A survey of retaining faculty at a new medical school: opportunities, challenges and solutions.

BACKGROUND: At well-established academic university settings, retaining faculty remains a pressing challenge due to competing market forces, decreasing institutional support, and changing personal expectations. There is a paucity of information about the difficulties faced by new medical schools to maintain their academic workforce. The objective of this study was to determine the challenges facing the faculty at a newly developed medical school. METHODS: Twelve founding faculty were surveyed anonymously by a 32-item questionnaire. Their responses were independently analyzed by three researchers. RESULTS: The views of the faculty were categorized into in four inter-related themes: personal, support, institutional, and environmental. The constant sources of satisfaction among faculty were higher academic rank (75%), harmonious inter-collegial relationships (74%), healthy pecuniary rewards (58%), better professional growth (58%) along with greater autonomy, administrative independence, minimum groupism and excellent team work. Poor opportunities for promotion (68%), reduced support for scholarly activities (67%) and unsatisfactory support from the administration (55%) were detrimental to retaining faculty. CONCLUSION: By addressing specific issues facing its staff, every new medical school will not only manage to retain its academic faculty but also be able to attract well qualified academic staff from established medical institutions worldwide.

Curriculum mapping as a tool to facilitate curriculum development: a new School of Medicine experience.

BACKGROUND: Every curriculum needs to be reviewed, implemented and evaluated; it must also comply with the regulatory standards. This report demonstrates the value of curriculum mapping (CM), which shows the spatial relationships of a curriculum, in developing and managing an integrated medical curriculum. METHODS: A new medical school developed a clinical presentation driven integrated curriculum that incorporates the active-learning pedagogical practices of many educational institutions worldwide while adhering to the mandated requirements of the accreditation bodies. A centralized CM process was run in parallel as the curriculum was being developed. A searchable database, created after the CM data was uploaded into an electronic curriculum management system, was used to ensure placing, integrating, evaluating and revising the curricular content appropriately. RESULTS: CM facilitated in a) appraising the content integration, b) identifying gaps and redundancies, c) linking learning outcomes across all educational levels (i.e. session to course to program), c) organizing the teaching schedules, instruction methods, and assessment tools and d) documenting compliance with accreditation standards. CONCLUSIONS: CM is an essential tool to develop, review, improve and refine any integrated curriculum however complex. Our experience, with appropriate modifications, should help other medical schools efficiently manage their curricula and fulfill the accreditation requirements at the same time.

Polycyclic aromatic hydrocarbons-induced ROS accumulation enhances mutagenic potential of T-antigen from human polyomavirus JC.

Polycyclic aromatic hydrocarbons (PAHs) are the products of incomplete combustion of organic materials, which are present in cigarette smoke, deep-fried food, and in natural crude oil. Since PAH-metabolites form DNA adducts and cause oxidative DNA damage, we asked if these environmental carcinogens could affect transforming potential of the human Polyomavirus JC oncoprotein, T-antigen (JCV T-antigen). We extracted DMSO soluble PAHs from Deepwater Horizon oil spill in the Gulf of Mexico (oil-PAHs), and detected several carcinogenic PAHs. The oil-PAHs were tested in exponentially growing cultures of normal mouse fibroblasts (R508), and in R508 stably expressing JCV T-antigen (R508/T). The oil-PAHs were cytotoxic only at relatively high doses (1:50-1:100 dilution), and at 1:500 dilution the growth and cell survival rates were practically unaffected. This non-toxic dose triggered however, a significant accumulation of reactive oxygen species (ROS), caused oxidative DNA damage and the formation of DNA double strand breaks (DSBs). Although oil-PAHs induced similar levels of DNA damage in R508 and R508/T cells, only T-antigen expressing cells demonstrated inhibition of high fidelity DNA repair by homologous recombination (HRR). In contrast, low-fidelity repair by non-homologous end joining (NHEJ) was unaffected. This potential mutagenic shift between DNA repair mechanisms was accompanied by a significant increase in clonal growth of R508/T cells chronically exposed to low doses of the oil-PAHs. Our results indicate for the first time carcinogenic synergy in which oil-PAHs trigger oxidative DNA damage and JCV T-antigen compromises DNA repair fidelity.

FishShapes v1: Functionally relevant measurements of teleost shape and size on three dimensions.

Teleost fishes account for 96% of all fish species and exhibit a spectacular variety of body forms. Teleost lineages range from deep bodied to elongate (e.g., eels, needlefish), laterally compressed (e.g., ribbonfish) to globular (e.g., pufferfish), and include uniquely shaped lineages such as seahorses, flatfishes, and ocean sunfishes. Adaptive body shape convergence within fishes has long been hypothesized but the nature of the relationships between fish form and ecological and environmental variables remain largely unknown at the macroevolutionary scale. To facilitate the investigation of the interacting factors influencing teleost body shape evolution we measured eight functionally relevant linear traits on adult-sized specimens along with specimen mass. Linear measurements of standard length, maximum body depth, maximum fish width, lower jaw length, mouth width, head depth, minimum caudal peduncle depth, and minimum caudal peduncle width were taken in millimeters with calipers, or tape measures for oversized specimens. We measured these traits on a total of 16,523 specimens (1-3 specimens per species) at the Smithsonian National Museum of Natural History and took approximately 7000 person hours of data collection to complete. The data went through a three-step error-checking process to clean and validate the data and then species averages were calculated. We present the complete specimen data set, which encompasses approximately one-fifth of extant teleost species diversity, spanning ~90% of teleost families and ~96% of orders. The species and family names are compatible with the taxonomy used by FishBase and the order information with the phylogenetically informed taxonomy of Betancur-R and colleagues published in 2014. This dataset is licensed under Creative Commons CC0 1.0 Universal (CC0 1.0) but please cite this paper when using the data or a subset of it.

Prepubertal children exposed to concentrated disadvantage: An exploratory analysis of inflammation and metabolic dysfunction.

OBJECTIVE: It is unclear whether physiologic and metabolic biomarkers are associated with chronic stressors evidenced during early childhood. METHODS: Cross-sectional data were obtained from a cohort of healthy, prepubertal (Tanner stage < 2) children (n = 96; age: 8.06 [7.8] years; M = 51 [53%]; F = 45 [47%]; African-American = 26 [27%]; Caucasian = 70 [73%]; with obesity = 21 [22%]; without obesity = 75 [78%]) from the MET study. Body mass index z-score (z_BMI), total body fat (BF), visceral adipose tissue (VAT), intrahepatic and intramyocellular lipids, and insulin resistance (HOMA-IR) were measured. Chronic stress was assessed using neighborhood concentrated disadvantage index (CDI) for the U.S. Census tracts in which participants resided. Spearman's rank correlations were used to examine relationships, accounting for sex and race. RESULTS: CDI was not positively associated with inflammatory and metabolic markers of dysfunction. However, z_BMI (-0.234, P = 0.023), BF (-0.228, P = 0.028, n = 95), and VAT (-0.241, P = 0.042, n = 74) were significantly negatively associated with CDI. When stratifying by race, these relationships remained significant in Caucasian children only. CONCLUSIONS: These findings suggest chronic stress during early childhood is not associated with inflammatory and metabolic biomarkers, typically observed in adults. Therefore, exposure to stress during this critical developmental period may remain latent and emerge during a later developmental stage.

The clinical skills laboratory: a cost-effective venue for teaching clinical skills to third-year medical students.

The authors taught clinical examination and procedural skills using manikins in a clinical skills laboratory as a part of an integrated curriculum in the third-year clerk-ship. This teaching modality was effective and well received by students and faculty.

Identification of speckle-type POZ protein somatic mutations in African American prostate cancer.

The speckle-type POZ protein (SPOP) is a tumor suppressor in prostate cancer (PCa). SPOP somatic mutations have been reported in up to 15% of PCa of those of European descent. However, the genetic roles of SPOP in African American (AA)-PCa are currently unknown. We sequenced the SPOP gene to identify somatic mutations in 49 AA prostate tumors and identified three missense mutations (p.Y87C, p.F102S, and p.G111E) in five AA prostate tumors (10%) and one synonymous variant (p.I106I) in one tumor. Intriguingly, all of mutations and variants clustered in exon six, and all of the mutations altered conserved amino acids. Moreover, two mutations (p.F102S and p.G111E) have only been identified in AA-PCa to date. Quantitative real-time polymerase chain reaction analysis showed a lower level of SPOP expression in tumors carrying SPOP mutations than their matched normal prostate tissues. In addition, SPOP mutations and novel variants were detected in 5 of 27 aggressive PCa and one of 22 less aggressive PCa (P < 0.05). Further studies with increased sample size are needed to validate the clinicopathological significance of these SPOP mutations in AA-PCa.

Impacto macroeconómico generado por la pandemia del VIH/SIDA informado por la literatura internacional desde 1990 a 2013 / Macroeconomic impact generated by the pandemic of HIV/AIDS informed by the international literature since 1990 to 2013

Introducción: en 2013, ONUSIDA reportó más de 62 millones de personas infectadas por el VIH desde el inicio de la pandemia; de estos, tres millones se infectaron durante el último año. El impacto del VIH/SIDA a nivel individual ha sido bien documentado, mas los efectos de la pandemia a nivel macroeconómico mundial han sido menos estudiados. Objetivo: determinar el impacto a nivel macroeconómico del VIH/SIDA. Materiales y métodos: estudio hermenéutico sobre fuentes secundarias de información que mediante la triangulación de esta con la teoría económica, se proyectaron posibles consecuencias en los países más afectados por la pandemia. Resultados: la pandemia del VIH/SIDA impacta la oferta de trabajo, mediante el aumento de la morbilidad y mortalidad. El SIDA reduce la productividad laboral, creando así crisis fiscales. El gasto público relacionado con el VIH/SIDA aumentará dentro del rango de 0,2% y 3,5% del presupuesto del gobierno. La baja productividad del sector primario nacional aumenta la importación de alimentos. En Sudáfrica para el año 2010 el PIB sería un 17% menor a un escenario sin VIH/SIDA. Conclusiones: se estima que el VIH/SIDA aumentará los costos de mantenimiento de la fuerza de trabajo, alterará la balanza comercial, induciendo déficit fiscal, así como una caída de la productividad cercana al 75% y del crecimiento económico de 5% del PIB en los próximos diez años. Aunque se realizó una búsqueda a nivel mundial, los resultados obtenidos se concentran en África.

Background: in 2013, UNAIDS reports more than 62 million people infected with HIV since the onset of the pandemic, of which 3 million became infected during the past year. The impact of HIV/AIDS at the individual level has been well documented, but the effects of the pandemic at the global macroeconomic level have been less studied. Objective: to determine the macroeconomic impact of HIV/AIDS. Materials and methods: hermeneutic study on secondary sources of information that through triangulation of this information with the economic theory was documented predictions of what will happen in the countries most affected by the pandemic. Results: the HIV/AIDS pandemic impacts the labour supply, through increased morbidity and mortality. AIDS reduces labour productivity, thus creating fiscal crises. Public spending related to HIV/AIDS will increase within the range of 0.2% and 3.5% of the government budget. The low productivity of the national primary sector increases the import of food. Slope of GDP in South Africa by 2010 the GDP would be 17% lower than a scenario without HIV/AIDS. Conclusions: it is estimated that HIV/AIDS will increase the costs of maintaining the labour force, will alter the trade balance, inducing a fiscal deficit, as well as a productivity decrease of close to 75% and economic growth of 5% of GDP in the next ten years. Although a search was carried out worldwide, the results obtained are concentrated in Africa.

Non-AIDS-defining cancers in New Orleans.

BACKGROUND: Non-AIDS-defining cancers in HIV-infected patients in the highly active antiretroviral therapy era have increased. To our knowledge a comprehensive review of non-AIDS-related malignancies in New Orleans has not yet been conducted. METHODS: Databases from main institutions in New Orleans were queried retrospectively for the years 2001 to 2011. The International Classification of Diseases, Ninth Revision codes were used to search for HIV infection and cancer comorbidity. RESULTS: A total of 16 patients were diagnosed with lung cancer (mean age 50 years) with 81% of the patients presenting with advanced stages. In all, 20 (mean age 47 years) were diagnosed with anal cancer, and 35% presented in late stages. In all, 14 patients (mean age 42 years) were diagnosed with Hodgkin Lymphoma, and 64% were diagnosed at late stage. A total of 5 women (mean age 44 years) were diagnosed with breast cancer with 40% of them presenting at late stage. CONCLUSION: Malignancies were diagnosed at late stages in the majority of the cases, presented with worse outcomes, and had higher recurrence rates. The role of HIV and other viruses (Epstein Barr virus, human papillomavirus) and the potential mechanisms or pathways of oncogene activation also need to be clarified.

Differences in outcomes between elderly and nonelderly breast cancer patients in Louisiana.

INTRODUCTION: Elderly breast cancer patients are diagnosed with a higher stage of disease. They are also found to undergo less surgery, receive more frequently hormonal treatment and have decreased relative survival. The interest of this study was to examine the differences in treatment and survival between elderly versus young (>65 versus <65) patients in Louisiana. METHODS: The SEER database was searched, and all cases of female breast cancer in the state of Louisiana between 2000 and 2008 were analyzed. Data were stratified by age group and year of occurrence. The SEER definitions for breast cancer, surgery, chemotherapy, elderly populations, young populations, radiation therapy and breast conservative surgery were applied. RESULTS: The state prevalence of localized breast cancer is lower compared with the national rate (128.5 versus 144, P < 0.001). The rate of regional breast disease is much higher in Louisiana patients than national average rate (69.7 versus 57.9, P < 0.001). There is no difference in disseminated disease. The elderly group was offered less surgery compared with the young group (11.39% versus 6.68%, P < 0.005). The elderly group received more general radiation interventions than the young group (65.97% versus 53.86%, P < 0.005). Mortality rates for the elderly group were higher in Louisiana compared with the national average. This difference was more remarkable in the >85 age group (127.8 versus 118.5, P < 0.001). CONCLUSIONS: Differences between young and elderly breast cancer patients were observed. Mortality is higher among elderly breast cancer patients in Louisiana compared with the national average. Further studies are needed to review these differences.

Management of elderly and frail elderly cancer patients: the importance of comprehensive geriatrics assessment and the need for guidelines.

OBJECTIVES: Management of elderly and frail patients with cancer is complex and requires a multidisciplinary approach. This article reviews and discusses the current literature that evaluates the relevance of comprehensive geriatrics assessment (CGA) and other evaluation tools in the detection of this vulnerable patient population. METHODS: A literature search of articles in English, Spanish and Portuguese was conducted in PubMed through September 2011. RESULTS: There is lack of detailed information concerning the efficacy, tolerability and toxicity of cancer therapies in senior adults, although the literature indicates that there is a trend toward including elderly patients and their outcome. Recent guidelines advocate a careful patient selection through a CGA. For vulnerable (pre-frail) and frail elderly cancer patients, there is no consensus in relation to selection and type of treatments. CGA has been advocated as the gold standard for evaluation of elderly patients, but thorough evaluation of vulnerable and frail patients has not been undertaken. A tool to evaluate vulnerable elderly patients to predict treatment outcomes is also needed. DISCUSSION: The adoption of the CGA in oncology practice has been slow because of the difficulties with practicality and objectivity. A shorter reliable tool for rapid and complete assessment is needed. Inclusion of frail elderly patients in treatment trials is recommended. New treatment approaches for frail elderly cancer patients need to be further investigated. Some studies that used serum markers of frailty found that even in the absence of clinical signs, some elderly patients might be already vulnerable. A potential cancer frailty index also needs further investigation.

Falls in HIV-infected patients: a geriatric syndrome in a susceptible population.

BACKGROUND: Falls is a common geriatric syndrome that has not been well characterized in HIV-infected populations. METHODS: We retrospectively reviewed our database and identified patients who fell over the last 12 months. RESULTS: Thirty-two patients were identified (incidence rate of 16 × 1000 patients per year). Twenty-five percent were female and 75% male. Sixty-seven percent were African American with 33% Caucasians. Average age was 48.19, number of years with HIV infection on average was 9.38 years, mean CD4 count 347.2 cell/mm(3), mean HIV viral load was 31 379 copies/mL. The average number of medications was 8.7 with a mean of 3.48 comorbidities. The mean vitamin D level was 27.20. Sixty-two percent of patients were compliant with antiretroviral therapy. Univariate and multivariate analysis showed that number of medications (< .005 medications; P < .005), more than 3 comorbidities (P < .005), and noncompliance (P < .001) were related to falls in this population. CONCLUSION: Falls is a common geriatric syndrome. Associated risk factors in our cohort included number of medications, more than 3 comorbidities, and noncompliance. Larger studies are needed to properly characterize this geriatric syndrome in HIV-infected patients. As HIV-infected populations age, a shift into a more comprehensive geriatrics care including fall risk evaluation may be needed.

[Competency-based training and work world: from grading to employability]. / La formación por competencias y el mundo del trabajo: de la calificación a la empleabilidad.

Considered as an element of business discourse, the competence-based education emerges associated with processes of productive restructuring influencing the economy since 1970. These processes arise as a consequence of the crisis of the accumulation model based on mass production and consumption following the principles of taylorism and fordism. In the last decades, the State has been unable to solve the periodic crisis that afflicts late capitalism. Because of this, the State moves away from its economic mission, promotes marketing mechanisms and, in the meantime, it tries to manage the motivational crisis of the population. This challenge forces the State to take interest in the vital world of individuals trying to solve the legitimacy crisis through educational reforms that affect the world of work. The relationship between the vertiginous changes of working world and a new educational formation is explicit. This educational formation must consider (at the same time) the management capacity, learning capacity, teamwork capacity and self-training. Based on this situation, there is a direct relationship between technologic advances, the structural crisis of capitalism and work organization. Besides, the "qualification" term is replaced with "competency-based education".

Fenofibrate-induced nuclear translocation of FoxO3A triggers Bim-mediated apoptosis in glioblastoma cells in vitro.

Anti-neoplastic potential of calorie restriction or ligand-induced activation of peroxisome proliferator activated receptors (PPARs) has been demonstrated in multiple studies; however, mechanism(s) by which tumor cells respond to these stimuli remain to be elucidated. One of the potent agonists of PPARα, fenofibrate, is a commonly used lipid-lowering drug with low systemic toxicity. Fenofibrate-induced PPARα transcriptional activity is expected to shift energy metabolism from glycolysis to fatty acid ß-oxidation, which in the long-term, could target weak metabolic points of glycolysis-dependent glioblastoma cells. The results of this study demonstrate that 25 µM fenofibrate can effectively repress malignant growth of primary glial tumor cells and glioblastoma cell lines. This cytostatic action involves G(1) arrest accompanied by only a marginal level of apoptotic cell death. Although the cells treated with 25 µM fenofibrate remain arrested, the cells treated with 50 µM fenofibrate undergo massive apoptosis, which starts after 72 h of the treatment. This delayed apoptotic event was preceded by FoxO3A nuclear accumulation, FoxO3A phosphorylation on serine residue 413, its elevated transcriptional activity and expression of FoxO-dependent apoptotic protein, Bim. siRNA-mediated inhibition of FoxO3A attenuated fenofibrate-induced apoptosis, indicating a direct involvement of this transcription factor in the fenofibrate action against glioblastoma. These properties of fenofibrate, coupled with its low systemic toxicity, make it a good candidate in support of conventional therapies against glial tumors.

Aberrant DNA methylation and prostate cancer.

Prostate cancer (PCa) is the most prevalent cancer, a significant contributor to morbidity and a leading cause of cancer-related death in men in Western industrialized countries. In contrast to genetic changes that vary among individual cases, somatic epigenetic alterations are early and highly consistent events. Epigenetics encompasses several different phenomena, such as DNA methylation, histone modifications, RNA interference, and genomic imprinting. Epigenetic processes regulate gene expression and can change malignancy-associated phenotypes such as growth, migration, invasion, or angiogenesis. Methylations of certain genes are associated with PCa progression. Compared to normal prostate tissues, several hypermethylated genes have also been identified in benign prostate hyperplasia, which suggests a role for aberrant methylation in this growth dysfunction. Global and gene-specific DNA methylation could be affected by environmental and dietary factors. Among other epigenetic changes, aberrant DNA methylation might have a great potential as diagnostic or prognostic marker for PCa and could be tested in tumor tissues and various body fluids (e.g., serum, urine). The DNA methylation markers are simple in nature, have high sensitivity, and could be detected either quantitatively or qualitatively. Availability of genome-wide screening methodologies also allows the identification of epigenetic signatures in high throughput population studies. Unlike irreversible genetic changes, epigenetic alterations are reversible and could be used for PCa targeted therapies.

El muestreo dirigido por los entrevistados (MDE) para acceder a poblaciones en condiciones de vulnerabilidad frente al VIH: su aplicación en grupos de hombres que tienen sexo con hombres: [revisión] / Respondent-driven sampling (rds) as a new method to access vulnerable populations to hiv: its application in men who have sex with men: [review]

La infección por el VIH afecta a cerca de 30 millones de personas, de las cuales las más vulnerables son los trabajadores del sexo, usuarios de drogas inyectables, personas transgénero y los hombres que tienen sexo con otros hombres (HSH). Los estudios de ITS y VIH realizados con muestreos intencionales como la bola de nieve no logran alcanzar representatividad ni posibilidad de inferencia al resto de la población. A esta limitación se suma el desconocimiento de los tamaños poblacionales de estos grupos, dados el estigma y la discriminación que enfrentan. Hace una década se diseñó un nuevo método de muestreo para acceder a estas poblaciones, basado en lasteorías de Markov y del reclutamiento en cadena. El método se conoce en español como muestreo dirigido por los entrevistados (mde) y se ha implementado en diversos estudios de vih. Este artículo de revisión presenta los antecedentes, los fundamentos teóricos y el método propiamente dicho, y analiza algunos estudios llevados a cabo con esta nueva metodología.

Approximately 30 million people are living with HIV all aroundthe world in 2010. The most vulnerable HIV/aids groups are sex workers, intravenous drug users, transgender people and populationof men who have sex with men (MSM). Up to now, the surveillance and behavioral studies on sexual transmitted diseases (STI) and HIV have been conducted using intentional sampling methods like the snowball methodology, but this kind of sampling does not achieve representation and does not represent a conclusive method for the study of hidden populations in order to extend and apply its results to the general population. Furthermore, it is necessary to add to this limitation the lack of knowledge about the size of these groups that must face situations of stigma and discrimination. A decade ago a new method was designed to sample hidden and hard to reach populations based on Markov theories and on chain recruitment. This new method is known as respondent-driven sampling (RDS) and it has been used in several behavioral and HIV prevalence studies. This review article presents the background, the theoretical support and a description of the method. It also analyzes some studies carried out using this new methodology.

La época del imperialismo y sus implicaciones en la salud pública / Imperialist times and its implications for public health

Este artículo estudia el denominado gran siglo XIX o largo siglo XIX, que comprende todo este siglo más las décadas que antecedieron y acompañaron a la primera guerra mundial y que se corresponde con la consolidación del imperialismo. Desde la perspectiva de la salud pública, es importante por haberse producido la transición de la higiene a la salud pública y que ya en 1880 caracteriza el advenimiento de la teoría bacteriológica y su influencia en las medidas de sanidad estatal imperantes. La medicina antes de 1900 se caracterizaba por 1)predominio de lo militar y de lo imperial; 2)principios de prevención importados y concentrados en prácticas sanitarias; 3)la medicina colonial no estaba separada de la medicina imperial; 4)interés en las colonias como fuerzas productivas o de inestabilidad política; 5)el interés pasó de las medidas de sanidad general a la búsqueda de agentes específicos para las enfermedades y a medidas para su control; y 6)la medicina tropical se vuelve un especialidad de posgrado. El fenómeno del imperialismo norteamericano comparte las principales característica con el imperialismo europeo, pero se diferencia en las medidas sanitarias, pues los americanos temían la introducción de enfermedades prevalentes en los trópicos, ya fuera por México, el Atlántico o el Pacífico, para lo cual diseñaron e implementaron rigurosas medidas de inspección y control en los países donde tenían intereses comerciales y en los puertos de embarque de pasajeros y mercancías hacía su territorio. El surgimiento de la medicina estatal en nuestra subregión es una consecuencia de la instauración de modos de producció. Ello implicó la consolidación de un cuerpo burocrático y un aumento de la intervención en la vida de los ciudadanos por la vía de las políticas sociales. En Colombia, la introducción de las prácticas de higiene y luego de la bacteriología tienen un discurrir particular, lo cual se pone de relieve a lo largo del siglo XIX, cuando las epidemias de viruela, cólera o fiebre amarilla que recorrieron con mayor o menor severidad el país, desde los litorales Atlántico y Pacífico hasta el interior, con el riesgo de diezmar las poblaciones obreras y afectar el incipiente intercambio comercial del país.

This articles studies the period called by historians as the Big or Long XIX century. Besides the XIX century by itself, it encompasses the decades that preceded it and the decades of the First World War. All of them belong to the consolidation of imperialism. From the perspective of public health, The Big XIX century is important because of the transition from hygiene to public health, and the beginning of the transition from hygiene to public health, and the benign of the bacteriologic theory in 1880, influencing sanitary control measures of the State. Before 1900, medicine was characterized by: 1) predominance of military and of imperial approaches, 2) prevention principles were imported and concentrated in sanitary practices; 3) colonial medicine was not separated from imperial medicine; 4) interest focused on colonies as productive forces or as sources of political instability; 5) the main concern went from general sanitary measurements to the search for specific disease agents and their control measurements; and 6) tropical medicine becomes a postgraduate specialty. North- American imperialism shares the main characteristics of European imperialism shares the main characteristics of sanitary measurements because Americans feared the introduction of prevalent diseases from the tropics to their territory either through Mexico or through the ports in the Atlantic or the Pacific oceans. In order to avoid this, Americans designed and implemented rigorous inspection and control meausurements in the countries where they had commercial interests and in the ports where passengers and merchandise were headed to the United States. The appearance of state medicine in Latin American is a logical consequence of the implementation of the capitalistic mode of production, provided social and economic relationships between the people and the State were hardly affected and transformed by the incipient industrialization the consolidation of such a production model. This implied the consolidation of a bureaucratic mass and an increased intervention in everyday lives of the citizens via the social policies. In Colombia, the beginning of hygiene practices and later on, of bacteriology developed in very distinctive ways. This can be observed along the XIX century, a period in which the bourgeoisie responded mainly to episodic events such as smallpox, cholera or yellow fever epidemics, which affected Atlantic and Pacific coasts towards the inner part of the country, threatening to reduce the population of workers and effecting the incipient commercial exchange of the country.

Análisis inmunoenzimático (ELISA) para determinar niveles de IgG anti Bothrops atrox en accidente ofídico / Inmunoenzymatic determination of IgG anti Bothrops atrox levels after snake bites

Se desarrolló un método de Inmunización de conejos con veneno de Bothrops atrox con el fin de preparar antisueros y estandarizar un Inmunoanálisis (ELISA) para medir niveles de IgG en pacientes con accidente ofídico. La respuesta Inmune de los conejos se siguió por inmunodifusión en doble dimensión (Ouchterlony) e inmunoelectroforesis, demostrando la presencia de bandas nítidas desde el dra 60 y en todas las sangrías posteriores; se comprobó que hay variabilidad Individual en su respuesta Inmune. El ELISA para detección de IgG humana antl B. atrox en los indígenas del Chocó fue una prueba simple y sensible (83.3 por ciento) pero inespecífica por las reacciones cruzadas en Individuos que habrán sufrido accidentes por B. nasutus. La técnica para detectar IgG equina anti B. atrox en pacientes tratados con antiveneno fue tambIén simple y muy sensible.

We developed an immunization method for the production of rabbit antisera against Bothrops atroxvenoms. An enzyme-Ilnked assay (ELISA) was standardized in order to measure IgG levels after snake bites. The immune response of rabbits, as determined by Ouchterlony and immunoelectrophoresis techniques, revealed bands of precipitation from the sixtieth day on. Individual variability in the immune response of rabbits was demonstrated. For the measurement of IgG levels In Indians from the Department of Choco (Colombia), ELISA proved to be a sensitive (83.3%) and simple but not an specific procedure, since there were cross-reactions in those previously bitten by B. nasutus. ELISA was also simple and sensitive (100%) for the determination of equine anti B. atrox IgG antibodies in patients treated with antivenom

Prediction of post-operative septic complications by determination of C-reactive protein levels

Forty patients undergoing clean-contaminated, contaminated, and dirty surgical procedures were studied to determine whether daily C-reactive protein (CRP) measurements for 10 days following surgery could predict the occurrence of septic complications before clinical recognition. Diagnostic criteria for septic complications and positive CRP response were defined in advance of the study. The CRP measurements were carried out using semiquantitative latex agglutination after the patients discharge from the hospital. Fifteen complications were diagnosed in fourteen patients. These complications consisted of wound infections (3), urinary tract infection (4), and pneumonia (3). The CRP examination was found to have a positive predictive value of 77% and a negative predictive value of 85%. We conclude that serial CRP determinations may be valuable as part of the armamentarium to surgical care in patients at considerable risk of post-operative septic complications. (Author)