Abstract The Committee for Infections in Immunocompromised Children of Sociedad Latinoamericana de Infectología Pediátrica, presents this Consensus document, titled “Management of episodes of febrile neutropenia in children with cancer. Consensus of the Sociedad Latinoamericana de Infectología Pediátrica 2021”. The document includes recommendations on prevention, prediction, diagnosis, treatment and prognosis of episodes of fever and neutropenia, including specific recommendations on: Analysis at admission; evaluation, adjustments and duration of antimicrobial therapies; diagnosis and management of invasive fungal infection; analysis of the main clinical source of infections; environmental conditions necessary for hospitals caring for children with cancer and chemoprophylaxis. Special emphasis has been placed on providing the best recommendations to optimize the management of episodes of fever and neutropenia in children with cancer, with equity and excellence through all the centers that treat these patients in Latin America.

Resumen El Comité de Infecciones en el Niño Inmunocomprometido de la Sociedad Latinoamericana de Infectología Pediátrica, entrega este documento de Consenso, llamado “Manejo de los episodios de neutropenia febril en niños con cáncer. Consenso de la Sociedad Latinoamericana de Infectología Pediátrica 2021”. El documento contiene recomendaciones sobre aspectos de prevención, predicción, diagnóstico, tratamiento y pronóstico de los episodios de fiebre y neutropenia, incluyendo recomendaciones específicas sobre: Análisis de ingreso; evaluación, ajustes y duración de terapias antimicrobianas; diagnóstico y manejo de infección fúngica invasora; análisis de los principales focos clínicos de infección; condiciones ambientales necesarias para hospitales que atienden niños con cáncer y quimioprofilaxis. Se ha puesto especial énfasis en entregar las mejores recomendaciones para optimizar el manejo de los episodios de fiebre y neutropenia en niños con cáncer, buscando la equidad y la excelencia a través de todos los centros que atienden estos pacientes en América Latina.

ABSTRACT After more than a year since the novel coronavirus (SARS-CoV-2) disease 2019 or COVID-19 has reached the status of a global pandemic, the number of COVID-19 cases continues to rise in Brazil. As no effective treatment been approved yet, only mass vaccination can stop the spread of SARS-CoV-2 and end the COVID-19 pandemic. Multiple COVID-19 vaccine candidates are under development and some are currently in use. This study aims to describe the characteristics of individuals who have registered in an online platform to participate in clinical trials for COVID-19 vaccines. Additionally, participants’ characteristics according to age and presence of comorbidities associated with severe COVID-19 and differences of SARS-CoV-2 testing across different geographical areas/neighborhoods are provided. This was a cross-sectional web-based study conducted between September and December/2020, aiming to reach individuals aged ≥18 years who live in Rio de Janeiro metropolitan area, Brazil. Among 21,210 individuals who completed the survey, 20,587 (97.1%) were willing to participate in clinical trials for COVID-19 vaccines. Among those willing to participate, 57.8% individuals were aged 18-59 years and had no comorbidity, 33.7% were aged 18-59 years and had at least one comorbidity, and 8.6% were aged ≥ 60 years regardless the presence of any comorbidity. Almost half (42.6%) reported ever testing for COVID-19, and this proportion was lower among those aged ≥ 60 years (p < 0.001). Prevalence of positive PCR results was 16.0%, higher among those aged 18-59 years (p < 0.009). Prevalence of positive antibody result was 10.0%, with no difference across age and comorbidity groups. Participants from areas/neighborhoods with higher Human Development Index (HDI) reported ever testing for SARS-CoV-2 more frequently than those from lower HDI areas. Interest to participate in clinical trials for COVID-19 vaccines candidates in Rio de Janeiro was significantly high. The online registry successfully reached out a large number of individuals with diverse sociodemographic, economic and clinical backgrounds.

ABSTRACT We studied the fungal endophyte community of the leaves of Myracrodruon urundeuva in Brazil along with their potential to produce L-asparaginase. In total, 187 endophytes were isolated. The colonization rate of leaf fragments from caatinga (10.41 %) was lower than those from brejo de altitude (39.58 %). Sequences of ITS rDNA from all endophytes revealed relationships with Ascomycota (Botryosphaeriales, Chaetothyriales, Diaporthales, Eurotiales, Glomerellales, Hypocreales, and Pleosporales) and Basidiomycota (Polyporales). The most frequent endophytes were members of the genus Diaporthe. Talaromyces was an indicator genus for caatinga while Phyllosticta, Diaporthe, and Colletotrichum were for brejo de altitude. The composition of endophytic fungi in caatinga and brejo de altitude differed significantly, its richness and diversity (H' = 3.41) being significantly higher in brejo de altitude. Diaporthe sp. URM 7793 was the best producer of L-asparaginase (2.41 U/g), followed by Diaporthe sp. URM 7779 (2.00 U/g), Talaromyces sp. URM 7785 (1.91 U/g), and Diaporthe sp. URM 7792 (1.47 U/g). The composition of endophytic fungi assemblages is strongly influenced by the type of ecosystem. In its natural habitat, M. urundeuva harbors an important diversity of endophytes, which could be used to produce L-asparaginase.

Resumen En las regiones tropicales se ubican las abejas sin aguijón, las cuales producen una sustancia dulce denominada miel de cántaro con propiedades y usos diferentes a los de las abejas melíferas (Apis mellifera). Actualmente, se han desarrollado diversos trabajos enfocados a su caracterización, con la finalidad de contribuir con su conocimiento y el establecimiento de estándares de calidad. En este estudio se realizaron estudios fisicoquímicos, de aceptación y palinológicos en mieles de abejas sin aguijón de Soconusco, Chiapas. Se recolectaron nueve muestras de miel de las siguientes especies: Melipona solani (Ms), M. beecheii (Mb) y Scaptotrigona mexicana (Sm) en diferentes meliponarios. Nuestros resultados registraron valores fisicoquímicos que variaron de la siguiente manera: pH 2.8-4.8, conductividad eléctrica (CE) 114-1 211 μS/cm, acidez libre 24-100 meq/kg, aw 59-71 g/100 g, humedad 35-38 %, color 0.13-0.75 escala Pfund, azúcares reductores 47-71 %, hidroximetilfurfural (HMF) no determinado - 2.72 mg/100 g, y actividad de la días-tasa 1.92-11.22 ND. Por otro lado, el análisis del componente principal (PCA) de los valores fisicoquímicos mostró que el 86.9 % de la variabilidad total entre las especies se explica por los siguientes parámetros: aw, humedad, acidez libre, color, pH, azúcares y CE. Las mieles de Sm (PCA) se asociaron con un mayor contenido de agua, acidez libre y colores más oscuros, mientras que las mieles de Melipona con un sabor más dulce y una actividad de días-tasa más baja; por lo tanto, las mieles podrían agruparse por géneros. La prueba de aceptación mostró que el 78 % de las mieles eran preferidas, siendo la muestra de SmCa en la categoría “Probablemente no me gusta” debido al sabor amargo (desaprobado por los consumidores). Los resultados melisopalinológicos mostraron que las mieles de M. beecheii son monoflorales con un 45 % de polen de Fabaceae, mientras que las mieles de M. solani y S. mexicana son multi o poliflorales con diferentes tipos de polen: Fabaceae, Melastomataceae, Malvaceae y Asteraceae. De este estudio complementario observamos que se requiere poner en contacto a investigadores y productores, para que el acceso a los análisis de las mieles de abejas sin aguijón sea posible, y así mismo se pueda ayudar con el mejoramiento del manejo de los melionarios al momento de identificar e introducir la flora preferida por las abejas sin aguijón.

Abstract Stingless bees are located in the tropic areas, and produced a sweet natural substance called pot honey, with different properties and uses. Recently, most studies are focused on characterizing them, in order to contribute to their knowledge and the establishment of quality laws. Thus physicochemical, acceptance and palynological studies were performed in stingless bee honeys from Soconusco, Chiapas, in order to learn and contribute to their knowledge in the Tropics. Nine honey samples were collected from Melipona solani (Ms), M. beecheii (Mb) and Scaptotrigona mexicana (Sm) in different meliponaries. Our results registered physicochemical values that ranged as follow; pH 2.8-4.8, electrical conductivity (EC) 114-1211 μS/cm, free acidity 24-100 meq/kg, aw 59-71 g/100g, moisture 35-38 %, color 0.13-0.75 Pfund scale, reducing sugars 47-71 %, hidroxymethylfurfural (HMF) not determined - 2.72 mg/100g, and diastase activity 1.92-11.22 DN. On the other hand, the principal component analysis (PCA) of physicochemical values showed that 86.9 % of the total variability between species was explained by the following parameters aw, moisture, free acidity, color, pH, sugars and EC. Sm honeys were associated (PCA) with a higher water content, free acidity and darker colors, while Melipona honeys with a sweeter taste and a lower diastase activity; thus honeys could be grouped by genera. The acceptance test showed that 78 % of honeys were preferred, being the SmCa sample in the category “I likely dislike” due to the bitter taste (disapproved by consumers). The melisopalynological results showed that M. beecheii honeys are monofloral with a 45 % of Fabaceae pollen, while Melipona solani and Scaptotrigona mexicana honeys are multi or polyfloral with diferent pollen types; Fabaceae, Melastomataceae, Malvaceae and Asteraceae. From this complementary study we can asume that it is necessary to implicate researchers with producers, so they could have accesss to stingless bee honey analysis and to help them to improve meliponaries management by identifying and introducing stingless bee flora.

RESUMO Objetivo O transtorno de ansiedade social (TAS) e a insatisfação com a imagem corporal (IIC) são problemas comuns em estudantes universitários, mas poucos estudos avaliaram estudantes de Medicina. O objetivo do estudo foi estimar a prevalência, a gravidade e os correlatos de sintomas de TAS e IIC em estudantes de Medicina de uma universidade pública brasileira. Métodos Estudo transversal com 479 estudantes utilizando os seguintes instrumentos de avaliação estruturados: Social Phobia Inventory (SPIN), Body Shape Questionnaire (BSQ) e Beck Depression Inventory (BDI). Análises bivariadas foram seguidas de modelos de regressão logística para identificar preditores independentes de sintomas de TAS, IIC e ambos os desfechos combinados. Resultados A maioria dos estudantes era solteira (99%) e do sexo feminino (58,7%). As prevalências de sintomas de TAS (SPIN ≥ 19) e de ICC (BSQ ≥ 81) foram de 36,3% e 34,7%, respectivamente. Sintomas depressivos (BDI ≥ 19) ocorreram em 8,8% da amostra. Sintomas de TAS associaram-se de modo independente com: IIC, pensamentos de abandonar o curso, dificuldade de fazer amigos, sintomas depressivos e tratamento de saúde mental antes de ingressar na universidade. Além de sintomas de TAS, IIC associou-se com sexo feminino, dificuldade de fazer amigos, sintomas depressivos e índice de massa corporal (IMC). Setenta e oito estudantes (16,3%) apresentaram sintomas de TAS e IIC, o que se associou com sexo feminino, dificuldade de fazer amigos, insatisfação com o curso, sintomas depressivos e IMC. Conclusão Sintomas de TAS e IIC são problemas comuns e inter-relacionados que devem ser rastreados em estudantes de Medicina. A identificação de correlatos específicos pode contribuir para a elaboração de medidas preventivas minimizando o sofrimento e o impacto negativo desses problemas de saúde mental nos relacionamentos e no desempenho acadêmico desses estudantes.

ABSTRACT Objective Social anxiety disorder (SAD) and body image dissatisfaction (BID) are common problems among college students, but few studies focused on medical students. We aimed to estimate the prevalence, severity and correlates of SAD symptoms and BID among medical students of a Brazilian public university. Methods A cross-sectional study with 479 students, using structured instruments: Social Phobia Inventory (SPIN), Body Shape Questionnaire (BSQ), and Beck Depression Inventory (BDI). Bivariate analyses were followed by logistic regression models to obtain independent predictors of SAD symptoms, BID and both outcomes combined. Results Most students were single (99%) and female (58.7%). The prevalence rates of SAD symptoms (SPIN ≥ 19) and BID (BSQ ≥ 81) were 36.3% and 34.7%, respectively. Depressive symptoms (BDI ≥ 19) occurred in 8.8% of the sample. SAD symptoms were independently associated with: BID, thoughts of abandoning the course, difficulty making friends, depressive symptoms, and mental health treatment prior to university. Besides SAD symptoms, BID was associated with female sex, difficulty making friends, depressive symptoms, and body mass index (BMI). Seventy-eight students (16.3%) presented SAD symptoms and BID, which was associated with female sex, difficulty making friends, dissatisfaction with the course, depressive symptoms and BMI. Conclusion SAD symptoms and BID are common and related problems that should be screened for among medical students. The identification of specific correlates could contribute to the elaboration of preventive measures, minimizing the distress and negative impact of these mental health problems on relationships and academic performance.

ABSTRACT Introduction Latent tuberculosis infection diagnosis based on the release of interferon-gamma in cultures of peripheral blood cells stimulated with Mycobacterium tuberculosis antigens has replaced the tuberculin skin test in many countries with low tuberculosis prevalence. The IFN-γ production can be influenced by genetic polymorphisms, of which the IFNG + 874 (rs62559044) locus is the most studied. We investigated the possible influence of the IFNG + 874 A/T polymorphism on interferon-gamma test performance. Methods Patients diagnosed with pulmonary tuberculosis (75), volunteers with positive tuberculin skin test (70) and healthy volunteers with negative tuberculin skin test and no history of contact with tuberculosis (57) were evaluated regarding the IFNG + 874 genotype and the IFN-γ levels in whole blood cultures performed using an interferon-gamma commercial kit (QuantiFERON-TB® Gold In-Tube). Results IFN-γ production was not influenced by the IFNG + 874 genotype, regardless of antigen or mitogen-based stimulation, which suggests that other genes may influence IFN-γ production in response to mycobacteria. The IFNG + 874 polymorphism was found to exert no influence over QFT-IT test sensitivity in our study. Conclusions The IFNG + 874 polymorphism was not shown to influence QuantiFERON-TB® Gold In-Tube test performance in an admixed population from northeastern Brazil.

RESUMO: Os dermatófitos são fungos que podem causar infecções superficiais da pele, cabelo e unhas em humanos e animais. As espécies de dermatófitos mais frequentemente isoladas dos cães e gatos afetados por micoses são Microsporum gypseum e principalmente Microsporum canis. O papel crucial durante o processo de infecção é a produção de enzimas extracelulares essenciais para a invasão e estabelecimento do agente patogênico no tecido do hospedeiro. O objetivo deste trabalho foi isolar dermatófitos de cães e gatos e avaliar o perfil enzimático dos isolados obtidos. Amostras de pelos e escamas epidérmicas foram coletadas de cães e gatos em instalações veterinárias em Recife/PE, e os isolados foram identificados com base nas características macroscópicas e microscópicas. A análise qualitativa das enzimas urease, protease, lipase, colagenase e fosfolipase foi avaliada a partir dos dermatófitos isolados. Durante 10 meses, um total de 106 animais, que compreendeu de 99 cães e sete gatos com sinais clínicos, independentemente do sexo e raça foram avaliados. Apenas oito animais foram confirmados com dermatofitose, principalmente cães (n=7), sendo seis afetados por M. canis e um por M. gypseum, a raça mais afetada foi Yorkshire (n=3). No entanto, apenas um gato foi confirmado com M. canis. Não foi observada predisposição relacionada ao sexo quanto à ocorrência de dermatofitose nos cães e gatos avaliados. Os dermatófitos isolados apresentaram perfis semelhantes para as enzimas urease, lipase, protease, fosfolipase e colagenase, característica importante em infecções patogênicas. O diagnóstico clínico destas zoonoses com base na confirmação microbiológica e uma compreensão dos mecanismos subjacentes é de grande importância para o tratamento e prevenção de doenças fúngicas em animais.

ABSTRACT: Dermatophytes are fungi that can cause superficial infections of the skin, hair and nails in man and animals. The most frequent dermatophyte species isolated from dogs and cats are Microsporum gypseum, most notably Microsporum canis. The crucial role during the infection process is the production of extracellular enzymes essential for the invasion and establishment of the pathogen in the host tissue. The objective of this research was to isolate dermatophytes from dogs and cats and evaluate the enzymatic profile of the isolates obtained. Hair samples and epidermal scales were collected from dogs and cats in veterinary facilities in Recife-PE, and the isolates were identified based on macroscopic and microscopic characteristics. The qualitative analysis of the enzymes urease, protease, lipase, collagenase and phospholipase was evaluated from the isolated dermatophytes. During 10 months, a total of 106 animals, comprising of 99 dogs and seven cats with clinical signs, regardless of sex and race were evaluated. Only eight animals were confirmed with dermatophytosis, mostly dogs (n=7), being six affected by M. canis and one by M. gypseum, the race most affected was Yorkshire (n=3). However, only one cat was confirmed with M. canis. No sex-related predisposition was observed regarding the occurrence of dermatophytosis in dogs and cats evaluated. Isolated dermatophytes showed similar profiles for the enzymes urease, lipase, protease, phospholipase and collagenase, important characteristic for pathogenic infections. The diagnosis of this zoonosis based on microbiological confirmation and a better understanding of the underlying mechanisms is of great importance for the treatment and prevention of fungal diseases in animals.

ABSTRACT The aim of this study was to evaluate the contamination index of 18 agricultural soil samples in the southwest of Guanajuato by carrying out an analysis of the total trace element concentrations (arsenic [As], cadmium [Cd], chrome [Cr], copper [Cu], lead [Pb] and zinc [Zn]) with the use of Inductively Coupled Plasma Optical Emission Spectrometry and the geoaccumulation index (Igeo). The trace element concentration ranges of As (<0.009 mg kg-1 - 14.97 mg kg-1), Cd (0.06 mg kg-1 - 0.76 mg kg-1), Cr (11.31 mg kg-1 - 33.85 mg kg-1), Cu (<0.004 mg kg-1 - 99.98 mg kg-1), Pb (4.87 mg kg-1 - 41.79 mg kg-1) and Zn (21.98 mg kg-1 - 109.44 mg kg-1) were below the total reference concentration compared to the Mexican Official Norm NOM-147-SEMARNAT/SSA1-2004 (DOF, 2007). In regard to the Igeo, As, Cu, Pb and Zn presented concentrations ranging from uncontaminated to moderately contaminated categories (Class 0, 1 and 2) while the soils were uncontaminated by Cr (Class 0). On the other hand, the Cd showed the highest Igeo (Class 3: moderately to heavily contaminated).

RESUMEN El objetivo de esta investigación fue evaluar la contaminación de 18 muestras de suelos de uso agrícola del suroeste del estado de Guanajuato mediante el análisis de las concentraciones totales de elementos traza (arsénico [As], cadmio [Cd], cromo [Cr], cobre [Cu], plomo [Pb] y zinc [Zn]) por Espectrometría de Emisión Óptica con Plasma Acoplado Inductivamente y el Índice de Geoacumulación (Igeo). Los rangos de concentración de As (< 0.009 mg kg-1 - 14.97 mg kg-1), Cd (0.06 mg kg-1 - 0.76 mg kg-1), Cr (11.31 mg kg-1 - 33.85 mg kg-1), Cu (< 0.004 mg kg-1 - 99.98 mg kg-1), Pb (4.87 mg kg-1 - 41.79 mg kg-1) y Zn (21.98 mg kg-1 - 109.44 mg kg-1) se encontraron por debajo de la concentración de referencia total de la NOM-147-SEMARNAT/ SSA1-2004. En cuanto al Igeo, el As, Cu, Pb y Zn presentaron concentraciones entre las categorías no contaminado a moderadamente contaminado (Clase 0, 1 y 2) mientras que los suelos resultaron no contaminados con Cr (Clase 0). Por su parte, el Cd presentó el Igeo más alto (Clase 3: moderado a fuertemente contaminado).

Introducción. Los trasplantes de órganos son el único tratamiento para pacientes con enfermedades crónicas avanzadas. Sin embargo, existe una disparidad entre el número de pacientes en lista de espera y el número de donantes. Una forma de solucionar esto es mediante la educación y la sensibilización de la comunidad. El objetivo de este estudio fue evaluar el impacto que tuvo una campaña de promoción de la donación en un centro de trasplantes colombiano. Métodos. Se hizo una encuesta en la institución sobre el conocimiento previo y las creencias sobre la donación. Posteriormente, se diseñó una estrategia para informar, educar y promover la donación y, finalmente, se llevó a cabo un estudio transversal para evaluar el impacto de la campaña. Resultados: hubo un incremento del 56 % de potenciales donantes, así como de la obtención de órganos y tejidos: 100 % de órganos sólidos, 200 % de tejido ocular y 850 % de tejido óseo. Discusión. El conocer la actitud hacia la donación permite determinar factores que influyen en la toma de decisiones y así elaborar campañas que generen un aumento en los índices de donación. Según nuestro estudio, el generar una cultura a favor de la donación tiene un alto impacto en los índices de donación, y una posible causa de los bajos índices podría corresponder a la falta de información que tienen las personas, incluyendo los trabajadores de la salud. Este trabajo puede ser extrapolado a nivel nacional para conocer las causas de las negativas a donar y adoptar políticas que aumenten los índices de donación.

Introduction: Organ transplant is the only effective treatment for patients with advanced chronic disease. Although there is a gap between the number of patients in the transplant waiting lists and the number of donors, one way to diminish the waiting lists is by educating and creating awareness in the community. The objective of this study was to evaluate the impact of an institutional campaign that encourages organ donation at a Colombian transplant center. Methodology: An institutional survey was carried out in order to assess the prior knowledge, myths and beliefs around organ and tissue donation. Subsequently, a plan was designed to inform, educate and promote organ donation within the institution. Finally, a cross-sectional study was carried out to evaluate the impact of the campaign during the years of 2014-2015. Results: There was an increase of 56% in the number of potential donors as well of as of organ and tissue procurements: 100% of solid organs, 200% ocular tissue and 850% bone tissue. Discussion: Knowing the attitude towards organ and tissue donation allows to determine factors that influence decision making and to develop campaigns that generate an increase in donation rates. According to our study, generating a culture for organ donation has a high impact on donation rates, and a possible cause of the low rates could correspond to the lack of information that people have, including health workers. This work could be extrapolated nationally in order to recognize the causes of donation denials and to adopt policies that increase donation rates.

Objective: To determine the clinical characteristics and management of subcapsular hepatic hematoma (SHH) as a result of severe preeclampsia and HELLP syndrome in the period 2004-2016. Design: Descriptive, retrospective study, series of cases type. Setting: Instituto Nacional Materno Perinatal, Lima, Peru. Material: We reviewed the clinical charts of patients with SHH. Methods: The clinical charts of cases with SHH attended at our institution between 2004 and 2016 were reviewed. Search also included PubMed and the results were compared with those in the literature. Main outcome measures: Incidence, clinical features, diagnosis, management and results. Results: 31 cases of SHH were found, with an incidence of 1 in 6 000 to 9 000 births. The mean maternal age was 34 years and 80% were multiparous. Diagnosis was usually through direct visualization of the hepatic rupture during caesarean section (45%). The most frequent symptoms were upper abdominal pain (52%), headache (36%), alteration of consciousness (31 %) and hematuria (48%). Liver packing was performed in 90% of the cases; observation and monitoring, in 10%. In 44% of cases, a Bogotá bag was placed during the first surgery. During the last 2 years, we have recurred to vacuum-assisted closure to prevent compartment syndrome. 74% of cases survived and 26% died. The average hospital stay was 23.2 days. Conclusions: The incidence of subcapsular hepatic hematoma as a result of severe preeclampsia and HELLP syndrome was 1 in 6 000 to 9 000 births. Hematuria was a significant sign and should be studied further. Liver packing was performed in 90% of patients, a statistically significant higher rate than that reported in the literature (p=0.0025), maybe due to a preference for conservative management. Despite only performing surgical treatment, the mortality rate was similar to that reported in the literature (26% versus 17%; p=0.2702).

Objetivo. Determinar las características clínicas y manejo de casos de hematoma hepático subcapsular (HHS), como consecuencia de preeclampsia y síndrome HELLP durante los años 2004 al 2016. Diseño. Estudio descriptivo, retrospectivo, tipo serie de casos. Lugar. Instituto Nacional Materno Perinatal, Lima, Perú. Material. Historias clínicas de pacientes con HHS. Métodos. Se revisó los casos de HHS atendidos durante los años 2004 al 2016, identificados en forma retrospectiva. Con fines de comparación, se identificó también los casos de la literatura mundial en PubMed. Principales medidas de resultados. Incidencia, características clínicas, manejo y evolución. Resultados. Se encontró 31 casos de HHS, con incidencia de 1 en 6 000 a 9 000 partos. La edad promedio fue 34 años y 81 % multíparas. La forma de diagnóstico más frecuente fue la visión directa durante la cesárea (45%). El síntoma más frecuente fue dolor en abdomen superior (52%), cefalea (36%), estado de conciencia alterado (31 %) Y hematuria (48%). En 90% se practicó empaquetamiento hepático y en 10% observación y monitoreo. En 44% se colocó Bolsa de Bogotá en la primera intervención quirúrgica y en los últimos 2 años se utiliza el sistema VAC para evitar el síndrome comparta mental. El 74% de los casos sobrevivió y 26% falleció. El promedio de estancia hospitalaria fue de 23,2 días. Conclusiones. La incidencia de hematoma hepático subcapsular como consecuencia de preeclampsia y síndrome HELLP fue 1 en 6 000 a 9 000 partos. La hematuria fue un signo relevante y debiera ser motivo de estudio posterior. El 90% de empaquetamiento hepático tuvo diferencias estadísticas con lo reportado en la literatura mundial (p = 0,0025), debido probablemente a la tendencia en procedimientos conservadores. A pesar de solo usar manejo quirúrgico, la cifra de mortalidad fue similar a la reportada en la literatura mundial (26% versus 17%; p = 0,2702).

The Model Community Health constitutes an important aspect in the territorial development and it can contribute to the health care management. To investigate this phenomenon, in the year of 2011 a quantitative-transverse study is applied to three groups of people: Hospital Professional, Clinic, and Community Leaders, who actively participate in Health, integrating an universe of 66 people. The goal was to establish the notion of the participation of the professionals and community leaders that actively participate in Health, for this reason, it is investigated the association between the Information Offices, Claims, Suggestions and Congratulations (OIRS) and the activities of citizen participation in a commune in southern Chile. The results indicate that the measures taken by Health institutions are strongly influenced by conflicts of interest, boosting civic-type actions to benefit supervised institutional needs and therefore, no influence the communal territorial development. This provides a space for reflection on the role that fits the development of health care management in Primary Health Care.

El Modelo de Salud Comunitario constituye un aspecto relevante en el desarrollo territorial y puede contribuir en la gestión del cuidado. Para indagar este fenómeno, el año 2011 se realiza un estudio cuantitativo-transversal a tres poblaciones: profesionales de Hospital, Consultorio y Dirigentes sociales que participan activamente en Salud, integrando un universo de 66 personas. El objetivo fue determinar la noción de participación que tienen los profesionales y los dirigentes sociales que participan activamente en salud, para ello se indaga en la asociación entre las Oficinas de Información, Reclamos, Sugerencias y Felicitaciones (O.I.R.S) y las actividades de participación ciudadana en una comuna del sur de Chile. Los resultados indican que las medidas adoptadas por las instituciones de salud están fuertemente influenciadas por conflictos de intereses, favoreciendo acciones de tipo cívico-tuteladas en beneficio de necesidades institucionales y por lo tanto, permea escasamente el desarrollo territorial comunal. Esto provee un espacio de reflexión respecto del rol que le cabe al desarrollo de la Gestión del Cuidado en Atención Primaria de Salud.

Contexto del problema: los hospitales son considerados claves para el éxito de los sistemas de salud. Objetivo: describir las percepciones de profesionales de la salud sobre la implementación de la política de autogestión en red en dos hospitales de alta complejidad en Chile. Justificación: una implementación exitosa demanda profesionales alineados con los cambios. Métodos: estudio cualitativo descriptivo y exploratorio basado en entrevistas semiestructuradas a profesionales de la salud de dos hospitales complejos del sur de Chile. Se seleccionó una muestra por conveniencia de diecinueve profesionales. Los datos se analizaron mediante análisis de contenido en su aproximación convencional. Resultados: para los profesionales, la política es conceptualizada desde la autonomía financiera. Como debilidad de la implementación persiste la ausencia de capacidades organizacionales y competencias de los recursos humanos en salud. Conclusiones: superar las brechas entre el diseño y la implementación es crucial para avanzar en la implementación de reformas a los hospitales.

Context of the problem: Hospitals have been considered a main component for health systems success. Objective: To describe perceptions from hospital staff regarding the implementation of the hospital self-management policy in two highly complex facilities in Chile. Justification: A successful policy implementation demands aligned health professionals regarding policy changes. Methods: Descriptive and exploratory qualitative study based on semi-structured interviews for health professionals from two hospitals in southern Chile. A convenience sample of nineteen health professionals was selected for interviewing. The interviews' analysis was thought as the content analysis technique in its conventional approach. Results: For health professionals, a hospital's self-management policy is conceptualized from financial autonomy. Human resources for health and organizational capabilities still remain as weaknesses of the implementation process. Conclusions: Overcoming gaps between design and implementation processes are crucial for success in hospital reform implementation.

Contexto do problema: os hospitais sao considerados chave para o sucesso dos sistemas de saúde. Objetivo: descrever as percepções de profissionais da saúde sobre a implementação da política de autogestão em rede em dois hospitais de alta complexidade no Chile. Justificação: uma implementacao exitosa demanda profissionais alinhados com as mudancas. Métodos: estudo qualitativo descritivo e exploratorio baseado em entrevistas semiestruturadas a profissionais da saúde de dois hospitais complexos do sul de Chile. Uma amostra por conveniencia de dezenove profissionais foi selecionada. Os dados analisaram-se mediante análise de conteúdo em sua aproximacao convencional. Resultados: para os profissionais, a política é concebida a partir da autonomia financeira. Como fraqueza da implementacao persiste a ausencia de capacidades organizacionais e competencias dos recursos humanos em saúde. Conclusoes: superar a fenda entre concepcao e implementacao é crucial para o progresso na implementacao de reformas aos hospitais.

Estudios sobre aspectos reproductivos, morfología y ultraestructura de las esporas de Lycopodiaceae no son abundantes en la literatura científica y constituyen información esencial para apoyar las relaciones taxonómicas y sistemáticas en el grupo. Con el fin de completar la información existente, añadiendo contribuciones nuevas y más amplias sobre estos temas, se realizó un análisis comparado de la ultraestructura de la esporogénesis, con énfasis en aspectos citológicos que tienen que ver con la formación de la cubierta de los esporocitos, el tapete, las meiosis monoplastidial y poliplastidial, la ontogenia del esporodermo y la ornamentación de las esporas maduras en 43 táxones de ocho géneros de Lycopodiaceae: Austrolycopodium, Diphasium, Diphasiastrum, Huperzia (incluyendo Phlegmariurus), Lycopodium, Lycopodiella, Palhinhaea y Pseudolycopodiella que crecen en los Andes de Colombia y el Neotrópico. Para estudios con microscopía electrónica de trasmisión (MET) las muestras se recolectaron en los departamentos de Cauca y Valle del Cauca, mientras que la mayoría de las muestras para microscopía electrónica de barrido (MEB) provienen de material herborizado de colecciones. Para la observación de las muestras con MET y MEB se utilizaron protocolos estándar para el procesamiento de esporas. La cubierta de los esporocitos está formada por pared primaria; los esporocitos invierten gran parte de su actividad metabólica en la producción de esa cubierta, que es mantenida hasta la liberación de las esporas y tiene funciones de protección de las células que harán meiosis. La abundancia de dictiosomas en los esporocitos se relacionó con la formación y desarrollo de la cubierta. Además de la actividad de los microtúbulos, la presencia de sinuosidades y plegamientos asociados con material electro denso en la membrana de los esporocitos determinarían tempranamente los patrones de ornamentación de las esporas. La condición monoplastidial es común en Lycopodium s.l.y la poliplastidial se observó en Huperzia y Lycopodiella s. l. En especies monoplastidiales el tapete presenta abundantes cuerpos plurivesiculares, en las poliplastidiales la actividad secretora del tapete es menos intensa. El desarrollo del esporodermo es centrípeto, el exosporio se forma primero, seguido del endosporio y el perisporio, si está presente, se deposita de último. En las esporas adultas de Lycopodiaceae se encontraron dos patrones de ornamentación: negativo o caviforme (esporas foveoladas) y positivo o muriforme (esporas rugadas y reticuladas). Las esporas foveoladas son características de Huperzia; las rugadas de unas pocas especies de Huperzia y las especies de Lycopodiella s. l., mientras que las reticulada son típicas de Lycopodium s. l.. Numerosos caracteres de la ornamentación resultan diagnósticos en el nivel específico. Los tipos principales no apoyan la extrema fragmentación reciente de la familia en varios géneros, aunque podría coincidir, a priori, con la idea de tres subfamilias. Los hallazgos de la esporogénesis, extremadamente similar en todos los táxones estudiados, apuntan más a la unificación de los géneros en la familia que a su segregación.

Studies on reproductive aspects, spore morphology and ultrastructure of Lycopodiaceae are not very common in the scientific literature, and constitute essential information to support taxonomic and systematic relationships among the group. In order to complete existing information, adding new and broader contributions on these topics, a comparative analysis of the sporogenesis ultrastructure, with emphasis on cytological aspects of the sporocyte coat development, tapetum, monoplastidic and polyplastidic meiosis, sporoderm ontogeny and ornamentation of the mature spores, was carried out in 43 taxa of eight genera of the Lycopodiaceae: Austrolycopodium, Diphasium, Diphasiastrum, Huperzia (including Phlegmariurus), Lycopodium, Lycopodiella, Palhinhaea and Pseudolycopodiella growing in the Andes of Colombia and the Neotropics. For this study, the transmission electron microscopy (TEM) samples were collected in Cauca and Valle del Cauca Departments, while most of the spores for scanning electron microscopy (SEM) analysis were obtained from herbarium samples. We followed standard preparation procedures for spore observation by TEM and SEM. Results showed that the sporocyte coat is largely composed by primary wall components; the sporocyte develop much of their metabolic activity in the production of their coat, which is retained until the spores release; protective functions for the diploid cells undergoing meiosis is postulated here for this layer. The abundance of dictyosomes in the sporocyte cytoplasm was related to the formation and development of the sporocyte coat. Besides microtubule activity, the membrane of sporocyte folds, associated with electrodense material, and would early determine the final patterns of spore ornamentation. Monoplastidic condition is common in Lycopodium s.l., whereas polyplastidic condition was observed in species of Huperzia and Lycopodiella s. l.. In monoplastidic species, the tapetum presents abundant multivesicular bodies, while in polyplastidic species, the secretory activity of the tapetum is less intense. Sporoderm development is centripetal, exospore is the first formed layer, then the endospore and, if present, perispore is the final deposited layer. Adult spores of the Lycopodiaceae showed two patterns of ornamentation: negative or caviform (foveolate spores) and positive or muriform ornamentation, the latter with two subtypes (rugate and reticulate spores). The spores of Huperzia are characteristically foveolate, the rugate spores were found in a few species of Huperzia and in all of the Lycopodiella s. l. taxa studied, while Lycopodium s.l. spores bear reticulate ornamentation. Numerous ornamentation traits are diagnostic at the specific level. The types of ornamentation found do not support the recent extreme fragmentation of the family in several genera, but could match, a priori, with the idea of three subfamilies. The findings of sporogenesis, extremely similar in all taxa studied, point more to consider fewer genera, more comprehensive, than the recent, markedsplitting of the family. Rev. Biol. Trop. 62 (3): 1161-1195. Epub 2014 September 01.

OBJECTIVE: To learn the perceptions of decision-makers concerning the implementation stage of a hospital self-management policy in two highly complex hospitals in southern Chile. METHODS: A descriptive, exploratory, qualitative study based on semi-structured in-depth interviews of decision-makers at the Regional Hospital of Valdivia and the Hospital San José de Osorno from August 2010 to December 2011. A convenience sample of 26 decision-makers was selected. The 26 interviews were recorded and transcribed verbatim. The information was analyzed using inductive content analysis. RESULTS: The interviewees consider the concept of self-management to be determined by autonomy in decision-making about resource allocation and the financing of health service delivery in the hospitals. They also stated that human resources and financing policies should be included to improve the implementation stage. They related weaknesses with the lack of organizational capabilities and managerial skills in the health teams implementing the changes. CONCLUSIONS: Conceptually, the hospital self-management policy is based on financial autonomy, and implementation is affected by persistent capacity gaps in policy design.

OBJETIVO: Conocer las percepciones de los tomadores de decisiones respecto de la etapa de implementación de la política de autogestión hospitalaria en dos hospitales de alta complejidad del sur de Chile. MÉTODOS: Se realizó un estudio cualitativo descriptivo y exploratorio basado en entrevistas semiestructuradas en profundidad a tomadores de decisiones de los hospitales Regional de la ciudad de Valdivia y San José de la ciudad de Osorno, durante el período de agosto de 2010 a diciembre de 2011. Se seleccionó una muestra por conveniencia de 26 tomadores de decisiones. Las 26 entrevistas fueron grabadas y transcritas en forma literal. El análisis de la información se hizo utilizando la técnica de análisis de contenido, en su aproximación inductiva. RESULTADOS: Para los entrevistados, la conceptualización de la autogestión está determinada por la autonomía para la toma de decisiones respecto de la asignación de recursos y el financiamiento de la provisión de servicios de salud en las instituciones hospitalarias. También manifestaron que para mejorar la etapa de implementación se deben incluir políticas de recursos humanos y de financiamiento de la función de provisión de servicios de salud. A las debilidades, por su parte, las relacionaron con la ausencia de capacidades organizacionales y competencias gerenciales de los equipos de salud para la implementación de los cambios. CONCLUSIONES: La política de autogestión hospitalaria es conceptualizada desde la autonomía financiera, y su implementación está determinada por las brechas de capacidad que persisten en el diseño de la política.

Anomis impasta (Guenée) é uma espécie que apresenta morfologia e comportamento muito similar ao curuquerê-do-algodoeiro, Alabama argillacea (Hübner). Durante duas safras de algodão, foi monitorada a alimentação de A. impasta em folhas e brácteas da cultura. Assim, este estudo foi conduzido para gerar informações biológicas sobre a espécie. As larvas foram criadas em folhas de algodão e botões florais (brácteas + botão floral), partes em que as lagartas foram comumente encontradas em campo. Larvas criadas com botão floral apresentaram maior período larval (18,5 ± 0,18 dias) e menor peso pupal (140,8 ± 2,26 mg) em comparação às larvas criadas apenas com folhas (14,0 ± 0,07 dias e 169,3 ± 2,06 mg). Assim, uma geração de A. impasta foi obtida alimentando-se as larvas com folhas de algodão. A média (variação) de duração para a fase de ovo, larva e pupa foi de 3,0 (3 a 4), 14,8 (14 a 18) e 9,7 (7 a 14) dias, respectivamente. A viabilidade para ovos, larva e pupa foi de 43,7; 98,3 e 94,7%, respectivamente. As fêmeas viveram em média 25,2 dias (15 a 37) e produziram 869 ovos (4 a 1866). O desenvolvimento e reprodução de A. impasta em algodoeiro, em especial quando as lagartas desenvolvem-se sobre folhas, fornecem indícios do seu potencial em atingir condição de praga na cultura. A semelhança com a espécie A. argillacea, como apresentado neste estudo, pode ser uma das razões de sua baixa constatação de A. impasta em campo. Portanto, acredita-se que as informações geradas com este estudo auxiliem pesquisadores e produtores na identificação dessas duas espécies desfolhadoras do algodoeiro.

Anomis impasta (Guenée) is a species that shows remarkable morphological and behavioral similarities with the cotton leafworm Alabama argillacea (Hübner). During two growing cotton seasons, A. impasta was observed feeding on leaves and flower bracts of cotton and monitored. Furthermore, a study was conducted under laboratory conditions to generate biological information about this species with larvae feeding cotton squares and leaves. Larvae fed on cotton squares exhibited delayed development (18.5 ± 0.18 days) and lower pupal weight (140.8 ± 2.26 mg) compared to larvae fed on cotton leaves (14.0 ± 0.07 days and 169.3 ± 2.06 mg). Thus, one generation cycle of A. impasta was obtained by feeding the larvae with cotton leaves. The mean (minimum-maximum) values for the duration of eggs, larvae and pupae were: 3.0 (3-4), 14.8 (14-18), and 9.7 (7-14) days, respectively. The viability of the eggs, larvae, and pupae were 43.7, 98.3, and 94.7%, respectively. Females lived on average 25.2 days (ranging from 15 to 37 days) and produced 869 eggs (from 4 to 1,866 eggs). The successful development and reproduction of A. impasta on cotton, especially, on the cotton leaves, suggest the potential of this species to reach a pest status in cotton. The similarities with A. argillacea, as discussed in this study, can be one of the reasons for low reference to A. impasta in the field. Therefore, the information provided here will allow researchers and growers to distinguish these two cotton defoliators.