Resumen En el escenario clínico es cada vez más frecuente la atención de pacientes adultos mayores, lo cual es un desafío debido a la presencia de mayor comorbilidad y de condiciones o síndromes geriátricos (fragilidad, sarcopenia, caídas) que usualmente los acompañan. La fragilidad es un síndrome común en el paciente anciano, en quien existe una disminución de la reserva fisiológica que genera vulnerabilidad frente a factores estresantes. Su prevalencia aumenta a la par con la expectativa de vida, y tiene un impacto significativo en la salud pública ya que estudios han demostrado que se asocia con mayores tasas de hospitalización, desenlaces adversos quirúrgicos, mortalidad y costos para los sistemas de salud. Se hace revisión actualizada de la relación existente entre la fragilidad y enfermedad cardiovascular. El conocimiento sobre fragilidad sirve como guía para tomar decisiones y como objeto de investigación de un segmento de una población con gran crecimiento.

Abstract The care of elderly patients is becoming increasingly more common in the clinical setting. This presents a challenge due to there being increased comorbidity and the presence of geriatric conditions or syndromes (frailty, sarcopenia, falls) that usually accompany them. Frailty is a common syndrome in the elderly patient, in which there is a decrease in physiological reserve that can lead to vulnerability to stress factors. Its prevalence increases on a par with life expectancy, and has a significant impact on public health since studies have demonstrated that it is associated with higher hospital admission rates, adverse surgical outcomes, mortality, and costs for the health systems. An update review has been made on the existing relationship between frailty and cardiovascular disease. Knowledge about frailty will serve as a guide to make decisions and as an objective in the investigation of an increasingly growing segment of the population.

Resumo Embora as infecções invasivas e a mortalidade causada por espécies de Candida estejam aumentando entre pacientes comprometidos, a resistência a agentes antifúngicos comuns também é um problema crescente. Analisamos 60 leveduras isoladas de pacientes com candidíase invasiva utilizando como estratégia PCR/RFLP baseada na região espaçadora transcrita interna (ITS2) para identificar diferentes espécies patogênicas de Candida. A análise por PCR foi realizada a partir de ADN genómico com um par de iniciadores da região ITS2-5.8S rDNA. As amostras PCR-positivas foram caracterizadas por RFLP. A restrição resultou em 23 isolados identificados como C. albicans usando AlwI, 24 isolados como C. parapsilosis usando RsaI e 13 como C. tropicalis usando XmaI. Em seguida, avaliou-se o grupo de todos os isolados quanto à sua susceptibilidade a um painel de leveduras killer previamente descritas, resultando em 75% sendo suscetíveis a pelo menos uma levedura killer, enquanto que as restantes não foram inibidas por qualquer cepa. C. albicans foi o grupo mais suscetível enquanto C. tropicalis teve o menor número de inibições. Não se obteve um padrão de inibição específico da espécie com este painel de leveduras killer. Metschnikowia pulcherrima, Pichia kluyveri e Wickerhamomyces anomalus foram as cepas que inibiram a maioria dos isolados de Candida spp.

Abstract Although invasive infections and mortality caused by Candida species are increasing among compromised patients, resistance to common antifungal agents is also an increasing problem. We analyzed 60 yeasts isolated from patients with invasive candidiasis using a PCR/RFLP strategy based on the internal transcribed spacer (ITS2) region to identify different Candida pathogenic species. PCR analysis was performed from genomic DNA with a primer pair of the ITS2-5.8S rDNA region. PCR-positive samples were characterized by RFLP. Restriction resulted in 23 isolates identified as C. albicans using AlwI, 24 isolates as C. parapsilosis using RsaI, and 13 as C. tropicalis using XmaI. Then, a group of all isolates were evaluated for their susceptibility to a panel of previously described killer yeasts, resulting in 75% being susceptible to at least one killer yeast while the remaining were not inhibited by any strain. C. albicans was the most susceptible group while C. tropicalis had the fewest inhibitions. No species-specific pattern of inhibition was obtained with this panel of killer yeasts. Metschnikowia pulcherrima, Pichia kluyveri and Wickerhamomyces anomalus were the strains that inhibited the most isolates of Candida spp.

OBJECTIVE: To understand the public policy-making process as it relates to breast cancer care in five Latin American countries. METHODS: An exploratory-evaluative study was conducted in Argentina, Brazil, Colombia, Mexico, and Venezuela in 2010, with the selection of countries based on convenience sampling. Sixty-five semi-structured interviews were conducted with government officials, academics, and representatives of trade associations and civil society organizations. A content analysis of secondary sources was performed. Information sources, data, and informants were mixed using the triangulation method for purposes of analysis. RESULTS: The countries that have made the most progress in public policy-making related to breast cancer are Brazil and Mexico. Although Argentina, Colombia, and Venezuela do not have policies, they do have breast cancer care programs and activities. Two perspectives on the development of public policies became evident: the first includes the broad participation of both governmental and nongovernmental sectors, whereas the second, more narrow approach involves government authorities alone. CONCLUSIONS: The results point to significant differences in public policy-making related to breast cancer in the Region. They also show that greater progress has been made in countries where policies have been developed through inclusive participation processes.

OBJETIVO: Conocer el proceso de formulación de política pública sobre la atención del cáncer de mama en cinco países de América Latina. MÉTODOS: Estudio evaluativo exploratorio realizado en Argentina, Brasil, Colombia, México y Venezuela en 2010. La muestra de países seleccionados fue de conveniencia. Se realizaron 65 entrevistas semiestructuradas a funcionarios gubernamentales, académicos y representantes de gremios profesionales y de organizaciones de la sociedad civil. Se realizó un análisis de contenido para fuentes secundarias. Se integraron fuentes de información, datos e informantes para el análisis mediante el método de triangulación. RESULTADOS: Los países con mayor avance en la formulación de políticas públicas sobre el cáncer de mama son Brasil y México. Argentina, Colombia y Venezuela, pese a no tener una política definida, disponen de programas y acciones para su atención. Se distinguen dos perspectivas de desarrollo para estas políticas públicas: una con amplia participación de los sectores gubernamental y no gubernamental, y otra más restringida a la participación exclusiva de autoridades gubernamentales. CONCLUSIONES: Los resultados traducen importantes diferencias entre países en la formulación de políticas públicas sobre el cáncer de mama en la Región y destacan el mayor avance en aquellos países donde se han desarrollado a través de procesos de participación incluyente.

Objetivo Analizar la formación académica que reciben los estudiantes de medicina y enfermería sobre el cáncer de mama (CaMa) durante el trascurso de su carrera universitaria. Materiales y Métodos Estudio exploratorio realizado en 2009. Basado en entrevistas semi-estructuradas a actores clave y revisión documental. Población de estudio: 199 Facultades/Escuelas de medicina y 108 Escuelas/Institutos de enfermería. Unidad de análisis: plan de estudios. Resultados En 16,8 % de los planes de estudio de medicina y 6,3 % de enfermería se encontró información específica de contenidos sobre CaMa. La capacitación que reciben los médicos es predominantemente desarrollada por las áreas biomédica y clínica y en menor proporción en el área socio-médica. En enfermería los temas que más se desarrollan son en áreas comunitarias, abordando contenidos de promoción de la salud y prevención de la enfermedad (estilos de vida saludable e identificación de mujeres con alto riesgo de padecer CaMa). Discusión Se encontró escasa evidencia sobre entrenamiento específico para la detección y atención del cáncer de mama en los planes de estudio. Por los resultados encontrados es necesario fortalecer los currículos para formar a los futuros profesionales con capacidades para trabajar en la solución de los problemas y necesidades específicos de salud de la población particularmente en acciones de prevención primaria y secundaria.

Objective Analyzing formal knowledge about breast cancer (BC) issues that medical and nursing students receive from different syllabuses and courses during their undergraduate studies. Materials and Methods This exploratory study was conducted in 2009; it was based on semi-structured interviews applied to key stakeholders and complemented by an analysis of their undergraduate courses. The study population consisted of 199 Faculties and Schools of Medicine and 108 Schools and Colleges of Nursing and the unit of analysis consisted of the syllabuses for the undergraduate courses. Results 16.8 % of the medical courses and 6.3 % of the nursing courses had specific information about BC. Medical students predominantly received their training in biomedical and clinical areas and the socio-medical area to a lesser extent. The issues in nursing courses was mainly focused (in community areas) on promoting health and preventing disease (healthy lifestyles and recognition of women at high risk regarding BC). Discussion Little evidence was found that medicine and nursing syllabuses contain issues related to BC. Medical and nursing curricula should be strengthened to improve professional skills and abilities related to BC to solve the affected population's problems and health needs, particularly regarding primary and secondary prevention.

Objective Analyzing formal knowledge about breast cancer (BC) issues that medical and nursing students receive from different syllabuses and courses during their undergraduate studies. Materials and Methods This exploratory study was conducted in 2009; it was based on semi-structured interviews applied to key stakeholders and complemented by an analysis of their undergraduate courses. The study population consisted of 199 Faculties and Schools of Medicine and 108 Schools and Colleges of Nursing and the unit of analysis consisted of the syllabuses for the undergraduate courses. Results 16.8 % of the medical courses and 6.3 % of the nursing courses had specific information about BC. Medical students predominantly received their training in biomedical and clinical areas and the socio-medical area to a lesser extent. The issues in nursing courses was mainly focused (in community areas) on promoting health and preventing disease (healthy lifestyles and recognition of women at high risk regarding BC). Discussion Little evidence was found that medicine and nursing syllabuses contain issues related to BC. Medical and nursing curricula should be strengthened to improve professional skills and abilities related to BC to solve the affected population's problems and health needs, particularly regarding primary and secondary prevention.

Objetivo Analizar la formación académica que reciben los estudiantes de medicina y enfermería sobre el cáncer de mama (CaMa) durante el trascurso de su carrera universitaria. Materiales y Métodos Estudio exploratorio realizado en 2009. Basado en entrevistas semi-estructuradas a actores clave y revisión documental. Población de estudio: 199 Facultades/Escuelas de medicina y 108 Escuelas/Institutos de enfermería. Unidad de análisis: plan de estudios. Resultados En 16,8 % de los planes de estudio de medicina y 6,3 % de enfermería se encontró información específica de contenidos sobre CaMa. La capacitación que reciben los médicos es predominantemente desarrollada por las áreas biomédica y clínica y en menor proporción en el área socio-médica. En enfermería los temas que más se desarrollan son en áreas comunitarias, abordando contenidos de promoción de la salud y prevención de la enfermedad (estilos de vida saludable e identificación de mujeres con alto riesgo de padecer CaMa). Discusión Se encontró escasa evidencia sobre entrenamiento específico para la detección y atención del cáncer de mama en los planes de estudio. Por los resultados encontrados es necesario fortalecer los currículos para formar a los futuros profesionales con capacidades para trabajar en la solución de los problemas y necesidades específicos de salud de la población particularmente en acciones de prevención primaria y secundaria.

The skin prick test (SPT) is a simple and fast method used routinely in allergology practice. Systemic reactions have been described with this technique on few occasions. We are presenting a case of anaphylaxis with hemodynamic consequences after carrying out skin prick test with a cat dander extract. A 23 years old female who suffered rhinoconjunctivitis and asthma following contact with cats. We performed skin prick test with a battery of the usual inhalants. Twenty minutes after carrying out the prick test the patient showed intense ocular irritation and reddening followed by dysphonia and a feeling of pharyngeal occupation. Although skin prick test is a safe diagnostic approach, it should be performed only in places equipped to treat anaphylaxis and for trained specialists.

Las pruebas cutáneas en prick (SPT) son un método sencillo y muy útil en la práctica alergológica diaria. Se han descrito reacciones sistémicas con este método diagnóstico en contadas ocasiones. Presentamos un caso de anafilaxia tras la realización de SPT con epitelio de gato. Se trataba de una mujer de 23 años que presentaba rinoconjuntivitis y asma bronquial al contacto con gato. Realizamos SPT con bateria de aeroalérgenos habituales, presentando cuadro de irritación ocular, disfonía y sensación de ocupación faríngea a los 20 minutos. Aunque el riesgo de reacción sistémica tras SPT es escaso, recomendamos la realización de esta prueba diagnóstica en lugares preparados para tratar reacciones anafilácticas y por personal experto.

Mesalazine is a derivative of 5-aminosalicylic acid (5-ASA), which is useful in the treatment of intestinal inflammatory disease. Sulfasalazine is formed by two parts, sulfapyridine and 5-ASA, the latter being the active part of the molecule. The new preparatives derived from 5-ASA were developed in an attempt to avoid the traditionally associated side effects to sulfapyridine, although they are still observed and new effects appear. We present two cases. The first is a man diagnosed of inflammatory intestinal disease, with background of two previous reactions of urticaria and angioedema after acetyl salicylic acid, who presented urticaria after taking mesalazine. The second one had generalized urticaria after three months of initiating treatment with mesalazine. Given the need for treatment in both cases, a desensitization protocol to mesalazine was made. It was developed in 17 days in our service. Tolerance to that drug to therapeutic doses is reached. When faced with patients with hypersensitivity to different drugs, that are necessary to treat their disease, "desensitization" regimes, that assure good tolerance, can be made.

La mesalazina es un derivado del ácido 5-aminosalicílico (5-ASA, el cual es útil en el tratamiento de la enfermedad inflamatoria intestinal. La sulfasalazina está formada por dos partes, la sulfapiridina y el 5-ASA, siendo ésta última la parte activa de la molécula. Los nuevos preparados derivados del 5-ASA se desarrollaron tratando de evitar los efectos secundarios tradicionalmente asociados a la sulfapiridina, aunque se siguen observando y aparecenA nuevos efectos. Presentamos dos casos, el primero es un varón diagnosticado de enfermedad inflamatoria intestinal, con antecedentes de dos reacciones previas de urticaria y angioedema tras ácido acetilsalicílico, que presenta urticaria tras la toma de mesalazina. El segundo presenta urticaria generalizada tras tres meses de iniciar tratamiento con mesalazina. Dada la necesidad de tratamiento en ambos casos, se realiza el protocolo de desensibilización a mesalazina desarrollado en 17 días en nuestro servicio, con el que se llega a la tolerancia de dicho fármaco hasta dosis terapéuticas. Ante pacientes con hipersensibilidad a distintos fármacos, que sean necesarios para el tratamiento de su patología, pueden realizarse pautas de "desensibilización", que aseguren una buena tolerancia.