Abstract The aim of this paper was to analyze the psychosocial experiences of Haitian men and women migratory processes to southern Brazil, especially from an intersectional perspective of race-ethnicity, gender, and age. Fifteen migrants were interviewed: nine women, two men, and four children, who were living in Porto Alegre, Rio Grande do Sul, southern Brazil. Data were submitted to inductive thematic analysis, which allowed the organization of three central themes: 1) motivations for migrating from Haiti to South America; 2) gender roles and their respective impacts on experiences in Brazil; and 3) reduced support network and experiences of racialized xenophobia. We discuss in which level gender and age differences, associated with the crossings of the phenomenon of racialized xenophobia, imply in different and unique psychosocial experiences for Haitians in their migratory process to Brazil, but in which most converge to a position of social marginalization.

Resumo O objetivo deste artigo foi analisar as experiências psicossociais dos processos migratórios de haitianos e haitianas ao sul do Brasil, sobretudo por uma perspectiva interseccional de raça-etnia, gênero e idade. Foram entrevistados 15 migrantes, sendo nove mulheres, dois homens e quatro crianças, que residiam em Porto Alegre, Rio Grande do Sul (RS). Os dados foram submetidos a análise temática indutiva, o que possibilitou a organização de três temas centrais: 1) as motivações para migrar do Haiti para a América do Sul; 2) os papéis de gênero e seus respectivos impactos nas vivências no Brasil; e 3) a rede de apoio reduzida e as experiências de xenofobia racializada. Discute-se em que medida as diferenças de gênero e etárias, associadas aos atravessamentos do fenômeno da xenofobia racializada, implicam em diferentes e singulares experiências psicossociais para haitianos em seu processo migratório para o Brasil, considerando que a maioria converge para uma posição de marginalização social.

Abstract The seeds of Erythrina americana Mill. are consumed by the bruchid Specularius impressithorax. Hence to evaluate the effect that the beetles can have on the sedes, the percentage of damage to E. americana seeds in the pre-dispersal stage was determined, as well as the accumulated damage during one year caused by S. impressithorax. The germination percentage of healthy and damaged seeds were evaluated. The seeds were collected in the Tulancingo Valley, Hidalgo, Mexico in December 2017. 1,272 seeds had been collected from nine different trees, which remained at least 500 m away from each other. The number of holes were counted in the seeds, that is, the number of bruchids that emerged from each seed (n = 269). The average damage percentage during the pre-dispersal of the seeds was 17.4% and for the post-dispersal stage it was 83.1%. Seeds with a bruchid exit hole germinated in 66.6%. The undamaged seeds presented a germination percentage of 2.2%, because the E. americana seeds present dormancy. The percentage of germination of the seeds with an emergency hole caused by S. impressithorax (66.6%), indicates that when an E. americana seed is consumed by a bruchid, it does not damage the embryo, and emulates a natural scarification process.

Resumen Las semillas de Erythrina americana Mill., son consumidas por el brúquido Specularius impressithorax, por lo que para evaluar el efecto que pueden tener los escarabajos sobre las semillas se determinó el porcentaje de daño en semillas de E. americana en la etapa de pre-dispersión, así como el daño acumulado durante un año causado por S. impressithorax. Se evaluó el porcentaje de germinación de semillas sanas y dañadas. Las semillas se colectaron en el valle de Tulancingo, Hidalgo, México en diciembre de 2017. Se colectaron 1,272 semillas provenientes de nueve árboles diferentes, los cuales se encontraban como mínimo a 500 m de distancia uno de otro. A las semillas se les conto el número de orificios, es decir el número de brúquidos que emergieron de cada semilla (n = 269). El porcentaje de daño promedio durante la pre-dispersión de las semillas fue de 17.4 % y para la etapa post-dispersión fue de 83.1 %. Las semillas con un orificio de salida de un brúquido germinaron en un 66.6 %. Las semillas sin daño presentaron un porcentaje de germinación de 2.2 %, debido a que las semillas de E. americana presentan dormancia. El porcentaje de germinación de las semillas con un orificio de emergencia causado por S. impressithorax (66.6 %), indica que cuando una semilla de E. americana es consumida por un brúquido, éste no daña el embrión, y emula un proceso de escarificación natural.

Resumen En México, la gobernanza de las metrópolis se ha dirigido a promover procesos de reforma y cambio institucional, donde los diferentes sectores de la sociedad buscan relacionarse con el propósito de controlar y regular el funcionamiento del entorno urbano, a fin de obtener una responsabilidad común que resuelva problemas con métodos de coordinación intergubernamental. El objetivo de este artículo es analizar los componentes de gobernanza metropolitana que existen en México, destacando sus características principales y la forma en que operan, para identificar sus alcances en el marco del desarrollo de propuestas que mejoren la estructura de colaboración existente. El caso de estudio es la Zona Metropolitana de Toluca, considerada una de las ciudades más representativas en la implementación de estrategias de gobernanza. Para el análisis, se considera la revisión de las características de conformación de la metrópoli y una exploración de su problemática urbana; estableciendo las particularidades de la gobernanza metropolitana desarrolladas. Se concluye que existe una desarticulación entre los componentes revisados; desde lo jurídico no se esclarece el ámbito de actuación de los procesos de coordinación; con respecto al marco organizacional, se perciben estructuras débiles con poca injerencia en la toma de decisiones y el entendimiento de un proceso de construcción del desarrollo metropolitano; e instrumentos de financiamiento y planeación, con insuficiente articulación de estrategias dirigidas a resolver las dificultades de la metrópoli.

Abstract In Mexico, the governance of the metropolises has been aimed at promoting reforms and institutional change where the different sectors of society interact to control and regulate the functioning of the urban environment in order to obtain a shared responsibility that solves problems with intergovernmental coordination methods. This article aims to analyze the components of metropolitan governance in Mexico by highlighting their main characteristics and how they operate. We identify their scope in developing proposals that improve the existing collaboration structure. The case study covers the Metropolitan Area of Toluca, considered one of the most representative cities in implementing governance strategies. For the analysis, reviewing the characteristics of the metropolis and exploring its urban problems are considered by establishing the peculiarities of metropolitan governance developed. It is concluded that there is a disarticulation between the revised components. From the legal standpoint, the scope of action of the coordination processes is not clarified. Regarding the organizational framework, weak structures are perceived with little interference in decision-making and understanding of the construction process of metropolitan development, financing, and planning instruments. They also display an insufficient articulation of strategies to solve the metropolis's difficulties.

Resumo No México, a governança das metrópoles vem sendo direcionada a promover processos de reforma e mudança institucional, em que os diferentes setores da sociedade buscam se relacionar com o objetivo de controlar e regularizar o funcionamento do ambiente urbano, para obter uma responsabilidade comum que resolva problemas com métodos de coordenação intergovernamental. O objetivo deste artigo é analisar os componentes de governança metropolitana que existem no México, com destaque para suas características principais e a forma em que operam, a fim de identificar seu escopo no âmbito do desenvolvimento de propostas que melhorem a estrutura de colaboração existente. O caso de estudo da Região Metropolitana de Toluca, considerada uma das cidades mais representativas na implementação de estratégias de governança. Para a análise, foi considerada a revisão das características de formação da metrópole e uma exploração de sua problemática urbana, a partir do estabelecimento das particularidades que foram desenvolvidas. Conclui-se que existe uma desarticulação entre os componentes revisados; a partir do jurídico, não é esclarecida a esfera de atuação dos processos de coordenação; a respeito do contexto organizacional, são percebidas estruturas fracas com pouca ingerência na tomada de decisões e no entendimento de um processo de construção do desenvolvimento metropolitano; instrumentos de financiamento e planejamento com insuficiente articulação de estratégias voltadas a resolver as dificuldades da metrópole.

Resumo Introdução: A asma continua a ser a doença crónica mais frequente na população pediátrica. O seu controlo é condicionado negativamente pela utilização incorreta dos dispositivos para terapêutica inalatória. A demonstração da técnica de utilização correta a pais ou cuidadores parece estar associada a uma redução da taxa de erro. Este estudo intervencional prospetivo pretendeu confirmar a hipótese de que a demonstração repetida da técnica inalatória a pais e cuidadores tem impacto positivo na adesão dos doentes, reduzindo a taxa de erro. Métodos: Cem participantes expuseram a sua técnica inalatória em consultas sequenciais (51 em 3 consultas; e 19 em 2 consultas) com preenchimento de formulário pelo médico assistente com registo “sim” ou “não” em diferentes passos relacionados com a técnica inalatória, lavagem da boca e cuidados com a câmara. Resultados: Trinta doentes foram excluídos, pois só tinham uma observação. Idade média de 2,8 anos (±1,9 anos), 63% rapazes. Ao longo do estudo, 43 participantes reduziram a taxa de erro, 11 mantiveram o erro e 16 apresentaram uma técnica correta desde o início. Verificou-se uma redução substancial da taxa de erro da técnica inalatória (p-value 0,019), bem como da lavagem da boca (p-value 0,000) e da câmara expansora (p-value 0,038). Os únicos fatores associados à redução da taxa de erro foram a demonstração prévia da técnica (p-value 0,003) e o uso prévio do dispositivo inalatório (p-value 0,038). Conclusão: A demonstração da técnica inalatória correta por um médico teve um impacto positivo imediato na redução do erro, que foi amplificado pela realização de demonstrações sequenciais.

Abstract Introduction: Asthma continues to be the most frequent chronic condition in the pediatric population. Its control is affected by the misuse of inhaled medication. Inhaler technique demonstration to patients or caregivers seems to reduce error rate. This prospective interventional study was designed to prove that repeated demonstration of the inhaler technique to patients and caregivers improves patients` compliance and reduces error rate. Methods: One hundred patients were asked to demonstrate inhaler technique in sequential visits (51 patients demonstrated three times and 19 twice), filling a form by the responsible doctor, with “yes” or “no” registry according to several varies related to inhaler technique, mouth wash and spacer care. Results: Thirty patients were excluded from final analysis because they had only one observation. Mean age of 2.8 years (±1.9 years), 63% boys. During the study, 43 patients reduced error rate, 11 maintained the error and 16 had a correct technique since the beginning. Over successive assessments, the number of errors decreased substantially in inhaler technique (p-value 0.019), mouthwash (p-value 0.000) and spacer care (p-value 0.038). The only factors that reduced error rate were previous technique demonstration (p-value 0.003) and preceding inhaler-user (p-value 0.038). Conclusion: Correct inhaler technique demonstration has immediate positive impact on error reduction, which is amplified when successive demonstrations are performed by physicians.

Resumo Os quistos do colédoco representam alterações raras da árvore biliar e dividem-se em vários subtipos, de acordo com a classificação de Todani, sendo a variante tipo III uma das formas mais raras. Os sintomas estão habitualmente relacionados com complicações, tais como colangite e pancreatite que, por sua vez, são condicionadas por estase biliar, coledocolitíase, inflamação ou sobre-infeção recorrentes. Apresentamos o caso de uma doente que recorreu ao serviço de urgência por febre e dor abdominal devido a obstrução de quisto do colédoco tipo III de Todani, com alterações características no estudo por tomografia computorizada e confirmação endoscópica.

Abstract Choledochal cysts constitute a group of rare biliary tree disorders, which are divided in several subtypes according to Todani classification. Type III choledochal cyst is one of the rarest subtype. Symptoms are almost always associated with complications such as cholangitis or pancreatitis, usually due to biliary stasis, choledocholithiasis, recurrent infection or inflammatory events. This article describes a case of a patient who presented to the emergency department due to fever and abdominal pain, owing to Todani type III cystic obstruction with representative findings in the computed tomography study and endoscopic confirmation.

O conceito de Espiritualidade, Religiosidade e Crenças pessoais (SRPB) tem sido apontado como um componente importante da percepção da Qualidade de Vida (QV). Considerando esse aspecto, este estudo tem por objetivo, através de um estudo quantitativo, analisar a relação entre SRPB e QV em homens e mulheres praticantes da religião protestante. Foram utilizados o WHOQOL-bref e o WHOQOL-SRPB, em uma amostra composta por 62 participantes, sendo 31 homens e 31 mulheres (M = 32,89; DP = 9,79) frequentadores de Células - reuniões semanais de grupos de integrantes de uma instituição Religiosa Protestante em uma cidade do interior do Rio Grande do Sul. Foram identificadas diferenças estatisticamente significativas nos domínios Psicológico e Esperança & Otimismo, com os homens apresentando médias superiores às mulheres e correlações estatisticamente significativas entre os domínios e facetas dos instrumentos. Os achados apontam que os homens utilizam a fé como uma das possibilidades de enfrentamento quando apresentam saúde física e emocional debilitada. Já as mulheres, quando não se sentem apoiadas por sua rede de apoio, buscam por uma explicação para sua vida na religião. Conclui-se que é diferente a maneira como espiritualidade e qualidade de vida se relaciona em homens e mulheres.

The concept of Spirituality, Religiosity and Personal Beliefs (SRPB) has been pointed out as an important component of the perception of Quality of Life (QoL). Considering this aspect, this study has as objective to analyze the relationship between SRPB and QV in men and women practitioners of the protestant religion. It is a quantitative survey of transversal character. The instruments used were the WHOQOL-bref and the WHOQOL-SRPB. The sample consisted of 62 participants, 31 men and 31 women (M = 32.89; DP = 9.79), who attended to Cells - weekly meetings of groups of people from a Protestant Religious Institution in the countryside of Rio Grande do Sul. It was identified statistically significant differences in the Psychological & Hope and Optimism domains, with men having superior scores compared to women and correlations statistically significant were presented among indexes in both instruments. The findings point out that men appeal to faith as one of the possibilities of coping when present weakened physical and emotional health. Women, when they do not feel supported by their social network, they seek for an explanation of life in religion. Therefore, it is concluded that it is different how spirituality and quality of life relate in men and women.

Abstract To assess the effect of beetles (Bruchidae) that consume seeds on the establishment of Prosopis laevigata in the Mezquital Valley, Hidalgo, the damage they cause in the seeds of 20 trees was quantified. We assessed if the damage affects seed viability, if the beetles have preference for some seed size and if beetle size is related to the size of the seed from which it emerges. Twenty-two percent of the seeds presented damage by beetles in the pre-dispersion stage, and 2, 4 and 6 months after they had fallen to the ground, the damage was 32.0, 54.4 and 66.3%, respectively. The seeds damaged by beetles did not germinate because they damaged the embryo. Bruchids use larger sized seeds for oviposition and beetle size was positively and significantly related with the size of the seeds from which they emerged. The loss of seeds by bruchids and their preference for larger seeds to oviposit may limit the establishment of P. laevigata, although the potential ecological implications of this seed predation still needs to be assessed.

Resumen Para evaluar el efecto que pueden tener los escarabajos (Bruchidae) que consumen semillas durante el establecimiento del mezquite Prosopis laevigata en el valle del Mezquital, Hidalgo, se cuantificó el daño en las semillas de 20 árboles. Se determinó si el daño afecta la viabilidad de las semillas, si los escarabajos tienen preferencia por algún tamaño de semilla y si el tamaño del escarabajo y el tamaño de la semilla de la cual emergen están relacionados. El 22% de las semillas presentó daño por escarabajos en la etapa de predispersión y el daño después de 2, 4 y 6 meses de que éstas caen al suelo fue de 32.0, 54.4 y 66.3%, respectivamente. Las semillas dañadas por los escarabajos no germinaron porque éstos dañan el embrión. Los brúquidos utilizan semillas de mayor tamaño para ovipositar y el tamaño de los escarabajos tuvo una relación positiva y significativa con el tamaño de las semillas de las cuales emergieron. La pérdida de semillas por brúquidos y su preferencia por semillas de mayor tamaño para ovipositar pueden limitar el establecimiento de P. laevigata, aunque aun quedan por evaluar las posibles implicaciones ecológicas de esta depredación de semillas en las poblaciones de mezquite.

O tumor miofibroblástico inflamatório do pulmão é um tumor benigno raro, de etiologia desconhecida. Apesar da sua natureza benigna é assim designado pela sua propensão para mimetizar um processo maligno. Esta entidade pode mimetizar situações clínicas mais frequentes, nomeadamente processos infeciosos, levando a ciclos prolongados de antibioterapia na ausência de isolamento de um agente. Esta deve ser suspeitada em quadros respiratórios com imagem sugestiva e ausência de resposta à terapêutica. Descreve-se o caso de um jovem que apresentou um tumor miofibroblástico inflamatório do pulmão.

Myofibroblastic inflammatory tumor of the lung is a rare benign tumor of unknown etiology. Despite its benign nature is known for its propensity to mimic a malignant process. This entity may mimic most common clinical situations, particularly infectious processes, leading to prolonged cycles of antibiotic therapy in the absence of isolation of an agent. It should be suspected in respiratory conditions with suggestive image in the lack of response to therapy. We report a case of a young man presented with a myofibroblastic inflammatory tumor of the lung

Abstract Background: Understanding the genetic structure of wild relatives of domesticated species is crucial for its conservation and to elucidate the sites of crop domestication. Lima bean is one of the five domesticated Phaseolus species and Mexico is one of its centers of domestication. Recent studies showed the existence of two wild gene pools (MI and MII) of this species in Mexico and suggested that their genetic divergence occurred in southeast Mexico. Question: Did MI and MII groups diverged around the Isthmus of Tehuantepec, Mexico? Studied species: Lima bean: Neotropical plant species, herbaceous, with an annual/short life cycle and with autogamous tendency. Study site and years of study: Seven wild populations were collected in 2012 in the State of Chiapas, México, area underrepresented in previous studies. Methods: Genetic diversity and grouping patterns of collected populations and their relationship to MI and MII groups were analyzed at eight microsatellite loci. Results: High genetic structure (FST: 0.42 to 0.96) and a high level of genetic diversity (HE = 0.48) were found. The analyses, and presence of admixed populations in MI and MII, suggested that the genetic divergence of these groups is an ongoing process centered around the Isthmus of Tehuantepec. Conclusions: Our results support the hypothesis that MI and MII groups diverged around the Isthmus of Tehuantepec; however, sampling should be increased both at population and genomic levels, to determine the precise organization of the genetic diversity of wild P. lunatus from Mexico.

Resumen Antecedentes: Entender la estructura genética de los parientes silvestres de las especies domesticadas es crucial para su conservación y para elucidar los sitios de domesticación de los cultivos. El frijol Lima es una de las cinco especies domesticadas del género Phaseolus y México es uno de sus centros de domesticación. Estudios recientes señalaron dos acervos genéticos silvestres (MI y MII) en México y sugirieron que su divergencia ocurrió en el sureste de México. Pregunta: ¿Los grupos silvestres MI y MII divergieron alrededor del Istmo de Tehuantepec, México? Especie en estudio: El frijol Lima es una especie Neotropical, herbácea, con ciclo de vida anual/corto y tendencia autógama. Sitio y años de estudio: Siete poblaciones silvestres fueron colectadas en 2012 en el Estado de Chiapas, México, área que fue subrepresentada en estudios previos. Métodos: Se analizó la diversidad genética y los patrones de agrupamiento de las poblaciones colectadas y su relación con los grupos MI and MII, usando ocho loci de microsatélites. Resultados: Se encontró una estructura genética alta (FST: 0.42 a 0.96) y niveles altos de diversidad genética (HE = 0.48). Los análisis y la presencia de poblaciones mezcladas en MI y MII sugieren que la divergencia de estos grupos aun continua alrededor del Istmo de Tehuantepec. Conclusiones: Nuestros resultados apoyan la hipótesis de que MI y MII divergieron alrededor del Istmo de Tehuantepec; sin embargo, hay que incrementar el muestreo, tanto a nivel genómico como poblacional, para determinar la organización precisa de la diversidad genética de P. lunatus silvestre en México.

Introdução: O angioedema intestinal é um efeito adverso raro dos inibidores da enzima de conversão da angiotensina. Caso clínico: Sexo feminino, 42 anos, recorreu ao Serviço de Urgência por dor abdominal difusa predominante nos quadrantes direitos, sem outra sintomatologia. Tinha iniciado perindopril e indapamida 72 horas antes por hipertensão arterial. Sem outros antecedentes de relevo. Ao exame objetivo salientava-se apenas sinais de irritação peritoneal à palpação da fossa ilíaca e flanco direitos. Analiticamente evidenciava discreta leucocitose, sem outras alterações. A ecografia e tomografia computorizada contrastada abdominal revelaram líquido moderado na escavação pélvica e espessamento das paredes do delgado. Foi internada para vigilância. Admitindo-se angioedema intestinal, o inibidor da enzima de conversão da angiotensina foi suspenso e não foi instituída qualquer outra terapêutica dirigida. Em 24 horas, verificou-se melhoria clínica, analítica e imagiológica, corroborando a hipótese de diagnóstico. Conclusão: O diagnóstico de angioedema intestinal por inibidor da enzima de conversão da angiotensina é, por vezes, difícil e moroso pela sua raridade e inespecificidade dos sintomas, podendo conduzir ao subdiagnóstico desta entidade.

Introduction: Intestinal angioedema is a rare adverse effect of angiotensin converting enzyme inhibitors. Clinical case: A 42-year old woman presented to the Emergency Department complaining of diffuse abdominal pain, predominantly in the right quadrants, with no other associated symptoms. She had been started on perindopril plus indapamide 72 h before the admission for arterial hypertension. There was no other relevant background. Physical examination suggested peritoneal irritation on the lower quadrants of the abdomen and right flank. Laboratory tests were relevant for mild leukocytosis. Abdomen ultrasound and contrast-enhanced computed tomography scan showed moderate amount of fluid in the pelvic excavation and small intestine wall thickening. She was admitted for observation. Once the hypothesis of intestinal angioedema was admitted, angiotensin converting enzyme inhibitor was withheld and no other-directed therapy was instituted. Within 24 h she showed clinical, analytic and imaging improvement, thus supporting this diagnosis. Conclusion: The diagnosis of intestinal angioedema induced by angiotensin converting enzyme inhibitor can be challenging and time consuming due to its rarity and nonspecific symptoms, which may lead to underdiagnosis of this entity.

Introduction: Disease-related malnutrition (DRM) is a frequent community healthcare problem that predominantly affects adults over 65 years of age and increases morbidity and mortality rates, while also decreasing quality of life. Objective: To study the prevalence of DRM in adults over 65 in different community healthcare centres belonging to the Regional Social Welfare Service of the Community of Madrid. Methods: We conducted a cross-sectional study in 33 community healthcare centres in Madrid (6 primary healthcare centres (PC), 9 care centres for the elderly (CE), 9 hospitals (H) and 9 nursing homes (NH)) selected by means of multistage sampling. The variables studied were age, sex, level of dependence according to the Red Cross disability scale, reason for admission and underlying disease, habitat (urban-periurban-rural) and geographical distribution (north-centre-south). The Mini Nutritional Assessment (MNA-screening) was employed as a nutritional screening tool in all the centres. In the case of patients with positive screening (at risk-malnutrition), the MNA-assessment was carried out. Statistical analysis was conducted with the SPSS 21.0 package and included descriptive statistics, Chi-square test and Fisher's exact test, one-way ANOVA, Kruskal-Wallis test and univariate and multivariate binary logistic regression analysis (LR). Statistical significance was considered to be p < 0.05. Results: A total of 1,103 subjects were recruited (275 PC, 278 CE, 281 H, 269 NH), mean age 79.5 ± 8.4 years (41.2% were males and 58.8% females). The subjects from H and NH had a higher degree of disability (p < 0.001). The overall prevalence of DRM was 10%, 23.3% being at risk of malnutrition, with differences among the 4 types of community healthcare centres (p < 0.001). The univariate LR analysis showed significant differences in the prevalence of malnutrition according to age, sex, degree of dependence, type of community healthcare centre, habitat and geographical zone. Nevertheless, in the multivariate analysis, only the degree of dependence, the type of centre and habitat were statistically significant. Conclusions: The prevalence of DRM in adults over 65 years of age in the Community of Madrid amounts to 10%, with another 23.3% at risk of malnutrition. The variables that were independently related with malnutrition in the multivariate analysis were only the patients' level of dependence and the type and setting of the community healthcare centre.

Introducción: la desnutrición relacionada con la enfermedad (DRE) es un problema sociosanitario frecuente que afecta preferentemente a los mayores de 65 años, que aumenta la morbimortalidad y disminuye la calidad de vida. Objetivo: estudiar la prevalencia de DRE en mayores de 65 años en diferentes centros sociosanitarios del Servicio Regional de Bienestar Social de la Comunidad de Madrid. Métodos: estudio transversal en 33 centros sociosanitarios de Madrid (6 centros de atención primaria [AP], 9 centros de mayores [CM], 9 hospitales [H] y 9 residencias [R]) seleccionados mediante muestreo polietápico. Las variables estudiadas fueron edad, sexo, nivel de dependencia según la escala de incapacidad de la Cruz Roja, motivo de ingreso y enfermedad de base, hábitat (urbano-periurbano-rural) y distribución geográfica (norte-centro-sur). Como herramienta de cribado nutricional se utilizó el Mini Nutritional Assessment (MNA-cribaje) en todos los centros. En los pacientes con cribado positivo (en riesgo-desnutrición) se realizó el MNA-evaluación. El estudio estadístico se realizó con el paquete SSS 21.0 e incluyó estadística descriptiva, test de Chi-cuadrado y prueba exacta de Fisher, ANOVA de un factor, Kruskal-Wallis y análisis de regresión logística (RL) binaria univariante y multivariante. Se consideró significación estadística p < 0,05. Resultados: se reclutaron 1.103 sujetos (275 AP, 278 CM, 281 H, 269 R), edad media de 79,5 ± 8,4 años (41,2% varones, 58,8% mujeres). Los sujetos procedentes de H y R tuvieron un mayor grado de incapacidad (p < 0,001). La prevalencia global de DRE fue del 10%, encontrándose un 23,3% en riesgo de desnutrición, con diferencias entre los cuatro tipos de centros sociosanitarios (p < 0,001). El análisis univariante de RL mostró diferencias significativas en la prevalencia de desnutrición según la edad, sexo, grado de dependencia, tipo de centro sociosanitario, hábitat y zona geográfica. Sin embargo, en el análisis multivariante solo el grado de dependencia, el tipo de centro y el hábitat tuvieron significación estadística. Conclusiones: la prevalencia de DRE en mayores de 65 años en la Comunidad de Madrid es del 10%, encontrándose además un 23,3% en riesgo de desnutrición. Las únicas variables que se relacionaron de forma independiente con la desnutrición en el análisis multivariante fueron el nivel de dependencia de los pacientes y el tipo y hábitat de centro sociosanitario.

Objective To stratify patients with bladder cancer into homogeneous risk groups according to statistically significant differences found in PFS (progression-free survival). To identify those patients at increased risk of progression and to provide oncological follow-up according to patient risk group. Materials and Methods A retrospective study of 563 patients treated with radical cystectomy (RC). In order to determine which factors might predict bladder tumour progression and death, uni- and multivariate analyses were performed. The risk groups were identified according to “inter-category” differences found in PFS and lack of differences, thus revealing intra-category homogeneity. Results Median follow up time was 37.8 months. Recurrence occurred in a total of 219 patients (38, 9%). In 63% of cases this was distant recurrence. Only two variables retained independent prognostic value in the multivariate analysis for PFS: pathological organ confinement and lymph node involvement. By combining these two variables, we created a new “risk group” variable. In this second model it was found that the new variable behaved as an independent predictor associated with PFS. Four risk groups were identified: very low, low, intermediate and high risk: • Very low risk: pT0 N0 • Low risk: pTa, pTis, pT1, pT2 and pN0 • Intermediate risk: pT3 and pN0 • High risk: pT4 N0 or pN1-3. Conclusions We retrospectively identified 4 risk groups with an independent prognostic value for progression-free survival following RC. Differences in recurrence patterns after RC between risk groups have led us to set different intervals in monitoring for cancer.

Drug resistance is one of the principal obstacles blocking worldwide malaria control. In Colombia, malaria remains a major public health concern and drug-resistant parasites have been reported. In vitro drug susceptibility assays are a useful tool for monitoring the emergence and spread of drug-resistant Plasmodium falciparum. The present study was conducted as a proof of concept for an antimalarial drug resistance surveillance network based on in vitro susceptibility testing in Colombia. Sentinel laboratories were set up in three malaria endemic areas. The enzyme linked immunosorbent assay-histidine rich protein 2 and schizont maturation methods were used to assess the susceptibility of fresh P. falciparum isolates to six antimalarial drugs. This study demonstrates that an antimalarial drug resistance surveillance network based on in vitro methods is feasible in the field with the participation of a research institute, local health institutions and universities. It could also serve as a model for a regional surveillance network. Preliminary susceptibility results showed widespread chloroquine resistance, which was consistent with previous reports for the Pacific region. However, high susceptibility to dihydroartemisinin and lumefantrine compounds, currently used for treatment in the country, was also reported. The implementation process identified critical points and opportunities for the improvement of network sustainability strategies.