Knowing Our Enemy in the Antimicrobial Resistance Era: Dissecting the Molecular Basis of Bacterial Defense Systems.

Bacteria and their phage adversaries are engaged in an ongoing arms race, resulting in the development of a broad antiphage arsenal and corresponding viral countermeasures. In recent years, the identification and utilization of CRISPR-Cas systems have driven a renewed interest in discovering and characterizing antiphage mechanisms, revealing a richer diversity than initially anticipated. Currently, these defense systems can be categorized based on the bacteria's strategy associated with the infection cycle stage. Thus, bacterial defense systems can degrade the invading genetic material, trigger an abortive infection, or inhibit genome replication. Understanding the molecular mechanisms of processes related to bacterial immunity has significant implications for phage-based therapies and the development of new biotechnological tools. This review aims to comprehensively cover these processes, with a focus on the most recent discoveries.

Are you sure it's an artifact? Artifact detection and uncertainty quantification in histological images.

Modern cancer diagnostics involves extracting tissue specimens from suspicious areas and conducting histotechnical procedures to prepare a digitized glass slide, called Whole Slide Image (WSI), for further examination. These procedures frequently introduce different types of artifacts in the obtained WSI, and histological artifacts might influence Computational Pathology (CPATH) systems further down to a diagnostic pipeline if not excluded or handled. Deep Convolutional Neural Networks (DCNNs) have achieved promising results for the detection of some WSI artifacts, however, they do not incorporate uncertainty in their predictions. This paper proposes an uncertainty-aware Deep Kernel Learning (DKL) model to detect blurry areas and folded tissues, two types of artifacts that can appear in WSIs. The proposed probabilistic model combines a CNN feature extractor and a sparse Gaussian Processes (GPs) classifier, which improves the performance of current state-of-the-art artifact detection DCNNs and provides uncertainty estimates. We achieved 0.996 and 0.938 F1 scores for blur and folded tissue detection on unseen data, respectively. In extensive experiments, we validated the DKL model on unseen data from external independent cohorts with different staining and tissue types, where it outperformed DCNNs. Interestingly, the DKL model is more confident in the correct predictions and less in the wrong ones. The proposed DKL model can be integrated into the preprocessing pipeline of CPATH systems to provide reliable predictions and possibly serve as a quality control tool.

Study of Canine Distemper Virus Presence in Catalonia's Wild Carnivores through H Gene Amplification and Sequencing.

Canine distemper virus (CDV) is recognised worldwide as an important pathogen in both domestic and wild carnivores. Few data are available on its impact and spread on the wildlife/wildlife-domestic animal-environment interface. This study, aimed at developing a conservation-oriented control strategy, analysed 89 sick or deceased animals from 2019 to 2023 at the Wildlife Rehabilitation Centre in Torreferrussa. RT-PCR and sequencing of the partial H gene were used to detect and analyse CDV in tissues. The total positive percentage was 20.22% (18/89), comprising 13 red foxes (44.8%), 4 European badgers (28.6%), and 1 American mink (4.5%), while 24 Eurasian otters tested negative. Phylogenetic analysis indicated that all of the CDV strains belong to the European lineage. Geographically distant individuals and different species shared the same viral strain, suggesting a strong capacity of CDV for interspecies and long-distance transmission. This calls for further research, particularly focusing on potential impacts of CDV on endangered carnivores.

Learning from crowds for automated histopathological image segmentation.

Automated semantic segmentation of histopathological images is an essential task in Computational Pathology (CPATH). The main limitation of Deep Learning (DL) to address this task is the scarcity of expert annotations. Crowdsourcing (CR) has emerged as a promising solution to reduce the individual (expert) annotation cost by distributing the labeling effort among a group of (non-expert) annotators. Extracting knowledge in this scenario is challenging, as it involves noisy annotations. Jointly learning the underlying (expert) segmentation and the annotators' expertise is currently a commonly used approach. Unfortunately, this approach is frequently carried out by learning a different neural network for each annotator, which scales poorly when the number of annotators grows. For this reason, this strategy cannot be easily applied to real-world CPATH segmentation. This paper proposes a new family of methods for CR segmentation of histopathological images. Our approach consists of two coupled networks: a segmentation network (for learning the expert segmentation) and an annotator network (for learning the annotators' expertise). We propose to estimate the annotators' behavior with only one network that receives the annotator ID as input, achieving scalability on the number of annotators. Our family is composed of three different models for the annotator network. Within this family, we propose a novel modeling of the annotator network in the CR segmentation literature, which considers the global features of the image. We validate our methods on a real-world dataset of Triple Negative Breast Cancer images labeled by several medical students. Our new CR modeling achieves a Dice coefficient of 0.7827, outperforming the well-known STAPLE (0.7039) and being competitive with the supervised method with expert labels (0.7723). The code is available at https://github.com/wizmik12/CRowd_Seg.

Focused active learning for histopathological image classification.

Active Learning (AL) has the potential to solve a major problem of digital pathology: the efficient acquisition of labeled data for machine learning algorithms. However, existing AL methods often struggle in realistic settings with artifacts, ambiguities, and class imbalances, as commonly seen in the medical field. The lack of precise uncertainty estimations leads to the acquisition of images with a low informative value. To address these challenges, we propose Focused Active Learning (FocAL), which combines a Bayesian Neural Network with Out-of-Distribution detection to estimate different uncertainties for the acquisition function. Specifically, the weighted epistemic uncertainty accounts for the class imbalance, aleatoric uncertainty for ambiguous images, and an OoD score for artifacts. We perform extensive experiments to validate our method on MNIST and the real-world Panda dataset for the classification of prostate cancer. The results confirm that other AL methods are 'distracted' by ambiguities and artifacts which harm the performance. FocAL effectively focuses on the most informative images, avoiding ambiguities and artifacts during acquisition. For both experiments, FocAL outperforms existing AL approaches, reaching a Cohen's kappa of 0.764 with only 0.69% of the labeled Panda data.

The association between sociodemographic characteristics, clinical indicators and body mass index in a population at risk of type 2 diabetes: A cross-sectional study in two Colombian cities.

AIMS: To assess the association between sociodemographic and clinical factors with body mass index (BMI) in a population at risk of type 2 diabetes (T2D) in Bogotá and Barranquilla, Colombia. METHODS: This cross-sectional study used data from the PREDICOL Study. Participants with a FINDRISC ≥ 12 who underwent an Oral Glucose Tolerance Test (OGTT) were included in the study (n=1166). The final analytical sample size was 1101 participants. Those with missing data were excluded from the analysis (n=65). The main outcome was body mass index (BMI), which was categorized as normal, overweight, and obese. We utilized unadjusted and adjusted ordinal logistic regression analysis to calculate odds ratios (OR) and 95 % confidence intervals (CI). RESULTS: The prevalence of overweight and obesity was 41 % (n=449) and 47 % (n=517), respectively. Participants with a 2-hour glucose ≥139 mg/dl had 1.71 times higher odds of being overweight or obese (regarding normal weight) than participants with normal 2-hour glucose values. In addition, being a woman, waist circumference altered, and blood pressure >120/80 mmHg were statistically significantly associated with a higher BMI. CONCLUSION: Strategies to control glycemia, blood pressure, and central adiposity are needed in people at risk of T2D. Future studies should be considered with a territorial and gender focus, considering behavioral, and sociocultural patterns.

Development of Continuous Assessment of Muscle Quality and Frailty in Older Patients Using Multiparametric Combinations of Ultrasound and Blood Biomarkers: Protocol for the ECOFRAIL Study.

BACKGROUND: Frailty resulting from the loss of muscle quality can potentially be delayed through early detection and physical exercise interventions. There is a demand for cost-effective tools for the objective evaluation of muscle quality, in both cross-sectional and longitudinal assessments. Literature suggests that quantitative analysis of ultrasound data captures morphometric, compositional, and microstructural muscle properties, while biological assays derived from blood samples are associated with functional information. OBJECTIVE: This study aims to assess multiparametric combinations of ultrasound and blood-based biomarkers to offer a cross-sectional evaluation of the patient frailty phenotype and to track changes in muscle quality associated with supervised exercise programs. METHODS: This prospective observational multicenter study will include patients aged 70 years and older who are capable of providing informed consent. We aim to recruit 100 patients from hospital environments and 100 from primary care facilities. Each patient will undergo at least two examinations (baseline and follow-up), totaling a minimum of 400 examinations. In hospital environments, 50 patients will be measured before/after a 16-week individualized and supervised exercise program, while another 50 patients will be followed up after the same period without intervention. Primary care patients will undergo a 1-year follow-up evaluation. The primary objective is to compare cross-sectional evaluations of physical performance, functional capacity, body composition, and derived scales of sarcopenia and frailty with biomarker combinations obtained from muscle ultrasound and blood-based assays. We will analyze ultrasound raw data obtained with a point-of-care device, along with a set of biomarkers previously associated with frailty, using quantitative real-time polymerase chain reaction and enzyme-linked immunosorbent assay. Additionally, we will examine the sensitivity of these biomarkers to detect short-term muscle quality changes and functional improvement after a supervised exercise intervention compared with usual care. RESULTS: At the time of manuscript submission, the enrollment of volunteers is ongoing. Recruitment started on March 1, 2022, and ends on June 30, 2024. CONCLUSIONS: The outlined study protocol will integrate portable technologies, using quantitative muscle ultrasound and blood biomarkers, to facilitate an objective cross-sectional assessment of muscle quality in both hospital and primary care settings. The primary objective is to generate data that can be used to explore associations between biomarker combinations and the cross-sectional clinical assessment of frailty and sarcopenia. Additionally, the study aims to investigate musculoskeletal changes following multicomponent physical exercise programs. TRIAL REGISTRATION: ClinicalTrials.gov NCT05294757; https://clinicaltrials.gov/ct2/show/NCT05294757. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/50325.

A 12-week multicomponent exercise program enhances frailty by increasing robustness, improves physical performance, and preserves muscle mass in older adults with HIV: MOVIhNG study.

Background: Our aim was to analyze the effects of a multicomponent exercise program (MEP) on frailty and physical performance in older adults with HIV (OAWH) since exercise can reverse frailty in the older population overall, but there is no data for OAWH. Methods: A prospective longitudinal study with intervention and control group was designed. Sedentary adults 50 or over with and without HIV were included. The intervention was a 12-week home-based MEP. Dependent variables were frailty (frailty phenotype), physical performance (Senior Fitness Test), muscle mass (ASMI) by bioimpedance. Pre- and postintervention measurements were analyzed using McNemar's test for categorical variables and the Wilcoxon signed-rank test for quantitative variables. Results: 40 OAWH and 20 OA without HIV. The median age was 56.5 years. 23.3% were women. The prevalence of frailty was 6.6% with no frail HIV-negative participants. Three of the four frail HIV-participants transitioned two (50%) from frail to prefrail and one (25%) to robust after the MEP. In participants with an adherence ≥50%, physical performance was significantly improved [basal vs. 12 week]: upper extremity strength [13 (13-15) vs. 16 (15-19), p = 0.0001], lower extremity strength [13 (11-16) vs. 15 (13-16), p = 0.004], aerobic endurance [62 (55-71) vs. 66 (58-80), p = 0.005]. Participants with low adherence experienced a significant worsening in ASMI [8.35 (7.44-9.26) vs. 7.09 (6.08-8.62), p = 0.03]. Conclusion: A 12-week MEP enhances frailty by increasing robustness in OAWH, and improves physical performance, and preserves muscle mass in older adults with good adherence to the MEP independently of HIV status.

Desarrollo profesional permanente en salud por intermedio del Campus Virtual de Salud Pública en Colombia (2012-2019)

[RESUMEN]. Objetivo. Reconstruir la experiencia del Campus Virtual de Salud Pública (CVSP) desde el año 2012 al 2019 en Colombia. Métodos. Se realizó la sistematización de la experiencia del proceso de formación en salud pública para Colombia, por intermedio del Campus para el periodo de 2012 a 2019. La información se presenta en series transversales de periodos de tiempo para visibilizar la evolución histórica del CVSP en Colombia. Resultados. Se han capacitado 2 627 profesionales de la salud en cursos con tutoría y 34 012 en cursos de autoaprendizaje en temáticas relevantes, actualizadas y prioritarias en salud pública. Se destaca la oportunidad y acceso a regiones remotas que ha tenido el Campus mediante procesos de formación sin costo para el usuario final. La experiencia destaca la relevancia del Campus en la reducción de la brecha de actualización del talento humano en salud, mediante procesos de educación virtual, con diversidad en la modalidad y en la oferta formativa. Conclusiones. La reconstrucción de la experiencia en Colombia mostró la evolución y fortalecimiento del CVSP para ofertar procesos de formación con calidad para responder a los problemas y necesidades del país; la consolidación del Campus se debió al trabajo colaborativo entre las universidades y la Organización Panamericana de la Salud.

[ABSTRACT]. Objective. Reconstruct the experience of the Virtual Campus for Public Health (VCPH) from 2012 to 2019 in Colombia. Methods. The experience of public health training through the VCPH in Colombia in the period 2012-2019 was systematized. The information is presented in cross-section time series to show the evolution of the VCPH in Colombia over time. Results. A total of 2 627 health professionals took tutored courses and 34 012 followed self-learning courses on relevant, up-to-date, priority public health issues. An important aspect was the opportunity to access remote regions through VCPH training processes that were cost-free for end users. The experience highlights the relevance of the VCPH in reducing the gap in updated human talent in the health field through virtual education with diversity in its modalities and content. Conclusions. Reconstruction of the experience in Colombia showed how the VCPH evolved and strengthened to offer quality training processes that respond to the country's problems and needs. Collaborative work between universities and the Pan American Health Organization resulted in consolidation of the VCPH.

[RESUMO]. Objetivo. Reconstruir a experiência do Campus Virtual de Saúde Pública (CVSP) de 2012 a 2019 na Colômbia. Métodos. Realizou-se a sistematização da experiência do processo de formação em saúde pública na Colômbia por meio do Campus, referente ao período de 2012 a 2019. As informações são apresentadas em séries transversais de períodos de tempo para mostrar a evolução histórica do CVSP na Colômbia. Resultados. Foram capacitados 2.627 profissionais de saúde em cursos com instrutor e 34.012 em cursos de autoaprendizagem sobre temas relevantes, atuais e prioritários de saúde pública. Destacam-se a oportunidade e o acesso a regiões remotas que o Campus obteve, por meio de processos de formação sem custo para o usuário final. A experiência destaca a relevância do Campus na redução da lacuna de atualização do talento humano da área da saúde, mediante processos de educação virtual com diversidade nas modalidades e ofertas de formação. Conclusões. A reconstrução da experiência da Colômbia mostrou a evolução e o fortalecimento do CVSP para oferecer processos de formação com qualidade, a fim de responder aos problemas e necessidades do país. A consolidação do Campus deve-se ao trabalho colaborativo entre as universidades e a Organização Pan-Americana da Saúde.

Desarrollo profesional permanente en salud por intermedio del Campus Virtual de Salud Pública en Colombia (2012-2019) / Permanent professional development in health through the Virtual Campus for Public Health in Colombia (2012-2019) / Desenvolvimento profissional permanente em saúde por meio do Campus Virtual de Saúde Pública na Colômbia (2012-2019)

RESUMEN Objetivo. Reconstruir la experiencia del Campus Virtual de Salud Pública (CVSP) desde el año 2012 al 2019 en Colombia. Métodos. Se realizó la sistematización de la experiencia del proceso de formación en salud pública para Colombia, por intermedio del Campus para el periodo de 2012 a 2019. La información se presenta en series transversales de periodos de tiempo para visibilizar la evolución histórica del CVSP en Colombia. Resultados. Se han capacitado 2 627 profesionales de la salud en cursos con tutoría y 34 012 en cursos de autoaprendizaje en temáticas relevantes, actualizadas y prioritarias en salud pública. Se destaca la oportunidad y acceso a regiones remotas que ha tenido el Campus mediante procesos de formación sin costo para el usuario final. La experiencia destaca la relevancia del Campus en la reducción de la brecha de actualización del talento humano en salud, mediante procesos de educación virtual, con diversidad en la modalidad y en la oferta formativa. Conclusiones. La reconstrucción de la experiencia en Colombia mostró la evolución y fortalecimiento del CVSP para ofertar procesos de formación con calidad para responder a los problemas y necesidades del país; la consolidación del Campus se debió al trabajo colaborativo entre las universidades y la Organización Panamericana de la Salud.

ABSTRACT Objective. Reconstruct the experience of the Virtual Campus for Public Health (VCPH) from 2012 to 2019 in Colombia. Methods. The experience of public health training through the VCPH in Colombia in the period 2012-2019 was systematized. The information is presented in cross-section time series to show the evolution of the VCPH in Colombia over time. Results. A total of 2 627 health professionals took tutored courses and 34 012 followed self-learning courses on relevant, up-to-date, priority public health issues. An important aspect was the opportunity to access remote regions through VCPH training processes that were cost-free for end users. The experience highlights the relevance of the VCPH in reducing the gap in updated human talent in the health field through virtual education with diversity in its modalities and content. Conclusions. Reconstruction of the experience in Colombia showed how the VCPH evolved and strengthened to offer quality training processes that respond to the country's problems and needs. Collaborative work between universities and the Pan American Health Organization resulted in consolidation of the VCPH.

RESUMO Objetivo. Reconstruir a experiência do Campus Virtual de Saúde Pública (CVSP) de 2012 a 2019 na Colômbia. Métodos. Realizou-se a sistematização da experiência do processo de formação em saúde pública na Colômbia por meio do Campus, referente ao período de 2012 a 2019. As informações são apresentadas em séries transversais de períodos de tempo para mostrar a evolução histórica do CVSP na Colômbia. Resultados. Foram capacitados 2.627 profissionais de saúde em cursos com instrutor e 34.012 em cursos de autoaprendizagem sobre temas relevantes, atuais e prioritários de saúde pública. Destacam-se a oportunidade e o acesso a regiões remotas que o Campus obteve, por meio de processos de formação sem custo para o usuário final. A experiência destaca a relevância do Campus na redução da lacuna de atualização do talento humano da área da saúde, mediante processos de educação virtual com diversidade nas modalidades e ofertas de formação. Conclusões. A reconstrução da experiência da Colômbia mostrou a evolução e o fortalecimento do CVSP para oferecer processos de formação com qualidade, a fim de responder aos problemas e necessidades do país. A consolidação do Campus deve-se ao trabalho colaborativo entre as universidades e a Organização Pan-Americana da Saúde.

Una mirada histórico-geográfica de las pandemias: para entender de manera compleja la COVID-19 / A Historical-Geographical View of Pandemics: to Understand COVID-19 in a Complex Way

RESUMEN El abordaje para la investigación de brotes/pandemias es una actividad desafiante, necesaria y retadora para los salubristas y epidemiólogos. Esta actuación permite que los servicios de epidemiología y de vigilancia profundicen el conocimiento de la enfermedad, recaben datos históricos de episodios pandémicos, caractericen vulnerables, planteen hipótesis e intervengan los factores de riesgos en un contexto ambiental y sociocultural determinado con una actuación local y una perspectiva global. Se considera un abordaje sindémico, de tal manera que conjugan aspectos de determinantes sociales interconectados y profundizando en la pandemia.

ABSTRACT The outbreak/pandemic investigation approach is a challenging, necessary and challenging activity for health professionals and epidemiologists. This approach allows epidemiology and surveillance services to deepen their knowledge of the disease, collect historical data on pandemic episodes, characterize vulnerabilities, develop hypotheses and intervene risk factors in a given environmental and sociocultural context with local action and a global perspective. A syndemic approach is considered, in such such a way that it combines aspects of interconnected social determinants and deepening in the pandemic.

Conocimiento de cáncer de mama y factores sociodemográficos, acceso y atención en salud en mujeres consultantes en centros oncológicos, Cartagena ­ Colombia / Conhecimento do câncer de mama e fatores sociodemográficos, acesso e cuidados de saúde em mulheres consultoras em centros de câncer, Cartagena ­ Colômbia / Knowledge of breast cancer and sociodemographic factors, access and health in women consultants in cancer centers, Cartagena ­ Colombia

Identificar los factores relacionados al conocimiento del estado actual de la enfermedad en mujeres con cáncer de mama y factores sociodemográficos, diagnóstico, tratamiento y atención del cáncer de mama en instituciones oncológicas, Cartagena-Colombia. Estudio descriptivo transversal; participaron 211 mujeres con cáncer de mama, mediante una encuesta estructurada. El Odd Ratio (OR) fueron calculados usando SPSS versión 23.0. Se encontró una asociación estadística entre la práctica del autoexamen de mama con el poseer estudios de educación superior y pertenecer al nivel contributivo; además, una mujer menor de 50 años con diagnostico confirmado de cáncer y que tenga un nivel educativo superior entró con una acción de tutela. Se identificaron lagunas derivadas de la estratificación social, segmentación geográfica y acceso a mecanismos de información telefónica. Por lo tanto, las condiciones de vulnerabilidad bajo nivel educativo y pobreza marcan diferencias y denotan oportunidades perdidas para la detección, atención y tratamiento.

Identificar fatores relacionados ao conhecimento do estado atual da doença em mulheres com câncer de mama e fatores sociodemográficos, diagnóstico, tratamento e cuidado do câncer de mama em instituições oncológicas, Cartagena-Colômbia. Estudo descritivo transversal; 211 mulheres com câncer de mama participaram através de uma pesquisa estruturada. Foi encontrada uma associação estatística entre a prática do auto-exame das mamas e o fato de ter uma educação superior e pertencer ao nível contributivo; além disso, uma mulher com menos de 50 anos de idade com diagnóstico confirmado de câncer e com um nível de educação superior entrou com uma ação de tutela. São identificadas as lacunas derivadas da estratificação social, segmentação geográfica e acesso a mecanismos de informação telefônica. Portanto, as condições de vulnerabilidade, baixo nível educacional e pobreza marcam diferenças e denotam a perda de oportunidades de detecção, cuidado e tratamento.

To identify factors related to knowledge of the current state of the disease in women with breast cancer and sociodemographic factors, diagnosis, treatment and care of breast cancer in oncological institutions, Cartagena-Colombia. Cross-sectional descriptive study; 211 women with breast cancer participated through a structured survey. A statistical association was found between the practices of breast self-examination and having a higher education and belonging to the contributory level; in addition, a woman under 50 years old with a confirmed diagnosis of cancer and with a higher education level uses guardianship action by right. Gaps derived from social stratification, geographical, health system segmentation and access to telephone information mechanisms are identified. Therefore, the conditions of vulnerability, low educational level and poverty mark differences and denote lost opportunities for detection, care and treatment.

Uso del cine como herramienta de aprendizaje en salud pública / The use of cinema as a learning strategy in public health

Introducción: El abordaje de las epidemias/pandemias debe llevarse a cabo desde una enseñanza transversal que involucre un pensamiento completo. Objetivo: Evaluar diferentes herramientas pedagógicas para el aprendizaje significativo activo en el aula. Métodos: Estudio de caso (n = 10), sin grupo de control, en el contexto de un seminario internacional. Se empleó una encuesta de percepciones y creencias ante pandemias, a través de la estrategia didáctica para observar, reflexionar y aplicar mediante el cine, y otros insumos para apoyar el aprendizaje. Resultados: Los docentes se mostraron favorables a la utilización del cine en el aula durante la propuesta metodológica, y apoyaron los instrumentos empleados para el aprendizaje y la dinámica docente en situaciones epidemiológicas. Asimismo, mejoró el proceso pedagógico, el análisis de los fenómenos desde la perspectiva local, la capacidad de objetivar situaciones que fomenten un pensamiento complejo y el uso de la interdisciplinariedad en el aula. Conclusiones: La incorporación del género de cine pandémico, acompañado de la estrategia ORA, el uso de cuestionario de percepciones y creencias, y otros insumos, mejora el proceso de enseñanza-aprendizaje, favorece el abordaje de problemas de pensamiento complejo, y mejora la empatía entre docentes y estudiantes en el aula(AU)

Introduction: Approach to epidemics/pandemics must be carried out from transversal teaching that involves complete thinking. Objective: To assess different pedagogical tools for active meaningful learning in the classroom. Methods: Case study (n= 10), without a control group, carried out in the context of an international seminar. A survey of perceptions and beliefs during pandemics was used by means of the didactic strategy to observe, reflect and apply through cinema and other elements to support learning. Results: The professors supported the use of cinema in the classroom during the methodological proposal, as well as the instruments used for learning and teaching dynamics in epidemiological situations. Likewise, there was an improvement of the pedagogical process, the analysis of phenomena from the local perspective, the ability to objectify situations that promote complex thinking, and the use of interdisciplinarity in the classroom. Conclusions: The incorporation of the pandemic cinema genre, accompanied by the observation-relation-application strategy, the use of a perceptions and beliefs questionnaire, as well as other elements, improves the teaching-learning process, favors the approach to complex thinking problems, and improves empathy between professors and students in the classroom(AU)

COVID-19 en la Región Caribe Colombiana: un análisis documental / Covid19 in the Colombian Caribbean Region: A Documentary analysis

Resumen Introducción: El impacto social y sanitario que ha generado la pandemia COVID-19 a nivel global permite repensar aspectos de vigilancia epidemiológica y comunicación en tiempos de crisis. Objetivo: Describir el comportamiento de la pandemia COVID-19 en los departamentos y distritos especiales de la región caribe colombiana. Materiales y Métodos: Análisis documental e interpretativo a partir de fuentes secundarias de vigilancia nacional "SIVIGILA" y datos de entes territoriales. Resultados: Cartagena de Indias es la primera unidad territorial del Caribe en presentar casos por COVID-19, seguido de Santa Marta y Barranquilla. El mayor número de casos se registró en Barranquilla, Atlántico, Cartagena y Córdoba. Así mismo, la mayor tasa de muertes por 100 000 habitantes se registró en Barranquilla, Atlántico, Córdoba, Santa Marta, Sucre y Cartagena. En el Caribe se implementaron estrategias de distanciamiento social como prohibición de eventos masivos y cierre de fronteras. Discusión: Para describir el comportamiento de la pandemia es importante que las autoridades sanitarias continúen asumiendo el reto para la detección, sistematización y manejo oportuno de los casos. El comportamiento de la pandemia ha sido similar en los departamentos del Caribe Colombiano, hay una homogeneidad al momento de acatar las normas del gobierno, y cada región adaptó diferentes estrategias dentro de un marco general para reducir la incidencia de la enfermedad. Se recomienda fortalecer la similitud entre los datos reportados por el Ministerio de Salud, SIVIGILA y los entes territoriales. El talento humano en salud cualificado puede soportar este ejercicio a fin de superar la actuación mediática y avanzar hacia la gobernanza.

Abstract Background: The social and health impact generated by the COVID-19 pandemic allows us to re-think aspects of epidemiological surveillance and communication in struggle-times. Objective: To describe the behavior of the COVID-19 pandemic in the departments and special districts of the Colombian Caribbean region. Methodology: This is a documentary and interpretive analysis from secondary sources of National Surveillance "SIVIGILA" and data from local governments. Results: Cartagena de Indias is the first territorial area in the Caribbean to present cases COVID-19, followed by Santa Marta and Barranquilla. The highest number of cases was registered in Barranquilla, Atlántico, Cartagena and Córdoba. Likewise, the highest death rate per 100,000 inhabitants was observed in Barranquilla, Atlántico, Córdoba, Santa Marta, Sucre and Cartagena. In the Caribbean, social distancing was implemented, as well as the limitation of mass gatherings and border closure. Discussion: To describe the pandemic behavior, it is important that health authorities continue to assume the challenges of detection, systematization, and timely handling of cases. The COVID-19 performance has been similar in the Colombian Caribbean. There is a homogeneity regarding the government regulations compliance and each region adapted different strategies to reduce the incidence of the dicease. It is recommended to strengthen the concordance between the data reported by the Ministry of Health, SIVIGILA, and the territorial entities. Qualified human talent can support this exercise in order to overcome the media performance through the strengthening of governance.

Determinantes sociales de salud y su relación con desnutrición infantil en dos comunidades étnicas colombianas / Social determinants and malnutrition of infants from two Colombian indigenous communities

RESUMEN Objetivo Identificar la relación entre los determinantes sociales de la salud y el estado nutricional de los niños pertenecientes a dos comunidades indígenas de la Costa Caribe colombiana, los wayús y los zenús. Métodos Estudio transversal que aborda el estado nutricional de los wayús y los zenús en edad preescolar y escolar. Incluyendo, además, estimación de determinantes sociales de la salud, referida por cuidadores de menores, que aborda algunos aspectos de ejes de desigualdad de tipo estructural (etnia, territorio, edad y sexo) e intermedios: vivienda, entorno y redes, mediante instrumentos de salud familiar. Se estandarizaron métricas de talla, peso e insumos de familiograma y ecomapa. Se estimaron medidas descriptivas de tipo frecuentistas y de medidas de tendencia central. Se estimó la odds ratio y su relación con variables independientes. Resultados La prevalencia de desnutrición global en la etnia Wayú fue del 59,1% IC (47,569,8) y en la etnia Zenú del 22,4% IC (15,9-30,4) para una p<0,001. Esta diferencia se relaciona con factores de riesgo intermediarios de saneamiento: inadecuadas excretas con OR=2.54; IC (1.42-4.53) p=0.002, la falta de empleo OR=1.94; IC (1.09-3.46) P=0.03 y falta de acceso a servicios de salud occidental OR=2.42; IC (1.34-4.40) p=0.005. Conclusiones La mejora en la nutrición requiere intervenir determinantes intermedios relacionados con saneamiento, modelo de salud, intersectorialidad de políticas en salud más enfoque étnico-cultural y territorial.

ABSTRACT Objetive To identify the relationship between the Health's Social Determinants and the nutritional status of children belonging to two indigenous communities on the Colombian Caribbean coast, the Wayú and the Zenú. Methods Cross-sectional study that addresses nutritional status in wayúes and zenúes at preschool and school age. Also including the estimation of health's social determinants, referred by minor's caregivers, which addresses some aspects of structural ¡nequality axes (ethnicity, territory, age, and sex) and intermediates: housing, environment, and networks, through health instruments family. Metrics for height, weight, and inputs for the familiogram and ecomap were standardized. Descriptive measures of frequencies and central tendency were estimated. Odds ratio and its relationship with ¡ndependent variables were estimated. Results The prevalence of global malnutrition in the Wayú ethnic group was 59.1% (47.5-69.8) and in the Zenú ethnic group 22.4% (15.9-30.4) for a p<0.001. This difference is related to intermedíate risk factors with sanitation: inadequate excreta with OR=2.54; CI (1.42-4.53) p=0.002, lack of employment OR=1.94; CI (1.09-3.46) P=0.03 and lack of access to western health services OR=2.42; IC (1.34-4.40) p=0.005. Conclusions Improvement in nutrition requires the intervention of intermediate determinants related to sanitation, health model, intersectoriality of health policies plus an ethnic-cultural and territorial focus.

Síndrome de burnout en el personal de enfermería en hospitales del departamento del Atlántico / Burnout syndrome in the nursing personal in health care institutions of the Atlantic department

RESUMEN Objetivo Determinar la prevalencia del síndrome de burnout en el personal de enfermería en hospitales del Departamento del Atlántico (Colombia). Materiales y Métodos Se realizó un estudio cuantitativo, descriptivo transversal, en 117 profesionales y 229 auxiliares de enfermería de cuatro hospitales del Departamento del Atlántico (Colombia), dos públicos y dos privados. Se empleó una encuesta anónima con datos sociodemográficos y la escala de Maslach. Resultados La prevalencia global del síndrome de burnout o desgaste profesional fue de 65%. En profesionales de enfermería, fue de 63,2% y en auxiliares de enfermería, de 65,9%. El 13,3% de los participantes presentó un grado elevado de burnout para el cansancio emocional; el 9,2%, para la despersonalización; y el 62,7% obtuvo puntuaciones bajas para la realización personal. En los profesionales de enfermería, el 12,7% obtuvo una puntuación alta para cansancio emocional; 7,4% para despersonalización, y 64,2% obtuvo puntuaciones bajas para la realización personal. Por su parte, en los auxiliares de enfermería el comportamiento en algunas subescalas fue muy similar; el 14,5% obtuvo una puntuación alta para cansancio emocional; 12,8%, para despersonalización y 59,8% obtuvo puntuaciones bajas para la realización personal. Conclusiones La presencia del síndrome de burnout en la población estudiada es alta. Es similar tanto en enfermeros como en auxiliares de enfermería. La dimensión más afectada fue la realización personal en ambos grupos estudiados, lo cual corresponde a sentimientos altos del "quemado".

ABSTRACT Objective To determine the prevalence of burnout syndrome in the nursing staff in four hospitals located in the State of Atlántico (Colombia). Material and Methods A descriptive cross-sectional study was conducted and included as participants 117 nursing professionals and 229 nursing auxiliaries from four hospitals located in the State of Atlantico (Colombia), two public and two privates. An anonymous self-study survey was used on sociodemographic, labor data and Maslach Scale. Results The overall prevalence of Burnout Syndrome or professional burnout was 65%. In nursing professionals it was 63,2% and in nursing auxiliaries 65,9%. At least 13,3% of the participants had a high degree of Burnout from emotional exhaustion, 9.2% for depersonalization, and 62,7% had low scores for personal fulfillment. In nursing professionals, 12,7% had a high score for emotional exhaustion, 7,4% for depersonalization, and 64,2% obtained low scores for personal fulfillment. On the other hand, in nursing auxiliaries the behavior in some subscales was very similar, 14,5% had a high score for emotional exhaustion, 12,8% for depersonalization and 59,8% had low scores for personal fulfillment. Conclusions The presence of burnout syndrome is high in the studied population, it is similar in both, nurses and nursing auxiliaries. The most affected dimension was the personal fulfillment in both groups, which corresponds to high feelings of the "burned".

Percepciones y creencias al uso de película comercial tipo epidemia/pandemia en el aula: Insumos para orientar el aprendizaje / Perceptions and beliefs to the use of epidemic / pandemic commercial film in the classroom: Inputs to guide learning

RESUMÉN Objetivo: Valorar el uso de la película comercial "Contagión" como estrategia para la enseñanza del método epidemiológico aplicado al campo de epidemias/pandemias. Materiales y métodos: Se trata de un proyecto de aula que involucró diversas tecnologías emergentes y de comunicación para disponer de herramientas atractivas y pedagógicas que favorezcan aprendizaje significativo para abordaje de temáticas complejas. La actuación pedagógica involucró diversos insumos: inicialmente se presenta la caracterización de un cuestionario "ah doc" que valoró creencias y percepciones ante una epidemia/pandemia y cómo visibilizaban entes de salud locales e internacionales, los científicos, la comunidad y el uso de película en el escenario de aprendizaje. Participaron 131 estudiantes. Resultados: En síntesis, los estudiantes identifican que este tipo de película muestra una realidad para el 70,2% (acuerdo y totalmente de acuerdo),favorece conductas de protección en un 80,2 % y al 78,6 % le modifica su conocimiento con respecto a la protección de salud. Favorece un aprendizaje en el aula, y para el 42 % se expresa de manera indiferente un estereotipo muy alejado de los científicos. Con este insumo inicial se desarrolló la sesión introductoria de abordaje de puntos críticos en la metodología epidemiológica ante una epidemia/pandemia; lo que permitió ilustrar la acción epidemiológica versus el contexto real o simulado, destacando actuaciones que involucran actos humanos. Conclusiones: Los estudiantes expresaron actitud positiva respecto a la estrategia utilizada en el aula, que se constituye en un insumo pertinente, activo, crítico y eficaz para el aprendizaje en el aula.

ABSTRACT Objective: To assess the use of commercial film "Contagion" as a strategy for teaching the epidemiological method applied to the field of epidemics/pandemics. Materials and methods: This is a classroom project that involved various emerging and communication technologies in order to have attractive and pedagogical tools that encourage meaningful learning to address complex issues. The pedagogical action involved several inputs: Initially, the characterization of an "ah doc." questionnaire was presented, which evaluated beliefs and perceptions in the face of an epidemic/pandemic and how local and international health entities, scientists, the community and the use of film in the learning scenario made them visible, with 131 students participating. Results: In summary, students identified that this type of film shows a reality "in agreement and total agreement in 70.2 %, favors protective behavior in 80.2 % and 78.6 % modify their knowledge with respect to health protection. This positions that it favors a learning in the classroom and for 42 % it expresses in an indifferent way a stereotype very far from the scientists. With this initial input, the introductory session was held to address critical points in the epidemiological methodology in the face of an epidemic/pandemic, which made it possible to illustrate the epidemiological action versus the real or simulated context by highlighting actions involving human acts. Conclusions: Students expressed a positive attitude towards the strategy used in the classroom, which constitutes a relevant, active, critical and effective input for classroom learning.

Polimorfismos de los genes del sistema leptina-melanocortina asociados con la obesidad en la población adulta de Barranquilla / Polymorphisms of leptin-melanocortin system genes associated with obesity in an adult population from Barranquilla

Introducción. La obesidad se considera un grave problema de salud pública y por ello se hacen esfuerzos en la búsqueda de genes como el LEP, el LEPR y el MC4R del sistema leptina-melanocortina, el cual opera en la regulación neuroendocrina de la ingestión y el equilibrio energético e influye en la patogenia de la enfermedad. Los resultados contradictorios en torno a la asociación de estos genes con la obesidad plantean la necesidad de nuevas investigaciones. Objetivo. Analizar los polimorfismos rs2167270 del gen LEP, rs1137101 del gen LEPR y rs17782313 del gen MC4R asociados con la obesidad y sus variables clínicas y bioquímicas en una muestra de pacientes adultos de Barranquilla. Materiales y métodos. Se estudiaron 111 personas obesas y 155 no obesas como controles. Los polimorfismos se determinaron mediante reacción en cadena de la polimerasa (PCR) en tiempo real. Se tomaron las medidas antropométricas, se evaluó la presión arterial y se hicieron pruebas bioquímicas. Resultados. No se encontraron diferencias estadísticas en la frecuencia alélica y genotípica de los polimorfismos en los grupos estudiados. En cuanto a las variables clínicas y bioquímicas, el genotipo CC del polimorfismo rs17782313 del gen MC4R, se asoció con un aumento de la presión arterial sistólica y, el alelo T y su genotipo homocigoto, con una disminución del colesterol HDL en los obesos. No se evidenció ningún efecto de los otros polimorfismos en estas variables. Conclusiones. Los polimorfismos rs2167270 del gen LEP, rs1137101 del gen LEPR y rs17782313 del gen MC4R, no se asociaron con obesidad en la población analizada. Se encontró que el polimorfismo rs17782313 del gen MC4R influyó en el aumento de la presión arterial sistólica y la disminución del colesterol HDL en las personas obesas.

Introduction: Obesity is considered a serious public health problem. Efforts have been directed to search for candidate genes such as LEP, LEPR, and MC4R involved in the leptin- melanocortin system. The neuroendocrine regulation of these genes on energy intake and balance influences the pathogenesis of this disease. Contradictory results regarding the association of these genes with obesity raise the need for new research. Objective: To analyze the association between obesity and LEP rs2167270, LEPR rs1137101, and MC4R rs17782313 polymorphisms and the clinical and biochemical variables in obese adults from Barranquilla, Colombia. Materials and methods: We analyzed 111 obese adults and 155 non-obese individuals as controls. The polymorphisms were determined by real-time PCR. Besides, anthropometric measures, blood pressure, and biochemical tests were evaluated. Results: No statistical differences were found in allele and genotype frequencies of gene polymorphisms between groups. The CC genotype of MC4R rs17782313 polymorphism was associated with increased systolic blood pressure and T allele and TT genotype, with decreased HDL cholesterol in obese adults. The effect of the other polymorphisms on these variables was not evidenced. Conclusions: LEP rs2167270, LEPR rs1137101, and MC4R rs17782313 polymorphisms were not associated with obesity in the population under study. MC4R rs17782313 polymorphisms were associated with an increase in systolic blood pressure and a decrease in HDL cholesterol.

Cardiometabolic risk factors associated with renal function in apparently healthy young students: a cross-sectional study

ABSTRACT Background: Cardiometabolic risk factors (CMRFs) appear decades before developing chronic kidney disease (CKD) in adulthood. Objective: The objective of the study was to identify the prevalence and association between CMRFs and kidney function in apparently healthy young adults (18-25 years old). Methods: We included 5531 freshman year students. Data collected on CMRFs included central obesity, high body mass index (hBMI >25), blood pressure, glycemia, lipids, uric acid (UA >6.8 mg/dL), and insulin. Glomerular filtration rate (GFR) was estimated by CKD-Epidemiology Collaboration formula. We used logistic regression and a log linear for odds ratio (OR) (95% confidence level) and probabilities. Results: The presence of any CMRF was observed in 78% (4312) of individuals; GFR ≥120/130 mL/min/1.73 m2sc was found in 33%, GFR <90 mL/min/1.73 m2sc in 3%, and proteinuria in 3%. Factors associated with high GFR were hBMI (OR 1.3 [1.14, 1.47]), UA (OR 0.2 [0.15, 0.26]), high-density lipoprotein (HDL) (OR 1.4 [1.2, 1.6]), and insulin resistance (OR 1.3 [1.05, 1.7]). CMRF associated with low GFR was UA (OR 1.8 [1.3, 2.6]), low-density lipoprotein cholesterol (OR 1.66 [1.05, 2.6]), and proteinuria (OR 3.4 [2.07, 5.7]). Proteinuria was associated with high UA (OR 1.59 [1.01, 2.5]) and hypercholesterolemia (OR 1.8 [1.03, 3.18]). The sole presence of hBMI+UA predicted low GFR with p = 0.6 and hBMI+UA+low HDL predicted proteinuria with p = 0.55. Conclusions: CMRFs were highly prevalent among this freshman student population and were associated with proteinuria and GFR abnormalities. Future studies should focus on public health programs to prevent or delay the development of CKD.

Diabetes gestacional: implementación de una guía para su detección en la atención primaria de salud / Implementation of a clinical guideline for detection of gestational diabetes in primary care

Background: Gestational diabetes (GD) impacts maternal and fetal morbidity. In 2012, the World Diabetes Foundation provided financing project in Barranquilla (Colombia), aimed to implement a clinical guide for the diagnosis and treatment of this condition. Aim: To estimate the adherence of the guide in primary care centers. Material and Methods: A Cross-sectional study of pregnant women suspected of having gestational diabetes. Pregnant women were classified according to the week of admission to the prenatal control program: < week 24 or later. Women with a fasting blood glucose over 92 mg/dL and under 126 mg/dL or with some positive result to the oral glucose tolerance test were included. Results: Nine percent (1,887 women) of 21,699 registries of pregnant women, were at risk for gestational diabetes. Of these, 1,880 registries with complete data were analyzed. Sixty nine entered the program at less than 24 weeks of pregnancy and 71% had had a fasting blood glucose measured in the first control. In 69.2% of these women, criteria for gestational diabetes was met. A glucose tolerance test was suggested to women with a blood glucose below 92 mg/dl. Among 72% of the latter, the glucose tolerance test met the criteria for gestational diabetes. Among the 498 women who entered the program after 24 weeks of gestation, 68% met the criteria for gestational diabetes with the fasting blood glucose levels. In 90 women, a glucose tolerance test was performed and 80% met the criteria for gestational diabetes. Conclusions: An adequate adherence to guidelines favors the detection of pregnant women with gestational diabetes.