulfide ores. In the present work, RNA arbitrarily primed PCR (RAP-PCR) was performed to identify cDNAs differentially expressed in A. ferrooxidans cells grown in the presence of Fe2+ and cells maintained for 24 h in the presence of the copper sulfides bornite and chalcopyrite. Eighteen cDNAs corresponding to genes with known function were identified, and their relative expression was further characterized by real-time quantitative PCR. Bornite had a mild effect on the expression of the 18 genes analyzed. None of these genes was down-regulated and among the few genes up-regulated, it is worth mentioning lepA and def-2 that are involved in protein synthesis. Chalcopyrite presented the most significant changes. Five genes related to protein processing were down-regulated, and another 5 genes related to the transport system were up-regulated. The up- and down-regulation of these genes in the presence of bornite and chalcopyrite could be due to alterations in the ideal pH, presence of copper ions in solution and nutrient limitation. The results suggest that gene expression modulation might be important for the A. ferrooxidans early response to copper sulfides.

[Cultural practices linked to health care and perception on the attention health facilities in residents of highandean settlements in Huancavelica, Peru]. / Prácticas culturales vinculadas al cuidado de la salud y percepción sobre la atención en establecimientos de salud en residentes de centros poblados alto-andinos de Huancavelica, Perú.

Inequalities in terms of access and quality of healthcare persist, especially among Andean populations, such as the community of Chopcca. Here, we describe the perception of healthcare provided in medical facilities as well as the practices linked to health care in residents of settlements in the Huancavelica region. We carried out a cross-sectional study by means of a structured questionnaire administered to 775 residents of urban and rural towns of the Yauli and Paucará districts. 68.7% refer always using medicinal plants to cure themselves; 86.7% never made a "payment" to Mother Earth; 81.4% has not practiced coca qaway or sara qaway. 88.5% of respondents visit the medical facility when they fall ill. 57.4% refer that the healthcare staff always transmits confidence and security, this proportion is higher in rural vs. urban areas (64.6% versus 28.8%). The communities under study demand the healthcare services offered by the formal system; nevertheless, traditional cultural practices persist, being the most important one the use of medicinal plants.

Las desigualdades en el acceso y la calidad de atención en salud persisten, especialmente en poblaciones andinas, como la colectividad Chopcca. Describimos la percepción sobre la atención en establecimientos de salud y las prácticas vinculadas al cuidado de la salud en residentes de centros poblados de la región Huancavelica. Realizamos un estudio transversal mediante cuestionario estructurado en 775 residentes de centros poblados urbanos y rurales de los distritos de Yauli y Paucará. 68,7% refieren usar siempre plantas medicinales para curarse, 86,7% nunca realizó pago a la tierra, 81,4% no ha practicado el coca qaway o sara qaway. 88,5% acude al establecimiento de salud cuando enferma. 57,4% refiere que el personal de salud siempre brinda confianza y seguridad, dicha proporción es mayor en zonas rurales que urbanas (64,6% versus 28,8%). Las comunidades estudiadas demandan los servicios de salud ofrecidos por el sistema formal. Sin embargo, persisten prácticas culturales tradicionales, siendo la más importante el uso de plantas medicinales.

Differentiation of Acidithiobacillus ferrooxidans and A. thiooxidans strains based on 16S-23S rDNA spacer polymorphism analysis.

Restriction fragment length polymorphism (RFLP) and sequence analyses of the PCR-amplified 16S-23S rDNA intergenic spacer (ITS) were used for differentiating Acidithiobacillus thiooxidans strains from other related acidithiobacilli, including A. ferrooxidans and A. caldus. RFLP fingerprints obtained with AluI, DdeI, HaeIII, HinfI and MspI enabled the differentiation of all Acidithiobacillus reference strains into species groups. The A. thiooxidans strains investigated (metal mine isolates) yielded identical RFLP patterns to the A. thiooxidans type strain (ATCC 19377(T)), except for strain DAMS, which had a distinct pattern for all enzymes tested. Fourteen A. ferrooxidans mine strains were assigned to 3 RFLP groups, the majority of which were grouped with A. ferrooxidans ATCC 23270(T). The spacer region of one representative strain from each of the RFLP groups obtained was subjected to sequence analysis, in addition to eleven additional A. thiooxidans strains isolated from sediment and water samples, and A. caldus DSM 8584(T). The tRNA(IIe) and tRNA(Ala) genes, present in all strains analyzed, showed high sequence similarity. Phylogenetic analysis of the ITS sequences differentiated all three Acidithiobacillus species. Inter- and infraspecific genetic variations detected were mainly due to the size and sequence polymorphism of the ITS3 region. Mantel tests showed no significant correlation between ITS sequence similarity and the geographical origin of strains. The results showed that the 16S-23S rDNA spacer region is a useful target for the development of molecular-based methods aimed at the detection, rapid differentiation and identification of acidithiobacilli.

Biological leaching of Mn, Al, Zn, Cu and Ti in an anaerobic sewage sludge effectuated by Thiobacillus ferrooxidans and its effect on metal partitioning.

The chemical fractionation and bioleaching of Mn, Al, Zn, Cu and Ti in municipal sewage sludge were investigated using Thiobacillus ferrooxidans as leaching microorganism. As a result of the bacterial activity, ORP increase and pH reduction were observed. Metal solubilization was accomplished only in experimental systems supplemented with energy source (Fe(II)). The solubilization efficiency approached approximately 80% for Mn and Zn, 24% for Cu, 10% for Al and 0.2% for Ti. The chemical fractionation of Mn, Al, Zn, Cu and Ti was investigated using a five-step sequential extraction procedure employing KNO3, KF, Na4P2O7, EDTA and HNO3. The results show that the bioleaching process affected the partitioning of Mn and Zn, increasing its percentage of elution in the KNO3 fraction while reducing it in the KF, Na4P2O7 and EDTA fractions. No significant effect was detected on the partitioning of Cu and Al. However, quantitatively the metals Mn, Zn, Cu and Al were extracted with higher efficiency after the bacterial activity. Titanium was unaffected by the bioleaching process in both qualitative and quantitative aspects.

[Inequity in health: its historical development]. / La inequidad en salud: su desarrollo histórico.

Health inequity, main issue of contemporary debates on public health, is based on philosophical and historical concepts that date back to the idea of justice from classic Greece. The Aristotelian approach on distributive justice and its higher form, epiekeia or equity, has been reviewed, as well as how this evolves from the Middle Ages and modernity to the heart of the debate of a variety of thinkers such as liberal Rawls and Nobel laureate Amartya Sen. On this conceptual debate lies the World Health Organization version that links equity to health determinants and intends to make it operational through the equitable provision of health services.

[Institutional iatrogeny and maternal death: Semmelweis and puerperal fever]. / Iatrogenia institucional y muerte materna: Semmelweis y la fiebre puerperal.

Puerperal fever is a disease that becomes epidemic in the eighteenth century as a result of two factors: the urban working masses generated by the industrial revolution and the progressive hegemonization and medicalization of birth care in large public hospitals. Institutionalized maternal death reached figures above 30%, while in the case of birth care provided by midwives, it was than 2%. Semmelweis, an Hungarian physician, sustained that physicians contaminated women in labor due to insufficient hygiene after performing necropsies and established prophylactic measures in the Vienna Hospital that reduced mortality dramatically. However, his ideas were rejected because they affected the institutionalization process of medicine, based on altruism and honor, which would make it impossible to cause harm to patients. He was forced to leave Vienna Hospital and he continued his struggle in Budapest, but the rejection and disagreement of his peers with his doctrine affected his mental health. He died in an asylum, a few years before Pasteur and Koch proved the existence of the bacteria that caused diseases such as puerperal fever.

Prácticas culturales vinculadas al cuidado de la salud y percepción sobre la atención en establecimientos de salud en residentes de centros poblados alto-andinos de Huancavelica, Perú / Cultural practices linked to health care and perception on the attention health facilities in residents of highandean settlements in Huancavelica, Peru

RESUMEN Las desigualdades en el acceso y la calidad de atención en salud persisten, especialmente en poblaciones andinas, como la colectividad Chopcca. Describimos la percepción sobre la atención en establecimientos de salud y las prácticas vinculadas al cuidado de la salud en residentes de centros poblados de la región Huancavelica. Realizamos un estudio transversal mediante cuestionario estructurado en 775 residentes de centros poblados urbanos y rurales de los distritos de Yauli y Paucará. 68,7% refieren usar siempre plantas medicinales para curarse, 86,7% nunca realizó pago a la tierra, 81,4% no ha practicado el coca qaway o sara qaway. 88,5% acude al establecimiento de salud cuando enferma. 57,4% refiere que el personal de salud siempre brinda confianza y seguridad, dicha proporción es mayor en zonas rurales que urbanas (64,6% versus 28,8%). Las comunidades estudiadas demandan los servicios de salud ofrecidos por el sistema formal. Sin embargo, persisten prácticas culturales tradicionales, siendo la más importante el uso de plantas medicinales.

ABSTRACT Inequalities in terms of access and quality of healthcare persist, especially among Andean populations, such as the community of Chopcca. Here, we describe the perception of healthcare provided in medical facilities as well as the practices linked to health care in residents of settlements in the Huancavelica region. We carried out a cross-sectional study by means of a structured questionnaire administered to 775 residents of urban and rural towns of the Yauli and Paucará districts. 68.7% refer always using medicinal plants to cure themselves; 86.7% never made a "payment" to Mother Earth; 81.4% has not practiced coca qaway or sara qaway. 88.5% of respondents visit the medical facility when they fall ill. 57.4% refer that the healthcare staff always transmits confidence and security, this proportion is higher in rural vs. urban areas (64.6% versus 28.8%). The communities under study demand the healthcare services offered by the formal system; nevertheless, traditional cultural practices persist, being the most important one the use of medicinal plants.

Biosorption and desorption of lanthanum(III) and neodymium(III) in fixed-bed columns with Sargassum sp.: perspectives for separation of rare earth metals.

Rare earth (RE) metals are essentials for the manufacturing of high-technology products. The separation of RE is complex and expensive; biosorption is an alternative to conventional processes. This work focuses on the biosorption of monocomponent and bicomponent solutions of lanthanum(III) and neodymium(III) in fixed-bed columns using Sargassum sp. biomass. The desorption of metals with HCl 0.10 mol L(-1) from loaded biomass is also carried out with the objective of increasing the efficiency of metal separation. Simple models have been successfully used to model breakthrough curves (i.e., Thomas, Bohart-Adams, and Yoon-Nelson equations) for the biosorption of monocomponent solutions. From biosorption and desorption experiments in both monocomponent and bicomponent solutions, a slight selectivity of the biomass for Nd(III) over La(III) is observed. The experiments did not find an effective separation of the RE studied, but their results indicate a possible partition between the metals, which is the fundamental condition for separation perspectives.

Hipólito Unanue y la medicina topográfica / Hipolito Unanue and topographic medicine

El autor revisa la importancia de la obra El clima de Lima y su influencia sobre los seres vivos de Hipólito Unanue en las primeras décadas del siglo XIX, introduciendo por primera vez en lengua española en América una novedosa corriente de pensamiento que trataba de explicar el fenómeno de la enfermedad, y en particular de las enfermedades epidémicas, con la topografía de esta parte del mundo.

The author reviews the importance of the work The climate of Lima and its influence on the living beings of Hipólito Unanue in the first decades of the 19th century, introducing for the first time in the Spanish language in America a new current of thought which tried to explain the phenomenon of the disease, and in particular of epidemic diseases, with the topography of this part of the world.

Los pueblos indígenas en aislamiento y contacto inicial en las regiones de Cusco y Madre de Dios. OTCA – Perú, 2014 / Indigenous peoples in isolation and initial contact in the regions of Cusco and Madre de Dios. OTCA – Peru, 2014

Los pueblos indígenas en aislamiento y en contacto inicial (PIACI) son vulnerables al contagio de enfermedades externas, pues carecen de defensas inmunitarias. Esto genera interés por el desarrollo de políticas de protección de salud y otros determinantes. Objetivo. Describir las experiencias del “Intercambio técnico in locus sobre la metodología de protección de los pueblos indígenas aislados y contacto inicial en las regiones de Cusco y Madre de Dios”. Resultados. Los establecimientos de salud implementan normas y guías técnicas de protección de salud de los PIACI, las que se traducen en acciones preventivo-promocionales considerando el componente cultural; la protección de la salud a través de la inmunización, trabajos comunales como las estrategias de sensibilización orientados a la protección de la salud de los indígenas aislados, el registro de atenciones en la hoja HIS considerando la pertenencia étnica, la reserva de medicamentos e insumos para posibles contingencias; entre otros. Los PIACI identifican como enfermedades de alto riesgo a las infecciones respiratorias agudas y enfermedades diarreicas agudas, por el alto riesgo de morbimortalidad que tienen. Los gobiernos locales tienen limitaciones legales para ofrecer servicios de programas sociales pues los beneficiarios deben de contar con el Documento Nacional de Identidad (DNI). Conclusión. La implementación de la norma y guías técnicas de salud vigentes ofrecen atención diferenciada de salud; los diálogos e intercambio de experiencias de los países participantes en la misión técnica generan espacios de búsqueda de alternativas de solución frente a la necesidad de diseñar el plan regional de acción conjunta.

Indigenous Peoples in Isolation and Initial Contact (PIACI) are more vulnerable to external diseases because they lack immune defenses. This generates interest in the development of policies to protect health and other determinants. Objective: To describe the experiences about “Technical Exchange Methodology In Locus on Protection of Indigenous Peoples in Isolation and Initial Contact in the regions of Cusco and Madre de Dios.” Results. Health facilities implementing Standards and Technical Guide to protect the health of PIACI, which translate into preventive and promotional aspects considering the cultural component; the protection of health through immunization, communal awareness and strategies aimed at protecting the health of indigenous isolated, registration facilities to leaf HIS considering ethnicity, backup drugs and supplies for contingencies; etc. The PIACI diseases identified as high risk for acute respiratory infections and acute diarrheal diseases for the high risk of morbidity and mortality. Local governments have legal limitations to provide social services programs for the beneficiaries, who must have National Identity Document (DNI). Conclusion. The Standard and Technical Guide Health Implementation offer differentiated health care; dialogue and exchange of experiences of the countries participating in the technical mission generated alternative solution to the need to develop a regional plan of joint action.

Formación, registro y la práctica autorizada de la medicina tradicional, alternativa y complementaria-OMS-Macao/China 2014 / Formation, registration and authorized practice of traditional medicine, alternative and complementary-WHO-Macao / China 2014

Muchos países están reconociendo la contribución potencial de la medicina tradicional alternativa y complementaria (MT/MAC) a la salud, el bienestar de las personas y al sistema oficial de salud, tal es así que existe un creciente interés por evaluar aspectos relativos a la formación, prácticas autorizadas y al registro de los profesionales de MT/MAC. Objetivo. Sistematizar las experiencias expuestas por diferentes países en el Taller de Capacitación Interregional de la OMS Sobre el Registro y la Práctica Autorizada de la MT/MAC-RAE Macao-China 2014. Para ello se ha seleccionado algunas experiencias de los cuarenta y uno expertos participantes, entre ellas: Hong Kong/China, China, Macao/China, Irán, India y Perú. Conclusión. Algunas países/regiones como: Hong Kong/China, Macao/China, China e Irán cuentan con regulaciones en MT/MAC en relación a registro y la práctica. En Hong Kong/China, Macao/China, China las prácticas de MT/MAC están integradas en el sistema oficial de salud; otros países como India y Perú realizan las prácticas de MT/MAC con equipos básicos. En relación a la formación y registro en Hong Kong/China, Macao/China y China cuentan con centros de educación superior oficialmente reconocidos en el que se imparten conocimientos en MT/MAC a nivel pregrado, posgrado (maestrías y doctorados) y estudios básicos de corta duración (3 años), asimismo, estas regiones cuentan con diversos comités de MT/MAC orientadas a la evaluación, registro – certificación, y vigilancia en el ejercicio ético de MT/MAC.

Many countries are recognizing the potential contribution of Traditional Complementary and Alternative Medicine (TCM) about the health and welfare of people who use these therapies, so much so that there is a growing interest in examining the training, authorized practices, and professionals of the TM/CAM. Objetive: To systematize experiences shared by different countries in The WHO Interregional Training workshop on TM/CAM- RAE Macao-China 2014. Hong Kong – China, Chinese Special Administrative Region (SAR) of Macau/China, Iran India and Perú were selected from forty-one participants. Conclusions: Some countries/regions such as Hong Kong/ China, Macao / China, China and Iran have regulations in TM/ CAM in relation to registration and practice. In Hong Kong / China, Macao / China, China practices TM/ CAM are integrated into the formal health system; other countries such as India and Perú performed practices TM/ CAM with basic equipment. In relation to formation and registration in Hong Kong / China, Macao / China and China have higher education officially recognized in wich knowledge is taught in TM/ CAM at undergraduate level, postgraduate (masters and doctorates) and basic studies short-term (3 years), also, these regions have various committees TM/ CAM oriented evaluation, registration – certification, and monitoring ethical practices in TM/ CAM.

Micosis superficiales en pacientes del estado Anzoátegui, Venezuela, periodo 2002-2012 / Superficial mycoses in patients from Anzoátegui state, Venezuela, period 2002-2012

Las enfermedades fúngicas superficiales que afectan la piel y sus faneras son motivo de consultas en los servicios básicos de triaje y en dermatología. Se encuentran distribuidas en Venezuela con una incidencia de 92,9%. El objetivo del presente estudio fue conocer los géneros y especies que causan dermatomicosis en pacientes residentes del estado Anzoátegui, Venezuela, en el período 2002-2012. Se estudiaron 4257 pacientes con edades entre 7 meses y 79 años. La prevalencia general fue de 30,9%. Las más frecuentes fueron las dermatofitosis (44,7%). M. canis produjo 148 casos de tiña de la cabeza. Tres agentes dermatofiticos representaron el 95% de todos los casos, con predominio significativo de T. mentagrophytes representado por un 50%. La candidosis se presentó en 28,4%. C. albicans, y el complejo C. parapsilosis, fueron responsables del 80% de los casos. Otras especies identificadas fueron C. tropicalis (n = 41; 11,0%), C. glabrata (n = 10; 2,7%), C. guilliermondii (n = 6; 1,6%), C. krusei (n = 4; 1,1%). Pitiriasis versicolor se presentó en (22,4%), y en menor frecuencia la onicomicosis por mohos no dermatofitos, dominando Fusarium oxysporum (n = 34; 65,4%), Aspergillus terreus (n = 16; 30,8%) y Scytalidium dimidiatum (2; 3,8%). Raros casos de onicomicosis por Trichosporon (0,5%) y un caso de tinea negra. Estos resultados revelan una alta frecuencia de las micosis superficiales con predominio de las dermatofitosis indicando la existencia de un problema de salud pública.

Superficial fungal diseases that affect the skin and its appendages are frequently seen in basic triage and in dermatology services. These diseases are distributed in Venezuela with an incidence of 92.9%. The aim of this study was to determine the genera and species that cause dermatomycoses in residents of Anzoátegui state, Venezuela, during the period 2002-2012. A total of 4257 patients with a presumptive diagnosis of superficial mycoses were studied, with ages from 7 months to 79 years. The overall prevalence was 30.9%. The most frequent were dermatophytosis (44.7%). M. canis produced 148 cases of tinea capitis. Three dermatophytic agents represented 95% of all cases, with a significant predominance of T. mentagrophytes with 50%. Candidosis occurred in 28.4%. C. albicans, and the C. parapsilosis complex, were responsible for 80% of the cases. The other species identified were C. tropicalis (n = 41, 11.0%), C. glabrata (n = 10, 2.7%), C. guilliermondii (n = 6, 1.6%), C. krusei (n = 4, 1.1%). Pityriasis versicolor occurred in 22.4% of the cases studied, and less frequently were present onychomycosis produced by a non dermatophytic mold: Fusarium oxysporum (n = 34, 65.4%), Aspergillus terreus (n=16, 30.8%) and Scytalidium dimidiatum (n=2; 3.8%). Rare cases of Trichosporon onychomycosis (0.5%) and one case of black tinea were also found. Health education in the population is recommended to promote measures to prevent transmission of these fungi and prevent the spread of this silent public health problem.

Iatrogenia institucional y muerte materna: semmelweis y la fiebre puerperal / Institutional iatrogeny and maternal death: semmelweis and puerperal fever

La fiebre puerperal es una enfermedad que asume carácter epidémico en el siglo XVIII como consecuencia de dos factores: las masas trabajadoras urbanas generadas por la revolución industrial, y la progresiva hegemonización y medicalización de la atención del parto en grandes hospitales públicos. La mortalidad materna institucionalizada alcanza cifras superiores al 30%, en tanto con la atención por parteras es menor al 2%. Semmelweis, médico húngaro, postula que los médicos contaminaban a las parturientas por insuficiente higiene luego de realizar necropsias, e implanta medidas profilácticas en el Hospital de Viena, las cuales reducen dramáticamente la mortalidad, pero sus ideas son rechazadas por que afectan el proceso de institucionalización de la medicina basado en el altruismo y honor, por los que supuestamente era imposible que causen daño a sus pacientes. Es obligado a retirarse del Hospital de Viena, y continua su lucha en Budapest, pero el rechazo y la incomprensión de sus colegas por su doctrina afecta su salud mental. Muere en un asilo, pocos años antes que Pasteur y Koch demuestren las bacterias causantes de enfermedades como la fiebre puerperal.

Puerperal fever is a disease that becomes epidemic in the eighteenth century as a result of two factors: the urban working masses generated by the industrial revolution and the progressive hegemonization and medicalization of birth care in large public hospitals. Institutionalized maternal death reached figures above 30%, while in the case of birth care provided by midwives, it was than 2%. Semmelweis, an Hungarian physician, sustained that physicians contaminated women in labor due to insufficient hygiene after performing necropsies and established prophylactic measures in the Vienna Hospital that reduced mortality dramatically. However, his ideas were rejected because they affected the institutionalization process of medicine, based on altruism and honor, which would make it impossible to cause harm to patients. He was forced to leave Vienna Hospital and he continued his struggle in Budapest, but the rejection and disagreement of his peers with his doctrine affected his mental health. He died in an asylum, a few years before Pasteur and Koch proved the existence of the bacteria that caused diseases such as puerperal fever.

La inequidad en salud: su desarrollo histórico / Inequity in health: it'shistorical Development

La inequidad en salud, centro de los debates contemporáneos sobre salud pública, se asienta en bases filosóficas e históricas que se remontan a la idea de justicia de la Grecia clásica. Se revisa la aproximación Aristotélica sobre la justicia distributiva y su forma superior la epiekeia o equidad y como esta evoluciona durante el medioevo y la modernidad hasta llegar a ser el centro del debate para pensadores tan diversos como el liberal Rawls y el premio nobel Amartya Sen. Sobre ese debate conceptual se resume la versión de la Organización Mundial de la Salud que vincula equidad con determinantes de la salud e intenta operativizarla a través de la provisión equitativa de servicios de salud.

Health inequity, main issue of contemporary debates on public health, is based on philosophical and historical concepts that date back to the idea of justice from classic Greece. The Aristotelian approach on distributive justice and its higher form, epiekeia or equity, has been reviewed, as well as how this evolves from the Middle Ages and modernity to the heart of the debate of a variety of thinkers such as liberal Rawls and Nobel laureate Amartya Sen. On this conceptual debate lies the World Health Organization version that links equity to health determinants and intends to make it operational through the equitable provision of health services.

La piedra de la locura: Inicios históricos de la salud mental / The stone of madness: Starting points of the history of mental health

Sobre la evidencia de la relativamente reciente preocupación de la salud pública por los problemas de salud mental, se revisa la evolución del concepto de enfermedad mental en la historia premoderna de occidente y las razones por las cuales se mantuvo fuera de la corriente principal de la actividad sanadora profesional. Asimismo, se explora las distinciones entre la visión naturalista y sobrenatural y su relación entre lo público y lo privado como explicación de su tardía incorporación como problema de Salud Pública