Abstract Background: Respiratory and immune changes during pregnancy can lead to viral infections. In coronavirus disease 2019 (COVID-19), clinical characteristics and perinatal risks are difficult to assess and are relatively unknown. Objective: To review placental pathology in asymptomatic women with COVID-19, and to evaluate effects on perinatal outcomes. Material and method: Retrospective, observational, cross-sectional study that included 29 pregnant women in 2020. The women underwent COVID-19 tests and were divided in two groups: 1) control, COVID-19-negative patients, and 2) asymptomatic COVID-19-positive patients; the placentas were studied at the pathology department, and clinical data were retrieved from the electronic medical record; in addition, a literature review was carried out. Results: When the groups were compared, no differences were observed in general data and clinical characteristics. On the day of delivery, patients 2, 4, 5, 6, 8 and 9 of the COVID-19 group were between day 0 and 10.5 after having tested positive; only patients 1, 3 and 7 had overcome the infection. There was a decrease in weeks of gestation in the COVID-19 group (37.8 ± 1.8 vs. 39 ± 0.8; p ≤ 0.05). COVID-19-positive patients' placental histopathology showed a higher prevalence of thrombotic alterations in placental villi (55.5 vs. 0 %). Conclusions: COVID-19 asymptomatic infection potentiates preexisting prothrombotic profile, thus increasing the risk of placental thrombosis and, potentially, of thrombosis in pregnant women.

Resumen Antecedentes: Los cambios respiratorios e inmunitarios en el embarazo pueden conducir a infecciones virales. En la enfermedad por coronavirus 2019 (COVID-19) las características clínicas y riesgos perinatales son difíciles de evaluar y son relativamente desconocidos. Objetivo: Revisar patología placentaria en mujeres asintomáticas con COVID-19 y evaluar efectos en datos perinatales. Material y método: Estudio retrospectivo, observacional y transversal, incluye 29 mujeres embarazadas en 2020. Se realizaron prueba COVID-19 y dividieron en dos grupos: 1) control, pacientes COVID-19 negativas y 2) COVID-19 asintomáticas con COVID-19 positivo; las placentas se estudiaron en patología y los datos clínicos se tomaron del expediente electrónico; asimismo, se realizó revisión de literatura. Resultados: Al comparar grupos no se observó diferencia en datos generales y características clínicas. El día del parto, las pacientes 2, 4, 5, 6, 8 y 9 del grupo COVID-19 se encontraban entre día 0 y 10.5 después de positividad; únicamente las pacientes 1, 3 y 7 habían superado la infección. Se presentó disminución de semanas de gestación en el grupo COVID-19 (37.8 ± 1.8 vs. 39 ± 0.8; p ≤ 0.05). La histopatología placentaria en COVID-19 mostró mayor prevalencia de alteraciones trombóticas en vellosidades placentarias (55.5 vs. 0%). Conclusiones: La infección asintomática por COVID-19, potencializa perfil protrombótico preexistente, incrementando riesgo de trombosis placentaria y trombosis en mujeres embarazadas.

RESUMEN El coronavirus 2 del síndrome respiratorio agudo grave es el tercer betacoronavirus desde el año 2003 capaz de ocasionar una infección del tracto respiratorio inferior, llevando, en casos críticos, al síndrome de dificultad respiratoria aguda y la muerte. La edad avanzada, la hipertensión arterial y la diabetes mellitus son, entre otros, tres factores determinantes en los peores desenlaces clínicos. Múltiples mecanismos pueden explicar la mayor susceptibilidad de las personas diabéticas a las infecciones respiratorias. La hiperglucemia crónica altera tanto a la inmunidad humoral como al celular. Esta enfermedad predispone a la sobreexpresión de la proteína de la membrana celular que sirve como receptora del virus y a una respuesta inflamatoria exacerbada, aumentando el riesgo de una descompensación y de la aparición de crisis hiperglicémicas. Ante la ausencia de un tratamiento efectivo o de una vacuna, todos los esfuerzos deben hacerse para procurar un buen control metabólico de los pacientes con diabetes mellitus con y sin COVID-19. Por lo anterior, se plantean en este artículo de reflexión, diferentes propuestas para el tratamiento de la diabetes mellitus en la unidad de cuidados intensivos, sin descartar la forma ambulatoria, en donde la telemedicina y otras tecnologías permitirán acortar la distancia y mantener las medidas de aislamiento preventivo.

SUMMARY Severe acute respiratory syndrome coronavirus 2 is the third beta-coronavirus since 2003 capable of causing lower respiratory tract infection, leading to severe cases of acute respiratory distress syndrome and death. Advanced age, high blood pressure and diabetes mellitus are three predictors of worse clinical outcomes. Multiple mechanisms could explain the greater susceptibility of diabetic people to respiratory infections. Chronic hyperglycemia alters both humoral and cellular immunity. This disease predisposes to virus receptor overexpression and an exaggerated inflammatory response, increasing the risk of decompensation and hyperglycemic crises. In the absence of an effective vaccine or treatment for the virus, this vicious circle should be stopped with an emphasis on controlling glucose. This paper presents different proposals for the treatment of diabetes mellitus both on an outpatient basis where telemedicine and other technologies will make it possible to continue adequate ambulatory care to maintain preventive isolation measures up to care in the intensive care unit.

Resumen El Lago de Tota es una fuente hídrica de gran importancia a nivel regional y nacional dado su valor ambiental y económico, este último representado por actividades agrícolas, pecuarias y piscícolas. Estas actividades han contribuido a la contaminación observada en la actualidad, siendo esta una problemática ambiental en constante ascenso, donde la salud, el desarrollo de las comunidades y los procesos ecológicos, se han visto afectados. De hecho, el Lago de Tota ha sido catalogado como uno de los ecosistemas más amenazados del planeta por la red mundial de humedales. A pesar de la problemática ambiental que representa la contaminación del Lago, son muy pocos los estudios que indagan acerca del daño genético generado por la exposición a los agentes tóxicos presentes en esta cuenca. A este respecto un modelo biológico óptimo para estudios de genotoxicidad lo constituye el pez cebra, dada su alta homología genética con el humano, así como su capacidad de regeneración, adaptación y respuesta inmune ante altas concentraciones de compuestos químicos como los plaguicidas. Esta revisión se enfoca en reportes recientes sobre la contaminación del Lago de Tota y en el uso de modelos biológicos para estudios de genotoxicidad.

Abstract Tota Lake is a water source of great importance at a regional and national level given its environmental and economic value, the latter represented by agricultural, livestock and fish farming activities. These activities have contributed to the contamination observed at present, being an environmental problem in constant rise, where the health, the development of the communities and the ecological processes have been affected. In fact, Lake Tota has been classified as one of the most threatened ecosystems on the planet by the global network of wetlands. Despite the environmental problems posed by the contamination of the Lake, there are very few studies that investigate the genetic damage generated by exposure to the toxic agents present in this basin. In this regard, an optimal biological model for genotoxicity studies is the zebrafish, given its high genetic homology with humans, as well as its capacity for regeneration, adaptation and immune response to high concentrations of chemical compounds such as pesticides. This review focuses on recent reports on Tota Lake contamination and the use of biological models for genotoxicity studies.

RESUMO Polymethylmetacrylte (PMMA) é um composto utilizado na indústria e desde os anos 80's também tem sido empregado nas áreas odontológica e biomédica como constituinte de cimentos ósseos. A hydroxyapatite (HAp) é uma biocerâmica produzida naturalmente nos ossos. Esses dois componentes são constituintes fundamentais no preparo de cimentos ósseos. A síntese artificial de HAp pode ser feita pelo método sol-gel. Bifosfanatos tem também sido utilizado na odontologia em implantes dentários e na medicina nuclear, como radiofármaco ou no tratamento paliativo sistêmico de redução de dor das metástasis ósseas com 153 Sm-EDTPM. A Vertebroplastia e Cifoplastia são técnicas empregadas na ortopedia utilizando o cimento ósseo, sendo procedimentos minimamente invasivos de baixo risco de infeções, aplicadas em osteoporose e fraturas de alto impacto. Recentemente, no Grupo de Pesquisa NRI – Nucleo de Radiações Ionizantes/UFMG, foi proposto um compósito de M-HAp com nuclideo metálico M incorporado na matriz, que após ativado é adicionado ao PMMA constituíndo um cimento ósseo radioativo que pode recuperar a estabilização o corpo ósseo, colando microfraturas, recompondo a anatômia e funcionalidade de peças afetadas pela compressão das metástases ósseas com possível redução de dor pela rápida descompressão induzida pela radiação. Modelos dosimétricos computacionais, sintese e caracterização destas biocerâmicas incorporando Re-188, Ho-166 ou Sm-153 tem indicado benefícios radioterapêuticos promissores, podendo se tornar uma alternativa para radioterapias convencionais, principalmente por conter a dose absorvida na estrutura óssea, por exemplo no corpo da vertebra poupando a medula espinhal. O presente artigo apresenta uma revisão sobre o tema. Nível de Evidência V, Opinião do Especialista

ABSTRACT Polymethylmetacrylte (PMMA) is used in the fields of dentistry and biomedicine as a constituent of bone cements. Hydroxyapatite (HAp) is a bioceramic produced naturally in the bones. PMMA and HAp are fundamental constituents in the preparation of bone cements. Bisphosphonates have also been used as radiopharmaceutical in dental implants and nuclear medicine, or as palliative systemic treatment for pain reduction in bone metastasis. Vertebroplasty and kyphoplasty are bone cement-based techniques used in orthopedics, being minimally invasive procedures with low risks of infections, applied in osteoporosis and high-impact fractures. Recently, Núcleo de Radiações Ionizantes da Universidade Federal de Minas Gerais proposed a synthetic composite of M-HAp with a metallic nuclide M. After irradiation, M-HAp was added to PMMA, compounding a radioactive bone cement that can recover bone body stabilization, pasting microfractures and recomposing the anatomy and functionality of the affected parts by the compression of bone metastases, with possible pain reduction through quick radiation-induced decompression. Computational dosimetric models, and the synthesis and characterization of bioceramics that incorporate Re-188, Ho-166, or Sm-153 have demonstrated the benefits of these biometrics as promising alternative therapies, mainly from their ability to maintain the ionization in the bone structure, thereby sparing the spinal cord. This article presents a review on this topic. Level of Evidence V, Expert Opinion.

Antecedentes: Las infecciones por Klebsiella pneumoniae productora de carbapenemasa (KPC) son un problema de salud pública mundial. Desde 2008 nuestra institución experimenta casos endémicos de infecciones por KPC posteriores a un brote cuyo caso índice fue un paciente de Israel admitido para trasplante hepático. Objetivo: Describir características clínicas y mortalidad en pacientes hospitalizados con infecciones nosocomiales por KPC. Métodos: Estudio observacional retrospectivo, descriptivo. Resultados: Un total de 52 pacientes fueron incluidos, la edad media fue 45,7 ± 27 años, 65,4% fueron hombres. Uso de inmunosupresores, cirugía gastrointestinal, hepatopatía crónica y trasplante de órgano sólido fueron las comorbilidades importantes. El 100% recibió antibióticos antes de la infección por KPC. Las principales infecciones fueron bacteriemia (30,7%), infección intraabdominal (23,1%) y neumonía (17,3%). El tratamiento fue dirigido por antibiograma en 50,7%. Tigeciclina fue administrada en el 51,9% y colistina en el 32,7%, ambas en terapia combinada con otros antibióticos. En el 15,4% se utilizó tigeciclina más colistina. La duración del tratamiento fue 15,7 ± 7,5 días. El 51,9% desarrolló bacteriemia y falla renal aguda y el 76,9% requirió atención en UCI. La mortalidad fue 48,1% y fue significativamente mayor en pacientes con bacteriemia vs. sin bacteriemia (74,1 vs. 20%; p = 0,01). No hubo diferencias significativas en mortalidad cuando se comparó uso de tigeciclina vs. colistina (45 vs. 52%; p = 0,609). Conclusión: La inmunosupresión, cirugía gastrointestinal, tratamiento previo con antibióticos y estancia en UCI son factores importantes para la infección por KPC. La mortalidad es alta a pesar de la terapia dirigida, especialmente en pacientes con bacteriemia.

Background: Carbapenemase-producing Klebsiella pneumoniae (KPC) infections are a worldwide public health problem. Since 2008, our institution has experienced endemic cases of KPC infection after an outbreak whose index case was a patient from Israel admitted for liver transplantation. Objective: To describe the clinical characteristics and mortality of inpatients with nosocomial KPC infections. Methods: Retrospective, descriptive observational study. Results: A total of 52 patients were included, with an average age of 45.7 ± 27 years; 65.4% were men. Use of immunosuppressants, gastrointestinal surgery, chronic liver disease and solid organ transplantation were significant comorbidities. All the patients had received antibiotics before the KPC infection. The primary infections were bacteraemia (30.7%), intra-abdominal infections (23.1%) and pneumonia (17.3%). Treatment was directed by antibiogram in 50.7% of cases. Tigecycline was administered in 51.9% of cases and colistin in 32.7%, both in combination therapy with other antibiotics. Colistin plus tigecycline was used in 15.4% of cases. The treatment duration was 15.7 ± 7.5 days, with 51.9% of patients developing bacteraemia and acute renal failure and 76.9% requiring ICU care. Mortality was 48.1% and was significantly higher in the patients with bacteraemia compared with those without (74.1 vs. 20%, respectively, p = 0.01). There were no significant differences in mortality between tigecycline and colistin use (45 vs. 52%, respectively, p = 0.609). Conclusion: Immunosuppression, gastrointestinal surgery, previous treatment with antibiotics and ICU stay are important factors for infection with KPC. Mortality is high despite targeted therapy, particularly in patients with bacteraemia.

La hiperplasia macro nodular bilateral o hiperplasia adrenal nodular bilateral independiente de la hormona adrenocorticotrópica es una de las causas menos frecuentes de hipercortisolismo, su diagnóstico supone un reto y no se tiene claridad de cuál es la mejor aproximación terapéutica. El muestreo venoso adrenal que frecuentemente se utiliza para hacer la distinción del sitio de producción hormonal en el hiperaldosteronismo primario podría ser una herramienta útil en este contexto ya que podría brindar información que pudiera guiar el tratamiento. Presentamos el caso de una paciente con síndrome de Cushing ACTH independiente en quien el uso del muestreo venoso adrenal con algunas modificaciones cambio de manera radical el tratamiento y permitió confirmar una hiperplasia adrenal macro nodular.

The primary bilateral macronodular adrenal hyperplasia or the independent adrenocorticotropic hormone bilateral nodular adrenal hyperplasia is a rare cause hypercortisolism, its diagnosis is challenging and there is no clear way to decide the best therapeutic approach. Adrenal venous sampling is commonly used to distinguish the source of hormonal production in patients with primary hyperaldosteronism. It could be a useful tool in this context because it might provide information to guide the treatment. We report the case of a patient with ACTH independent Cushing syndrome in whom the use of adrenal venous sampling with some modifications radically modified the treatment and allowed the diagnosis of a macronodular adrenal hyperplasia.

Introduction: Tuberculosis (TB) remains an entity of high prevalence and mortality worldwide. The rising drug resistance is a public health problem. Besides, non-tuberculosis mycobacterial (NTM) infections are described with increasing frequency in areas of high prevalence of TB. Objectives: To determine epidemiological, clinical and microbiological characteristics of mycobacterial infections documented by culture. Materials and Methods: An observational, descriptive study in hospitalized patients. Results: M. tuberculosis complex was identified in 90,9% of 187 patients; 9,1% had NTM, 64% were male and the mean age was 40 years (range 1-88 years). The main co-morbidities were HIV / AIDS (23.5%), use of corticosteroids (13.3%) and chronic kidney disease (9.6%). Clinical forms were pulmonary (56.6%), extra-pulmonary (23.9%) and disseminated (19.2 The most common extra-pulmonary compromise was nodal (7.4%) and gastrointestinal (7%). 10.6% of M. tuberculosis were multi-drugresistant (MDR) and 2.12% had extended drug resistance (XDR). Mycobacterium avium andM. abscessus were the most frequent NTM. Overall mortality was 10%. Conclusions: In our study immune suppression is the main risk factor for extrapulmonary and disseminated disease. Resistance, MDR and XDR is higher in inpatients with TB. MNT infections are not uncommon in our country.

Introducción: Tuberculosis (TBC) es aún una entidad de alta prevalencia y mortalidad en el mundo. La resistencia ascendente a fármacos es un problema de salud pública. Además se describen con mayor frecuencia infecciones por micobacterias no tuberculosas (MNT) en áreas de alta prevalencia de TBC. Objetivos: Determinar características epidemiológicas, clínicas y microbiológicas de las infecciones por micobacterias documentadas por cultivo. Materiales y Métodos: Estudio observacional, descriptivo, en pacientes hospitalizados. Resultados: De 187 pacientes, en 90,9% se identificó complejo M. tuberculosis y en 9,1% MNT; 64% fueron hombres. Edad promedio 40 años (rango 1-88 años). Las principales co-morbilidades fueron infección por VIH/SIDA (23,5%), uso de corticoesteroides (13,3%) y enfermedad renal crónica (9,6%). Las formas clínicas fueron pulmonares (56,6%), extra-pulmonares (23,9%) y diseminadas (19,2%). El compromiso extra-pulmonar más frecuente fue ganglionar (7,4%) y gastrointestinal (7%). En M. tuberculosis 10,6% fueron multidrogoresistentes (MDR) y 2,12% con resistencia extendida (XDR). Mycobacterium avium y M. abscessus fueron las MNT más frecuentes. La mortalidad general fue 10%. Conclusiones: Inmuno-supresión es el principal factor de riesgo para enfermedad extrapulmonar y/o diseminada y la resistencia a fármacos en pacientes hospitalizados con TBC es llamativa, con mayor incidencia de MDR y XDR. Las infecciones por MNT no son infrecuentes en nuestro medio.

Infection is the most serious complication of arthroplasty. It's a rare event usually caused by Staphylococcus spp. Prosthetic tuberculosis is rarely reported. We report the case of a 41 year-old patient who underwent a hip replacement for osteoarthritis and after multiple procedures an infection caused by Mycobacterium tuberculosis was documented. We review the literature of previously reported cases.

La infección es la complicación más seria de una artroplastia. Es un evento poco frecuente, usualmente causado por especies de Staphylococcus. La tuberculosis protésica es una entidad poco habitual. Comunicamos el caso de una paciente de 41 años sometida a un reemplazo de cadera por una artrosis y después de múltiples procedimientos se documentó una infección por Mycobacterium tuberculosis. Realizamos una revisión de la literatura de los casos previamente reportados.

Visamos aqui problematizar as diferentes concepções de pobreza e "questão social" na tradição liberal, e suas formas típicas de enfrentamento, no contexto do liberalismo clássico, no século XIX, do keynesianismo, no século XX, e do neoliberalismo, a partir da atual crise do capital. Com isto, oferecemos uma reflexão sobre aspectos para uma caracterização histórico-crítica de pobreza e "questão social". Finalmente, procuramos problematizar os caminhos para a busca de diminuição da desigualdade social, mediante políticas compensatórias no contexto atual.

We aim at questioning the various concepts of poverty and "social issue" in the liberal tradition, and their typical ways of confrontation, in the context of the classical liberalism in the nineteenth century, of the keynesianism, in the twentieth century and of the neo-liberalism from the current crisis of the capital. Doing so, we offer a reflection concerning aspects related to a historical and critical characterization of poverty and "social issue". Finally, we question the ways of reducing social inequality, through compensatory policy in the current context.

Martha Senn es tal vez la cantante lírica colombian a de mayor reconocimiento mundial. En estas páginas se hace una semblanza de su vida profesional, resaltando los giros en su trayectoria. Su vida ha sido una búsqueda permanente de respuestas a sus propias indagaciones vitales sobre el sentido de lo social, asociado con lo que mejor sabe hacer: cantar. Al final queda formulado un principio fundamental en las palabras de la propia Martha: la necesidad de utilizar la música como herramienta de transformación social.

Martha Senn is perhaps the greatest worldwide-recognized Colombian opera singer. These pages make a resemblance of her career, highlighting the big turns in her pursues. Her life has been a constant search for answers to her own vital inquiries about the meaning of the social ground, associated with what she does best: singing. At the end, a fundamental principle is formulated in the words of Martha herself: the need to use music as a social transformation tool.

Martha Senn é talvez a cantora de ópera colombiana com maior reconhecimento mundial. Estas páginas trazem um esboço de sua carreira, destacando os giros de sua trajetória profissional. Sua vida tem sido uma busca constante de respostas para suas próprias investigações vitais sobre o significado da vida social em relação com o que ela faz de melhor que é cantar. No final fica formulado um princípio fundamental nas palavras da mesma Martha: a necessidade de usar a música como ferramenta de transformação social.

O artigo visa apresentar a sistematização dos dados sobre pós-graduação e pesquisa nos países hispano-americanos, a partir de documentos apresentados em dois eventos latino-americanos de pós-graduação. O objetivo é estimular a articulação, os convênios e o intercâmbio entre as unidades de ensino brasileiras e as dos demais países do subcontinente latino-americano.

This article presents the systematization of data on postgraduation and research in Spanish American countries Such systematization was done from documents submitted in two Latin American postgraduation events. The goal is to stimulate the joint ventures, the agreements and the exchanges among Brazilian and other Latin American colleges.

As transformações sociais contemporâneas, operadas pela programática neoliberal sob o comando do capital financeiro, trazem novos desafios ao conjunto de cidadãos e de homens e mulheres que vivem da venda de sua força de trabalho. Os assistentes sociais, individual e coletivamente, não são alheios a esta realidade. A profissão já se caracterizou por enfrentar estes desafios, questionando e problematizando seu papel na sociedade, tentando assumir perfis mais críticos e comprometidos com os interesses dos trabalhadores e dos setores subalternos. Exemplo disso são o "Movimento de Reconceptualização" e a posterior tentativa de definir um "Serviço Social Alternativo" preocupado com o sentido de sua prática, com o processo de conhecimento crítico, com a crítica ao capitalismo e às situações de injustiça social. Os desafios atuais levam a, superando anteriores debilidades, construir coletivamente um projeto ético-político profissional que possa enfrentar com competência e compromisso, no interior das forças sociais progressistas, as condições nas quais vivem os trabalhadores (com e sem emprego) e os demais setores subalternos.

Contemporary social transformations, operated by the neoliberal program under the command of financial capital, bring new challenges to the group of citizens and men and women who live by the sale of their labor power. Social workers, individually and collectively, are not separate from this reality. The profession was characterized by its confrontation with these challenges and its questioning and analysis of its role in society, in its attempt to assume more critical profiles and commitments to the interests of workers and the subaltern sectors. An example of this is the "Reconceptualization Movement" and the later attempt to define an "Alternative Social Service" concerned with the meaning of its practice, with the process of critical knowledge, with a criticism of capitalism and its situations of social injustice. The current challenges include overcoming earlier weaknesses, collectively constructing an ethical-political professional project that can competently and committedly confront, at the heart of progressive social forces, the conditions in which workers live (with or without employment) as well as other subaltern populations.