Abstract Objective. To carry out a cultural adaptation of the Cultural Competence Measurement Scale for Health Care Workers (EMCC-14) for the Colombian context. Methodology: cultural and content validation by expert judgment, including concordance and reliability analysis. Main results: the overall Kappa index of 0.151 implied a low agreement among coders and a concept of slight reliability. The following categories were explored: concordance, semantic content analysis, item wording, clarity and precision, and cultural relevance; concordance ranged from poor to acceptable, with semantic analysis showing greater affectation. After adjustments, the level of reliability for the scale and by dimensions obtained a Cronbach's alpha 0.738, which is interpreted as an acceptable level of reliability. Main conclusion: The version of the EMCC-14 culturally adapted to the Colombian context obtained an adequate level of comprehensibility and reliability, allowing its application to determine the level of cultural competence in health care workers.

Resumen Objetivo. Realizar adaptación cultural de la Escala de Medición Competencia Cultural en trabajadores de la salud (EMCC-14), para el contexto colombiano. Método: validación cultural y de contenido por juicio de expertos, incluido análisis de concordancia y fiabilidad. Resultados principales: el índice global de Kappa de 0.151, implicó un bajo acuerdo entre codificadores y un concepto de leve fiabilidad. Se exploraron las categorías: congruencia, análisis semántico de contenido, redacción de los ítems, claridad y precisión, y pertinencia cultural; la concordancia osciló entre pobre y aceptable, el análisis semántico presentó mayor afectación. Realizados los ajustes, el nivel de confiabilidad para la escala y por dimensiones, obtuvo un alfa de Cronbach 0.738, interpretándose como un nivel de confiabilidad aceptable. Conclusión principal: La versión del EMCC-14 adaptada culturalmente al contexto colombiano obtuvo un adecuado nivel de comprensibilidad y confiabilidad, permitiendo su aplicación para determinar el nivel de competencia cultural en trabajadores de salud.

BACKGROUND Polymyxins are currently used as a “last-line” treatment for multidrug-resistant Gram-negative infections. OBJECTIVES To identify the major mechanisms of resistance to polymyxin and compare the genetic similarity between multi-drug resistant Klebsiella pneumoniae strains recovered from inpatients of public hospitals in the Mid-West of Brazil. METHODS 97 carbapenems non-susceptible K. pneumoniae were studied. β-lactamases (bla OXA-48, bla KPC, bla NDM, bla CTX-M, bla SHV, bla TEM, bla IMP, bla VIM) and mcr-1 to mcr-5 genes were investigated by polymerase chain reaction (PCR). Mutations in chromosomal genes (pmrA, pmrB, phoP, phoQ, and mgrB) were screened by PCR and DNA sequencing. Clonal relatedness was established by using pulsed-field gel electrophoresis and multilocus sequence typing. FINDINGS K. pneumoniae isolates harbored bla KPC (93.3%), bla SHV (86.6%), bla TEM (80.0%), bla CTX-M (60%) genes. Of 15 K. pneumoniae resistant to polymyxin B the authors identified deleterious mutations in pmrB gene, mainly in T157P. None K. pneumoniae presented mcr gene variants. Genetic polymorphism analyses revealed 12 different pulsotypes. MAIN CONCLUSIONS Deleterious mutations in pmrB gene is the main chromosomal target for induction of polymyxin resistance in carbapenem-resistant K. pneumoniae in public hospitals in the Mid-West of Brazil.

Resumo O período das Juntas Provisórias de Governo provincial foi um período de transformações liberais-constitucionais e de recomposição dos poderes regionais. Nosso objetivo aqui é demonstrar como as Juntas da Real Fazenda, formas tradicionais e jurisdicionais de administração fazendária, se tornam a base dos novos poderes políticos e econômicos regionais.

Abstract The period of the Provisional Government Boards (Juntas) in the provinces of Brazil was characterized by liberal-constitutional transformations and the re-composition of regional powers. In this work, we will show how the Boards of the Royal Treasury, traditional and jurisdictional forms of treasury management, became the basis for the configuration of new regional political and economic powers.

Marco contextual: La Incontinencia Urinaria (IU) origina alteraciones en la Calidad De Vida (CDV) de la mujer, con limitaciones fisiológicas, psicológicas y socioeconómicas. Objetivos: Evaluar la percepción de la CDV de las mujeres con IU; analizar la influencia del tipo de IU en la CDV; analizar la influencia de las variables sociodemográficas, obstétricas y ginecológicas en la CDV. Metodología: Estudio transversal y analítico. Los datos se recogieron a través de un cuestionario constituido por variables sociodemográficas, obstétricas, ginecológicas y la escala King's Health Questionnaire. La muestra estuvo formada por 305 mujeres de la región centro de Portugal con una edad media de 50,01±10,37 años. Resultados: Las mujeres mostraron una CDV moderada y que esta, en la mayoría de las dimensiones, está influida por la edad, la nacionalidad, la situación profesional actual, el área de residencia, el índice de masa corporal, el número de hijos, las lesiones pélvicas durante el parto, el peso del niño al nacer, los años de pérdidas de orina, la IU de esfuerzo (IUE) y la IU de urgencia. Las mujeres con IUE presentan peor CDV. Conclusión: La incontinencia urinaria afecta moderadamente a la CDV de la mujer.

Enquadramento: A Incontinência Urinária (IU) provoca alterações na Qualidade de Vida (QV) da mulher, com limitações fisiológicas, psicológicas e socioeconómicas. Objetivos: Avaliar a perceção da QV das mulheres com IU; analisar a influência do tipo de IU na QV; analisar a influência das variáveis sociodemográficas, obstétricas e ginecológicas na QV. Metodologia: Estudo transversal e analítico. Os dados foram recolhidos por questionário constituído por variáveis sociodemográficas, obstétricas e ginecológicas e o King's Health Questionnaire. Amostra com 305 mulheres, da região centro de Portugal, com média de 50,01±10,37 anos. Resultados: As mulheres revelaram moderada qualidade de vida global, sendo que na generalidade das dimensões, esta é influenciada pela idade, nacionalidade, situação profissional atual, área de residência, índice de massa corporal, número de filhos, lesões pélvicas no trabalho de parto, peso da criança à nascença, anos de perda de urina, incontinência urinária de esforço, incontinência urinária de urgência. As mulheres com IU de esforço apresentam pior qualidade de vida. Conclusão: A incontinência urinária influencia moderadamente a QV da mulher.

Background: Urinary Incontinence (UI) impacts the Quality of Life (QoL) of women, causing physiological, psychological, and socio-economic limitations. Objectives: To assess the perception of QoL of women with UI; to analyse the influence of the type of UI on QoL; to analyse the influence of socio-demographic, obstetric, and gynaecological variables on QoL. Methodology: A cross-sectional analytic study was conducted. Data were collected using a questionnaire consisting of socio-demographic, obstetric, and gynaecological variables, and the King's Health Questionnaire. The sample was composed of 305 women from the central region of Portugal, with a mean age of 50.01±10.37 years. Results: Overall, women showed moderate QoL. In most dimensions, QoL is influenced by age; nationality; current employment status; area of residence; body mass index; number of children; pelvic lesions during delivery; child's weight at birth; years of urine loss; stress incontinence; urge incontinence. Women with urinary stress incontinence have a worse QoL. Conclusion: UI moderately affects the QoL of women.

The emergence of β-lactamase-producing Enterobacteriaceae in the last few decades has become major challenge faced by hospitals. In this study, isolates of Klebsiella pneumoniae carbapenemase-2 (KPC-2)-producing K. pneumoniae from a tertiary hospital in Mato Grosso do Sul, Brazil, were characterized. Bacterial identification was performed by matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF; Bruker Daltonics, Germany) mass spectrometry. The minimum inhibitory concentrations of carbapenems were determined using the agar dilution method as recommended by the Clinical Laboratory Standards Institute guidelines. Carbapenemase production was detected using the modified Hodge test (MHT) and polymerase chain reaction (PCR), followed by DNA sequencing. Of 360 (12.2%) K. pneumoniae isolates obtained between May 2009 and May 2010, 44 (12.2%) were carbapenem nonsusceptible. Of these 44 isolates, thirty-six K. pneumoniae isolates that were positive by MHT and PCR carried the blaKPC-2 gene. Thus, KPC-2producing Klebsiella pneumoniae has been present in a Brazilian hospital located in the Midwest region since at least 2009.

As dissecções da artéria carótida devem ser consideradas como possível etiologia de acidentes vasculares cerebrais e acidentes isquêmicos transitórios em pacientes jovens e de meia-idade e em geral têm bom prognóstico. Técnicas nãoinvasivas, em particular a ressonância magnética (ponderadas em T1 e T2, supressão de gordura em T1) e a angiografia por ressonância magnética de cabeça e pescoço com e/ou sem gadolínio, devem ser usadas rotineiramente para triagem de pacientes com dissecção da artéria carótida interna. A angiografia por tomografia computadorizada pode ser também uma técnica diagnóstica alternativa ou complementar usada para avaliação da dissecção. A angiografia convencional deve ser reservada para casos selecionados, em que ainda não foi possível chegar a um diagnóstico depois dos primeiros exames. Outros estudos são necessários para avaliar as melhores opções de tratamento para pacientes com dissecção arterial.

Carotid artery dissections usually have a good prognosis and should be thought as a potential etiology of stroke and transient ischemic attacks (TIAs) in young patients. Noninvasive imaging techniques, in particular magnetic resonance imaging (MRI) (T1- and T2-weighted, fat-suppressed T1) and magnetic resonance angiography (MRA) of head and neck with and/or without gadolinium, should be used routinely for screening of patients with internal carotid artery (ICA) dissection. Computed tomographic angiography (CTA) can be an alternative or adjunctive diagnostic technique used for evaluation of dissection. Conventional angiography should be reserved for selected cases where the diagnosis remains indeterminate after initial studies have been performed. Further studies are necessary to evaluate the best therapeutic options for patients with arterial dissection.

Descreve-se o caso de paciente com síndrome parkinsoniana à direita, associada a disfunções cognitivas e síndrome de hipertensão intracraniana. A tomografia de crânio e o estudo angiográfico de vasos intracranianos demonstraram a presença de volumoso processo expansivo fronto-temporal esquerdo. A eletromiografia revelou tremor de repouso com frequência de 4 a 6 ciclos por segundo. A paciente foi submetida a ressecção cirúrgica da massa tumoral, cujo exame histológico revelou tratar-se de meningioma. A evolução pós-operatória foi excelente e após dois meses todas as anormalidades neurológicas haviam desaparecido. Um ano após a remoção do tumor a paciente permanecia assintomática sem uso de qualquer medicação. São discutidos aspectos fisiopatológicos do parkinsonismo por processo expansivo e as particularidades do presente caso são analisadas em confronto a dados da literatura.

We are presenting an uncommon case of cerebral tumor whose major manifestation was parkinsonism. The patient was a 50-year-old woman presented with a 5-month history of tremor of the right hand, particularly at rest, and headache. On neurological examination of March, 1987 there were: slight right-sided hemiparesis with symmetrical hiperreflexia; discrete bradykinesia in combination with cogwheel rigidity also on the right-side; resting tremor of the right hand; and bilateral papilledema. The neuropsycho-logycal examination disclosed: nominative aphasia, impaired recent memory and right-left disorientation. The computed tomography showed a large, left frontotemporal tumor. Angiograms of the left internal and external carotid arteries revealed a tumor blush in the left frontotemporal region supplied by a enlarged middle meningeal artery. An electromyogram revealed a 4-6 HZ tremor on right hand. A course of treatment with dexametasone 16mg/day and levodopa plus benzerazine (500mg/day) was unsuccessful. A left fronto-temporo-parietal craniotomy was performed and an attached sphenoid wing tumor was mtacroseopically completely removed. Microscopy indicated that the tumor was a meningioma. Postoperativelly, the patient made an uneventful recovery. After two weeks, her right-sided palsy and parkinsonism had disappeared, and neuropsyehologyeal deficits improved. Two months later there was no abnormalities on neurological and neuropsyehologycal examination. It was concluded that the parkinsonism was caused by mechanical pressure on the basal ganglia.