Abstract Asthma symptoms can be controlled through proper self-management, medication adherence, and avoidance of triggers, thus avoiding high costs for multiple hospitalizations, emergency or outpatient visits. This article seeks to develop a conceptual framework of the factors that influence asthma self-management in a pediatric population living in the Andean urban area of Cuenca-Ecuador. A phenomenological study was carried out (February-April 2021) in 10 children and adolescents from 7 to 17 years old with asthma attending public and private hospitals. In-depth interviews were applied using open questions created after reviewing the literature. Factors influencing asthma self-management include individual (attitudes, self-education, seeking medical attention, managing crisis triggers) and environmental (health system, school/family support). The interviews were audio-recorded, transcribed, and analyzed by two independent researchers. Our results show that the pediatric population identifies individual and environmental influences that affect asthma self-management, with age and socioeconomic status moderating the influential factors. The participants described the beliefs, attitudes, practices, perceptions, and specific experiences in the family, school, and health system contexts as relevant to comply with asthma self-management. In addition, problems or barriers that hinder the self-management of the disease, mainly related to adherence to treatment, were identified. In conclusion, our analysis highlights the need to empower the pediatric population in asthma self-management. When delivering patient-centered education for effective asthma management, future interventions must consider children´s age and socioeconomic status influences in individual and environmental factors.

A leishmaniose visceral é uma doença emergente e negligenciada em processo de expansão para áreas urbanas. A incidência da doença humana está relacionada com a infecção canina. Araçatuba e Birigui são municípios do Estado de São Paulo, Brasil, com soroprevalência da infecção canina de 8 a 10%, que empregam estratégias de controle voltadas ao reservatório canino baseado em inquérito sorológico e eutanásia dos cães soropositivos. Usando dados desses programas de controle para parametrizar modelos matemáticos, este estudo avaliou a eficácia dessas atividades. Estimamos que o controle atualmente empregado é capaz de reduzir em cerca de 20% a incidência de casos de leishmaniose visceral canina (LVC). Considerando-se um controle contínuo e um esforço das atividades de inquérito sorológico igual ao triplo da média do observado em Araçatuba e Birigui, a atividade de eutanásia de cães com diagnóstico positivo seria efetiva para o controle da infecção canina. Embora teoricamente possível, na prática, o controle da LVC com as estratégias preconizadas atualmente é insuficiente, pois exigiria superpor dificuldades enfrentadas por estas atividades como falta de recursos materiais, humanos e financeiros, além das questões éticas e jurídicas associadas.

Visceral leishmaniasis is an emerging and neglected disease that is currently expanding to urban areas. The incidence of human disease is related to canine infection. Araçatuba and Birigui are municipalities (counties) in the state of São Paulo, Brazil, with 8-10% seroprevalence of canine infection and that employ control strategies targeting the canine reservoir, based on serological survey and culling of seropositive dogs. Using data from these control programs to parameterize mathematical models, this study assessed the efficacy of these activities. We estimated that current control is capable of reducing the incidence of canine visceral leishmaniasis (CVL) by approximately 20%. Assuming continuous control and three times the current serological survey activities in Araçatuba and Birigui, culling dogs with a positive CVL diagnosis would be effective for the control of canine infection. Although theoretically possible, in practice the control of CVL with the currently recommended strategies is insufficient, since it would require overcoming the difficulties in these activities, such as lack of material, human, and financial resources, besides associated ethical and legal issues.

La leishmaniasis visceral es una enfermedad emergente y pasada por alto en proceso de expansión hacia áreas urbanas. La incidencia de la enfermedad humana está relacionada con la infección canina. Araçatuba y Birigui son municipios del estado de São Paulo, Brasil, con una seroprevalencia de infección canina de un 8 a un 10% que emplean estrategias de control dirigidas al reservorio canino, basado en una encuesta serológica y eutanasia de los perros seropositivos. Usando datos de esos programas de control para proporcionar parámetros en modelos matemáticos, este estudio evaluó la eficacia de esas actividades. Estimamos que el control actualmente empleado es capaz de reducir cerca de un 20% la incidencia de casos de leishmaniasis visceral canina (LVC). Si se considera un control continuo y un esfuerzo de las actividades de encuesta serológica igual al triple de la media de lo observado en Araçatuba y Birigui, la actividad de eutanasia de perros con diagnóstico positivo sería efectiva para el control de la infección canina. A pesar de que teóricamente es posible, en la práctica el control de la LVC con las estrategias preconizadas actualmente es insuficiente, puesto que exigiría superar dificultades a las que se enfrentan estas actividades como la falta de recursos materiales, humanos y financieros, además de las cuestiones éticas y jurídicas asociadas.

A leishmaniose visceral é uma doença emergente e negligenciada em processo de expansão para áreas urbanas. A incidência da doença humana está relacionada com a infecção canina. Araçatuba e Birigui são municípios do Estado de São Paulo, Brasil, com soroprevalência da infecção canina de 8 a 10%, que empregam estratégias de controle voltadas ao reservatório canino baseado em inquérito sorológico e eutanásia dos cães soropositivos. Usando dados desses programas de controle para parametrizar modelos matemáticos, este estudo avaliou a eficácia dessas atividades. Estimamos que o controle atualmente empregado é capaz de reduzir em cerca de 20% a incidência de casos de leishmaniose visceral canina (LVC). Considerando-se um controle contínuo e um esforço das atividades de inquérito sorológico igual ao triplo da média do observado em Araçatuba e Birigui, a atividade de eutanásia de cães com diagnóstico positivo seria efetiva para o controle da infecção canina. Embora teoricamente possível, na prática, o controle da LVC com as estratégias preconizadas atualmente é insuficiente, pois exigiria superpor dificuldades enfrentadas por estas atividades como falta de recursos materiais, humanos e financeiros, além das questões éticas e jurídicas associadas.

Visceral leishmaniasis is an emerging and neglected disease that is currently expanding to urban areas. The incidence of human disease is related to canine infection. Araçatuba and Birigui are municipalities (counties) in the state of São Paulo, Brazil, with 8-10% seroprevalence of canine infection and that employ control strategies targeting the canine reservoir, based on serological survey and culling of seropositive dogs. Using data from these control programs to parameterize mathematical models, this study assessed the efficacy of these activities. We estimated that current control is capable of reducing the incidence of canine visceral leishmaniasis (CVL) by approximately 20%. Assuming continuous control and three times the current serological survey activities in Araçatuba and Birigui, culling dogs with a positive CVL diagnosis would be effective for the control of canine infection. Although theoretically possible, in practice the control of CVL with the currently recommended strategies is insufficient, since it would require overcoming the difficulties in these activities, such as lack of material, human, and financial resources, besides associated ethical and legal issues.

La leishmaniasis visceral es una enfermedad emergente y pasada por alto en proceso de expansión hacia áreas urbanas. La incidencia de la enfermedad humana está relacionada con la infección canina. Araçatuba y Birigui son municipios del estado de São Paulo, Brasil, con una seroprevalencia de infección canina de un 8 a un 10% que emplean estrategias de control dirigidas al reservorio canino, basado en una encuesta serológica y eutanasia de los perros seropositivos. Usando datos de esos programas de control para proporcionar parámetros en modelos matemáticos, este estudio evaluó la eficacia de esas actividades. Estimamos que el control actualmente empleado es capaz de reducir cerca de un 20% la incidencia de casos de leishmaniasis visceral canina (LVC). Si se considera un control continuo y un esfuerzo de las actividades de encuesta serológica igual al triple de la media de lo observado en Araçatuba y Birigui, la actividad de eutanasia de perros con diagnóstico positivo sería efectiva para el control de la infección canina. A pesar de que teóricamente es posible, en la práctica el control de la LVC con las estrategias preconizadas actualmente es insuficiente, puesto que exigiría superar dificultades a las que se enfrentan estas actividades como la falta de recursos materiales, humanos y financieros, además de las cuestiones éticas y jurídicas asociadas.

Abstract Background: Inhibitory control has been described as a factor causing difficulties in the regulation present in the ADHD. Objective: The aim was to analyze the relationship between inhibitory control and symptoms of ADHD in a sample of 81 subjects diagnosed with ADHD (Mage=10.05, SD=2.53). Methods: A quantitative, cross-sectional and correlational scope research was carried out. The instruments used were the ADHD RS IV and SIMON experiment. Correlation inferential statistical regression and regression processes were applied. Results: Three regression models were tested, where inhibitory control presents a significant prediction with the (a) attention deficit F (1,79) =20.69, p=<.001, R 2 =.21, (b) hyperactivity and impulsivity F (1, 79) =5.90, p=.01, R 2 =.07 and (c) the combination of both (a+b) F (1, 79) =13.25, p=< .01, R 2 =.14. Conclusions: The findings suggest that inhibitory control is one of the main executive functions that determines the degree of affectation of the symptomatology of the child population with ADHD.

Resumen Antecedentes: El control inhibitorio ha sido descrito como un factor causal que genera problemas de déficit de atención, impulsividad e hiperactividad que engloban la sintomatología del TDAH. Objetivo: El fin de esta investigación fue analizar la relación entre el control inhibitorio y los síntomas del TDAH en una muestra de 81 sujetos diagnosticados con TDAH (M edad = 10.05, DE = 2.53). Método: Se ejecutó una investigación cuantitativa, transversal y alcance correlacional. Los instrumentos utilizados fueron ADHD RS IV y el experimento SIMON. Se aplicaron procesos de análisis estadístico inferencial correlacional y regresión. Resultados: Tres modelos de regression fueron testeados, donde el control inhibitorio present una relación significativa, prediciendo (a) el déficit de atención F (1, 79) = 20.69, p=< .001, R 2 =.21, (b) hiperactividad e impulsividad F (1, 79) = 5.90, p=.01, R 2 =.07 y (c) la combinación de ambos (a+b) F (1, 79) = 13.25, p=< .01, R 2 =.14. Conclusiones: Los hallazgos encontrados sugieren que el control inhibitorio es una de las funciones ejecutivas principales que determina el grado de afectación de la sintomatología de la población infantil con ADHD.

Chronic recurrent multifocal osteomyelitis is a sterile inflammatory limb disorder. It mainly affects children simulating an infectious osteomyelitis. It may be associated with inflammatory skin and intestinal tract disorders. Acute phase reactant levels are normal or slightly high. X-rays show osteolytic injuries surrounded by sclerosis, which may be normal at the beginning of the disease. A timely diagnosis based on identifying the disease characteristics and ruling out an infectious etiology, allows to indicate the proper treatment. We present three patients with this pathology. A 24-year-old man with persistent and recurrent inflammatory symptoms in the right ankle, that evolved for 8 years. An 11-year-old girl who periodically attends due to pain in hemithorax, right clavicle and left ankle; and a 12-year-old girl with multiple brief episodes of inflammatory symptoms in both ankles. The three cases, without leukocytosis, acute phase reactants slightly increased or negative, with major and minor Jasson's diagnosis criteria for this pathology. These conditions improved with non-steroidal anti-inflammatory drugs. It is important to know this rare condition as a diagnostic possibility, as a timely diagnosis prevents unnecessary use of antibiotics and it may resolve with a simple therapy of non-steroidal anti-inflammatory drugs, without the need of surgical procedures that increase comorbidities.

La osteomielitis crónica recurrente multifocal es un trastorno inflamatorio estéril en las extremidades. Afecta principalmente a niños simulando una osteomielitis infecciosa. Puede estar asociada a trastornos inflamatorios cutáneos y del tracto intestinal. Los niveles de reactantes de fase aguda están normales o levemente altos. Las radiografías muestran lesiones osteolíticas rodeadas por esclerosis, pero pueden ser normales al inicio de la enfermedad. Identificar las características propias de la enfermedad y descartar una etiología infecciosa permiten establecer un diagnóstico oportuno y ofrecer el manejo adecuado. Se presentan tres casos de esta patología. Un hombre de 24 años con síntomas inflamatorios persistentes y recidivantes en el tobillo derecho, de 8 años de evolución. Una niña de 11 años que acude reiterativamente por dolor en hemitórax, clavícula derecha y tobillo izquierdo, y una niña de 12 años con múltiples episodios breves de síntomas inflamatorios en ambos tobillos. Los tres casos, sin leucocitosis, reactantes de fase aguda levemente aumentados o negativos, con criterios mayores y menores de Jasson para diagnóstico de esta patología. Los cuadros mejoraron con antinflamatorios no esteroides. Es importante conocer esta rara entidad como posibilidad diagnóstica, pues un diagnóstico oportuno evita el uso innecesario de antibióticos y la resolución del cuadro se logra con antinflamatorios no esteroides, sin necesidad de procedimientos quirúrgicos que aumentan las comorbilidades.

RESUMO OBJETIVO Estimar a cobertura das atividades de controle da leishmaniose visceral e relacioná-las com a ocorrência de leishmaniose visceral em humanos em área urbana endêmica. MÉTODOS Foram considerados como população de estudo os casos de leishmaniose visceral em humanos e em cães avaliados por inquérito sorológico censitário realizado em Araçatuba, SP, de 2007 a 2015. Os casos de leishmaniose visceral em humanos foram geocodificados pelo endereço de residência dos pacientes e, os cães, pelo endereço de residências dos respectivos tutores. Foram calculadas as coberturas do inquérito sorológico, da eutanásia e de borrifação de inseticida, as soroprevalências caninas e as taxas de incidência de leishmaniose visceral em humanos. A relação entre a leishmaniose visceral em humanos e as medidas de controle, bem como a soroprevalência foram avaliadas por comparação de mapas e por meio de regressão linear. A relação entre a doença canina e a humana também foi avaliada por meio da função K de Ripley . RESULTADOS As taxas de incidência de leishmaniose visceral em humanos apresentaram um período de declínio (2007 a 2009) e um período de estabilidade (2010 a 2015), comportamento semelhante ao das soroprevalências caninas. Em geral, a cobertura das medidas de controle foi baixa e a não associação com a incidência de leishmaniose visceral em humanos pode ser consequência do período analisado e do número pequeno de unidades analisadas (setores da Superintendência de Controle de Endemias). A distribuição dos casos humanos apresentou dependência espacial com a distribuição dos cães soropositivos de 2007 a 2009. CONCLUSÕES Este trabalho reafirmou a relação entre a ocorrência da doença no homem e no cão, verificou a diminuição das taxas de leishmaniose visceral em humanos e em cães em Araçatuba ao longo do tempo, mesmo em baixa cobertura das atividades de controle. Entretanto, novos estudos são necessários para averiguar se fatores além das atividades de vigilância e controle estariam envolvidos na diminuição das incidências.

ABSTRACT OBJECTIVE Estimate the coverage of control measures of visceral leishmaniasis and relate them with the occurrence of human visceral leishmaniasis in endemic urban area. METHODS Cases of human and canine visceral leishmaniasis were considered as study population and evaluated by a serological survey conducted in Araçatuba, state São Paulo, from 2007 to 2015. The cases of human visceral leishmaniasis were geocoded by the address of the patients and the canine disease by the address of the dogs’ owners. The coverage of serological survey, euthanasia, and insecticide spraying was calculated, as well as the canine seroprevalence and the incidence rates of human visceral leishmaniasis. The relationship between human visceral leishmaniasis and control measures was evaluated, as well as the seroprevalence by comparing maps and by linear regression. The relationship between the canine and the human disease was also evaluated by the Ripley’s K function. RESULTS The incidence rates of human visceral leishmaniasis showed a period of decline (2007 to 2009) and a period of stability (2010 to 2015), a behavior similar to that of canine seroprevalence. In general, the coverage of control measures was low, and the non-association with the incidence of human visceral leishmaniasis can be a result of the period analyzed and of the small number of analyzed units (sectors of the Superintendence for the Control of Endemic Diseases). The distribution of human cases showed spatial dependence with the distribution of seropositive dogs from 2007 to 2009. CONCLUSIONS This study reaffirmed the relationship between the occurrence of the disease in humans and dogs, it verified a decrease in the rates of visceral leishmaniasis in Araçatuba over time, even at low coverage of control activities. However, further studies are needed to determine if factors beyond monitoring and control measures are involved in the reduction of incidences.

RESUMO OBJETIVO Estimar a cobertura das atividades de controle da leishmaniose visceral e relacioná-las com a ocorrência de leishmaniose visceral em humanos em área urbana endêmica. MÉTODOS Foram considerados como população de estudo os casos de leishmaniose visceral em humanos e em cães avaliados por inquérito sorológico censitário realizado em Araçatuba, SP, de 2007 a 2015. Os casos de leishmaniose visceral em humanos foram geocodificados pelo endereço de residência dos pacientes e, os cães, pelo endereço de residências dos respectivos tutores. Foram calculadas as coberturas do inquérito sorológico, da eutanásia e de borrifação de inseticida, as soroprevalências caninas e as taxas de incidência de leishmaniose visceral em humanos. A relação entre a leishmaniose visceral em humanos e as medidas de controle, bem como a soroprevalência foram avaliadas por comparação de mapas e por meio de regressão linear. A relação entre a doença canina e a humana também foi avaliada por meio da função K de Ripley . RESULTADOS As taxas de incidência de leishmaniose visceral em humanos apresentaram um período de declínio (2007 a 2009) e um período de estabilidade (2010 a 2015), comportamento semelhante ao das soroprevalências caninas. Em geral, a cobertura das medidas de controle foi baixa e a não associação com a incidência de leishmaniose visceral em humanos pode ser consequência do período analisado e do número pequeno de unidades analisadas (setores da Superintendência de Controle de Endemias). A distribuição dos casos humanos apresentou dependência espacial com a distribuição dos cães soropositivos de 2007 a 2009. CONCLUSÕES Este trabalho reafirmou a relação entre a ocorrência da doença no homem e no cão, verificou a diminuição das taxas de leishmaniose visceral em humanos e em cães em Araçatuba ao longo do tempo, mesmo em baixa cobertura das atividades de controle. Entretanto, novos estudos são necessários para averiguar se fatores além das atividades de vigilância e controle estariam envolvidos na diminuição das incidências.

ABSTRACT OBJECTIVE Estimate the coverage of control measures of visceral leishmaniasis and relate them with the occurrence of human visceral leishmaniasis in endemic urban area. METHODS Cases of human and canine visceral leishmaniasis were considered as study population and evaluated by a serological survey conducted in Araçatuba, state São Paulo, from 2007 to 2015. The cases of human visceral leishmaniasis were geocoded by the address of the patients and the canine disease by the address of the dogs’ owners. The coverage of serological survey, euthanasia, and insecticide spraying was calculated, as well as the canine seroprevalence and the incidence rates of human visceral leishmaniasis. The relationship between human visceral leishmaniasis and control measures was evaluated, as well as the seroprevalence by comparing maps and by linear regression. The relationship between the canine and the human disease was also evaluated by the Ripley’s K function. RESULTS The incidence rates of human visceral leishmaniasis showed a period of decline (2007 to 2009) and a period of stability (2010 to 2015), a behavior similar to that of canine seroprevalence. In general, the coverage of control measures was low, and the non-association with the incidence of human visceral leishmaniasis can be a result of the period analyzed and of the small number of analyzed units (sectors of the Superintendence for the Control of Endemic Diseases). The distribution of human cases showed spatial dependence with the distribution of seropositive dogs from 2007 to 2009. CONCLUSIONS This study reaffirmed the relationship between the occurrence of the disease in humans and dogs, it verified a decrease in the rates of visceral leishmaniasis in Araçatuba over time, even at low coverage of control activities. However, further studies are needed to determine if factors beyond monitoring and control measures are involved in the reduction of incidences.

ABSTRACT Introduction: Patent ductus arteriosus (PDA) is the most frequent cardiocirculatory defect in preterm infants; it is inversely related to gestational age and birth weight; it is also associated with various complications. Objective: To determine the intrahospital morbidities in very low birth weight infants (VLBWI) with and without PDA. Materials and Methods: This was a retrospective study of cases and controls nested in a cohort of VLBWI admitted in the NICU, from January 2013 to December 2015. We excluded newborns with congenital malformations, who died in the delivery room, who died on the first day of life because of severe perinatal asphyxia or who were transferred to other institutions. The baseline characteristics were: weight, gestational age, sex, prenatal, maternal hypertension, multiple pregnancy, growth restriction, prenatal corticosteroids, prolonged rupture of membranes, type of delivery, and Apgar score. The morbidities analyzed were respiratory distress (RDS), pulmonary hemorrhage, necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), sepsis, respiratory support, bronchopulmonary dysplasia (BPD), alveolar rupture, retinopathy of prematurity (ROP) and death. The data were recorded in SSPS 17 and Epi info 7.2, the X² or Fischer test, Student t test and the Mann Whitney test were applied. Significance was defined as p <0.05 with a 95% confidence interval. Results: We included 131 newborns, 62 with PDA and 69 without PDA, whose baseline characteristics were similar, except for the use of prenatal corticosteroids in the group without PDA (p 0.035) RR 0.7 (0.5-0.9). Newborns with PDA had more RDS (p 0.0003) RR 1.5 (1.1-1.9), pulmonary hemorrhage (p 0.024) RR 8.9 (1,1-69), mechanical ventilation (p 0, 0001) RR 1.7 (1.3-2.2), oxygen at 28 days (p 0.001) RR 2.2 (1.3-3.8), longer duration of TPN (p 0.01), transfusions (p 0.01) RR 1.7 (1.3-2.2), IVH (p 0.003) RR 2.1 (1.2-3.6), BPD (p 0.0001) RR 2.6 1.5-4.5), more hospitalization days (p 0.008) and a risk of death (p 0.001) RR 3.5 (1.5-8.2). No association with was observed with NEC (p 0.195), ROP (p 0.739), clinical sepsis (p 0.123) or late sepsis (p0.12). Conclusion: VLBWI with PDA had a higher risk of death and severe morbidity compared to those who did not have PDA.

RESUMEN Introducción: El ductus arterioso persistente (DAP) es el defecto cardiocirculatorio más frecuente en prematuros, está inversamente relacionado con la edad gestacional y el peso al nacimiento; y se asocia a diversas complicaciones. Objetivo: Evaluar la morbilidad asociada a la presencia de ductus arterioso persistente (DAP) en Recién Nacidos de muy bajo peso al nacer (RMBPN). Materiales y Métodos: Estudio retrospectivo de casos y controles anidado en una cohorte de RMBPN admitidos en la UCIN, de enero de 2013 a diciembre de 2015. Excluidos RN con malformaciones congénitas, fallecidos en sala de parto, fallecidos el primer día de vida asociados a asfixia perinatal severa y trasladados a otras instituciones. Las características basales fueron: peso, edad gestacional, sexo, control prenatal, hipertensión materna, embarazo múltiple, restricción del crecimiento, corticoide prenatal, ruptura prolongada de membranas, tipo de parto, Apgar. Las morbilidades analizadas fueron: distres respiratorio (SDR), hemorragia pulmonar, enterocolitis necrozante (ECN), hemorragia intraventricular (HIV), sepsis, soporte respiratorio, broncodisplasia pulmonar (DBP), ruptura alveolar, retinopatía del prematuro (ROP), días de internación y muerte. Se consignaron los datos en SSPS 17 y Epi info 7.2, se aplicó la prueba X² o Fischer, t de Student o la prueba de Mann Whitney. Significancia p< 0,05 con intervalo de confianza 95%. Resultados: Se incluyeron 131 RN, con DAP 62 y sin DAP 69, cuyas características basales fueron similares, salvo el uso de corticoides prenatales para el grupo sin DAP (p 0.035) RR 0,7 (0,5-0,9). Los RN con DAP tuvieron SDR (p 0,0003) RR 1,5 (1,1-1,9), hemorragia pulmonar (p 0,024) RR 8,9 (1,1-69), ventilación mecánica (p 0,0001) RR 1,7(1,3-2,2), oxígeno a los 28 días (p 0,001) RR 2,2 (1,3-3,8), mayor duración de NPT (p 0.01), trasfusiones (p 0,01) RR 1,7(1,3-2,2), HIV (p 0,003) RR 2,1 (1,2-3,6), BDP (p 0,0001) RR 2,6(1,5-4,5), y mayor cantidad de días de internación (p 0,008). Riesgo de muerte (p 0,001) RR 3,5 (1,5-8,2). Sin asociación con ENC (p 0,195), ROP (p 0,739), Sepsis clínica (p 0,123) ni sepsis tardía (p 0,12). Conclusión: Los RMBN con DAP tuvieron mayor riesgo de muerte y morbilidades graves en comparación con los que no desarrollaron DAP.

Objetivo: Determinar la prevalencia y severidad de fluorosis dental en población de 8 a 12 años de edad de los colegios públicos de Villavicencio, Colombia. Materiales y Métodos: Estudio descriptivo con participación voluntaria y previo consentimiento informado de los adultos responsables de 459 infantes de 8 a 12 años de edad, seleccionados de una población de 32.306 matriculados en los colegios públicos de Villavicencio, mediante muestreo probabilístico. Trabajo avalado por el Comité de Bioética de la Universidad Cooperativa de Colombia. El examen clínico fue realizado por 6 odontólogos previamente calibrados por un experto en el diagnóstico de fluorosis dental según índice de Thylstrup y Fejerskov (TFI) obteniéndose índices de Kappa > 0,80. Se realizó análisis exploratorio de datos (AED), distribución de frecuencias y estadística inferencial (prueba de asociación Chi² de Pearson con a = 0,05), usando el programa estadístico SPSS versión 21.0 con licencia de la Universidad Cooperativa de Colombia. Resultados: La prevalencia de fluorosis (TFI ≥ 1) fue de 65,8% (n = 302) (IC 95% = 61,5% a 68,5%). El sexo masculino presentó una prevalencia del 51,3% (n = 155) (IC 95% = 47,3% a 55,3%) (p = 0,94). En la zona urbana la comuna de procedencia más afectada fue la número 6 con una prevalencia de 70,8% (IC 95% = 59,8% a 81,8%) (p = 0,84). El 31,4% de los niños presentaron un TFI = 2, el 23% un TFI = 1. Los dientes más afectados fueron los premolares superiores (48,2%) e inferiores (40,6%), seguidos de los incisivos laterales (40,2%). Conclusión: En la población infantil de 8 a 12 años de los colegios públicos de Villavicencio se presenta una elevada prevalencia de fluorosis con una severidad leve y moderada, representando un problema de salud pública que requiere una intervención de los organismos de control.

Objective: To determine the prevalence and severity of dental fluorosis in the population aged 8-12 years old in public schools in Villavicencio, Colombia. Materials and Methods: A descriptive study, with voluntary participation and previous consent of the responsible adults, of 459 children aged 8 to 12 years, selected from a population of 32,306 students enrolled in public schools in Villavicencio, using probability sampling. This work is supported by the bioethics committee of the Universidad Cooperativa de Colombia. Clinical examination was carried out by six dentists previously calibrated by an expert in the diagnosis of dental fluorosis according Thylstrup and Fejerskov (TFI) obtaining Kappa indexes > 0.80. Exploratory data analysis (EDA), frequency distribution and inferential statistics (test partnership with Pearson Chi² a = 0.05) were performed with SPSS version 21.0. Licensed by Universidad Cooperativa de Colombia. Results: The prevalence of fluorosis (TFI ≥ 1) was 65.8% (n = 302) (95% CI = 61.5% to 68.5%). Boys presented a prevalence of 51.3% (n = 155) (95% CI = 47.3% to 55.3%) (p = 0.94). In urban areas the most affected district of origin was No. 6 with a prevalence of 70.8% (95% CI = 59.8% to 81.8%) (p = 0,84). The 31.4% of children had a TFI = 2, 23% one TFI = 1. The most affected teeth were premolars (48.2%) (40.6%), followed by lateral incisors (40.2%). Conclusion: In the population of 8-12 years old children of public Villavicencio schools a higher prevalence of fluorosis with a mild to moderate severity is present, representing a public health problem that requires intervention by the supervisory bodies.

Objetivo: Determinar a prevalência e severidade de fluorose dentaria em povoação de 8 a 12 anos de idade dos colégios públicos de Villavicencio, Colômbia. Materiais e Métodos: Estudo descritivo com participação voluntaria e prévio consentimento informado dos adultos responsáveis de 459 infantes de 8 a 12 anos de idade, selecionados de uma povoação de 32.306 matriculados nos colégios públicos de Villavicencio, através de uma amostra probabilística. Trabalho avaliado pelo Comitê de Bioética da Universidade Cooperativa de Colômbia. No teste clinico foi realizado por 6 dentistas previamente calibrados por um especialista no diagnostico de fluorose dentaria segundo índice de Thylstrup e Fejerskov (TFI) obtendo se índices de Kappa > 0,80. Realizou se analise exploratório de dados (AED), distribuição de freqüências estadística inferencial (prova de associação Chi² de Pearson com a = 0,05), usando o programa estatístico SPSS versão 21.0 com licencia da Universidade Cooperativa de Colômbia. Resultados: A prevalência de fluorose (TFI ≥ 1) foi de 65,8% (n = 302) (IC 95% = 61,5% a 68,5%). O sexo masculino apresentou uma prevalência do 51,3% (n = 155) (IC 95% = 47,3% a 55,3%) (p = 0,94). Na zona urbana a comuna de procedência mais afetada foi a numero 6 com uma prevalência 70,8% (IC 95% = 59,8% a 81,8%) (p = 0,84). O 31,4 das crianças apresentaram um TFI = 2, o 23% um TFI = 1. Os dentes mais afeitados foram os pré- molares superiores (48,2%) e inferiores (40,6%), seguidos dos incisivos laterais (40,2%). Conclusão: Na povoação infantil de 8 a 12 anos dos públicos de Villavicencio apresenta se uma elevada prevalência de fluorose com uma severidade leve e moderada, representando um problema de saúde publica que requere uma intervenção dos organismos de controle.

White oaks have recalcitrant seeds that remain viable for short periods of time, but this information is still conspicuously lacking for Mexican oaks. This is the case of Quercus polymorpha, a drought-tolerant species widely distributed across Sierra Madre Oriental that can be used in forest restoration programs. The acorns used to develop their saplings are collected during the reproductive season and stored by several months before their germination. This study focused in 1) determining how many seeds are lost during storage because of physiological factors linked to their viability, 2) quantifying how many seeds were lost by other factors, and 3) assessing whether cold stratification can stimulate acorn germination. Acorns used in this study were stored during a round year. We found that 70 % of these acorns were parasitized by insects prior to their storage, while an additional 20 % had lost their viability due to physiological factors or fungal infestation. Germination trials were performed by only using potentially viable acorns, which were subjected to three different cold stratification periods (0, 20 and 50 days). This experiment indicated acorns stratified during 50 days display higher germination rates (64.2 %) than those stratified by 20 (44.8 %) and 0 days (16.5 %).

Los encinos blancos tienen semillas recalcitrantes que se mantienen viables por corto tiempo. Sin embargo, esta información es escasa para encinos mexicanos. Este es el caso de Quercus polymorpha, una especie tolerante a la sequía y ampliamente distribuida en la Sierra Madre Oriental que puede utilizarse en programas de restauración forestal. Las bellotas son colectadas durante la época reproductiva y son almacenadas por varios meses antes de su germinación. Este estudio se enfocó en 1) determinar cuántas semillas se pierden durante el almacenamiento debido a factores fisiológicos relacionados con su viabilidad, 2) cuantificar las semillas que se pierden por otros factores, y 3) evaluar si la estratificación fría puede estimular la germinación de las bellotas. Las bellotas utilizadas fueron almacenadas durante un año. El 70 % de las bellotas estaban parasitadas por insectos antes de su almacenamiento, mientras que el 20 % perdió su viabilidad debido a factores fisiológicos o infestación por hongos. Los ensayos de germinación se llevaron a cabo utilizando sólo bellotas potencialmente viables, las cuales fueron sometidas a tres periodos de estratificación en frío (0, 20 y 50 días). El experimento mostró que las bellotas estratificadas durante 50 días tienen mayores tasas de germinación (64.2 %) que las de 20 (44.8 %) y 0 días (16. 5 %).

Enterotoxigenic Escherichia coli (ETEC) is recognized as the main cause of bacterial diarrhoea among children in Asia, Africa and Latin America but less investigated in Bolivia. OBJECTIVE: To determine the relation between enterotoxins, CFs and serotypes as well as the antimicrobial resistance patterns in a set of ETEC isolates collected from hospitalized children with acute diarrhea. In the present study we characterized 43 ETEC strains isolated from 2002 to 2006 from hospitalized children (0-5 years) with acute diarrhea in Bolivia. The strains were analyzed for heat-labile (LT) and heat-stable (ST) enterotoxins and colonization factor (CF) profiles, as well as for serogroups and antimicrobial resistance using phenotypic (ELISA, dot blot, slide agglutination and disc diffusion) and genotypic (Multiplex PCR) methods. Among the ETEC isolates tested, 30 were positive for LT, 3 for STh and 10 for LT/STh. Sixty-five percent (28/43) of the strains expressed one or more CF. The most common CFs were CS17 (n = 8) and CFA/I (n = 8). The phenotypical and genotypical results for toxins and CFs were congruent except for CS21 that was amplified in 10 of the strains by multiplex PCR, but CS21 pili was only detected phenotypically in four of these strains. The ETEC strains had diverse O and H antigens and the most common types were O8:H9 LT CS17 (n = 6; 14%) and O78:HNM LT-ST CFA/I (n = 4; 9%). The analysis of antibiotic resistance showed that 67% (n = 29/43) of the strains were resistant to one or several of the antimicrobial agents tested. Presence of CFs was associated with antibiotic resistance. CONCLUSION: The most common toxin profile was LT 70%, LT/STh 23% and STh 7%. High antimicrobial resistance to ampicillin among serogroups O6, O8 and O78 were the most common.

Objetive: To describe features, preferences, and proposals from physicians that are preparing themselves to take the 2011 National Medical Residency Examination in Peru. Material and ethods: This is a descriptive study, considering a referential population including 4328 candidates, according to the 2010 National Medical Residency Examination. The Epidat 3.1 statistical software was used, with a 95% confidence limit, and a 5% precision value, and the simple size was established in 353 physicians. A self-applicable and previously validated questionnaire was previously used as a pilot in 20 candidates. Results: Of the 416 surveyed physicians (median age, 27 years), most of them come from provinces outside Lime (52.6%). Nearly half of all physicians (42.5%) are currently working, 79.5 of them in the private sector and 79.2 on an outsourcing basis. Nearly half of all candidates (48.6%) performed their rural healthcare service (SERUMS, according to its Spanish initials) in extremely poor areas in Peru (Quintile I). More than half of the candidates (54.3%) had already taken the Medical Residency Examination in the past. Nearly half of the candidates (48,6%) do not agree with the current status for the National Medical Residency Examination, 67.5% prefer a single national examination, and 39,2% prefer that the contest is separated for each specialty. More than one third (38.9%) considered that the examination should be led by CONAREME (National Commission for Medical Residency) and each Medical School. More than half of the candidates do not agree with the increase of the so-called captive places, and 78.1% disagreed with the proposal by the Ministry of Health to establish an additional mandatory period of work for medical specialists in the less developed areas in the country. Conclusions: The majority of candidate physicians surveyed come from medical schools outside Lima, they do not have a family of their own to care for, les tan half of them are properly employed, and most of those who have a job are in an outsourcing schedule. Most of all candidates do not agree with the current process for the National Medical Residency Examination and they favor a single examination according to medical specialties, and female physicians prefer clinical areas for specialization. Most of the candidates do not agree with the proposal to have an additional mandatory period of time working in the most depressed areas, and they propose that the process for the National Medical Residency Examination must be more transparent, and that the charge by CONAREME as a requisite for taking the examination must be eliminated.

Objetivo: Describir las características, preferencias y propuestas de los médicos que se preparan para rendir el examen, respecto al proceso de admisión vigente al residentado médico en el Perú. Material y método: Se realizó un estudio descriptivo, considerando una población referencial de 4 328 postulantes, según el examen de residentado médico 2010, utilizando el programa estadístico Epidat 3,1, con un nivel de confianza del 95%, y precisión del 5%, se obtuvo 353 como valor muestral. Utilizando un cuestionario autoaplicable y validado previamente en 20 médicos postulantes. Resultados: De los 416 médicos encuestados (mediana de 27 años) la mayoría procede de universidades del interior del país (52,6%). El 42,5% trabaja actualmente, de éstos, el 79,7% en el sector privado y el 79,2% bajo la modalidad de locación de servicios. El 48,6% realizó el Servicio Rural Urbano Marginal en Salud (SERUMS) en establecimientos correspondientes al Quintil I (extrema pobreza). El 54,3% ha tenido una experiencia previa del proceso de admisión al residentado médico. El 48,6% está en desacuerdo con el proceso actual del residentado médico, 67,5% está a favor del examen único nacional, y 39,2% prefiere el concurso por especialidades. El 38,9% considera que la evaluación del examen debe ser realizada por el CONAREME y cada universidad. El 54,1% está en desacuerdo al incremento del número de vacantes cautivas y 78,1% expresó estar en desacuerdo ante la propuesta del Ministerio de Salud de implementar tiempo de servicio obligatorio adicional en el residentado médico en regiones de menor desarrollo del país. Conclusiones: La mayoría de médicos encuestados procede de universidades del interior del país, sin carga familiar importante, menos de la mitad trabaja y lo hace en su mayoría bajo la modalidad de locación de servicios. La mayoría está en desacuerdo con el proceso de admisión vigente y a favor del examen único nacional, dividido por especialidades, con una intención marcada por el área de clínicas en las mujeres. La mayoría está en desacuerdo con la propuesta del tiempo de servicio obligatorio adicional de residentado, y proponen mayor transparencia y la eliminación del cobro de CONAREME como requisito de postulación.

El objetivo de este estudio fue determinar patrones de resistencia y multirresistencia de cepas de Salmonella spp. aisladas de una planta procesadora de aves, hacia las quinolonas y fluoroquinolonas (ácido nalidíxico=Na, ciprofloxacina=Cf y enrofloxacina=Ex), así como a otros antimicrobianos: tetraciclinas (T), oxitetraciclina (O), neomicina (N), nitrofurantoina (Nf), trimetoprim (Tr) y cloranfenicol (C). Un total de 146 aislamientos de Salmonella spp. fueron obtenidos de diferentes fuentes: 34 cepas provenientes de mezclas de vísceras blancas (colón, ciegos) y vísceras rojas (hígado y bazo); 87 cepas aisladas de las canales en los procesos de desplume, eviscerado, enfriamiento y empacado; 8 cepas obtenidas de subproductos comestibles (patas, cuellos, hígados y mollejas) y 19 cepas de muestras de ambientes (agua, hielo y superficies de equipos). Se utilizaron técnicas microbiológicas convencionales, pruebas bioquímicas, serológicas y pruebas de susceptibilidad a los antibióticos por difusión en agar. Los resultados revelaron una alta resistencia para Na (73,3%; 107/146), Nf (60,2%; 88/146), T (56,2%; 82/146), O (54,8%; 80/146), Tr (54,1%; 79/146) y una menor resistencia a Ex (6.2%; 9/146), Cf (2,7%; 4/146), N (2,0%; 3/146) y C (2,5%; 4/146). Se encontró un porcentaje elevado de multirresistencia (65,0%; 95/146) y dentro de ellos, los más notorios fueron: NaNfTTr (42,1%), NaNfTr (26,3%) y NaNfT (10,5%). No se observó relación significativa (P>0,05) entre los patrones de resistencia y multirresistencia encontrados con el origen de las diferentes cepas de Salmonella. Estos resultados evidencian el surgimiento de cepas de Salmonellas resistentes a las quinolonas y la necesidad de programas de vigilancia de resistencia antimicrobiana.

The aim of this study was to determine the resistance and multi-resistance patterns of strains of Salmonella spp. isolated in a poultry processing plant in Zulia State, to quinolones and fluoroquinolones (Nalidixic acid=Na, ciprofloxacin=Cf, and enrofloxacin=Ex), as well as other antimicrobial drugs: tetracycline (T), oxitetracycline (O), neomycin (N), nitrofurantoine (Nf), trimetropim (Tr) and chloranfenicol (C). A total of 146 Salmonella isolates were obtained from different sources: 34 strains from pools of Intestines (duodenal and colon) and internal organs (liver and spleen); 87 strains of carcass samples collected in four different phases: carcasses after defeathering, evisceration, chilling, and final packed products; 8 strains from edible by-products (neck, liver, gizzard and legs) and 19 strains from environmental samples (water, ice, and equipment surfaces). The detection analyses were performed using conventional microbiological techniques, biochemical tests, serological and agar diffusion methods for antimicrobial susceptibility. The results showed a high resistance to Na (73.3%; 107/146), Nf (60.2%; 88/147), T (56.2%; 82/146), O (54.8%; 80/146), Tr (54.1%; 79/146) and low resistance to Ex (6.2%; 9/146), Cf (2.7%; 4/146), N (2.0%; 3/146) and C (2.7%; 4/146). There was observed a high percentage of multi-resistant strains (65.0%; 95/146) and within of them, the most common patterns were: NaNfTTr (42.1%), NaNfTr (26.3%) and NaNfT (10.5%). No significant relationship was observed (P>0.05) between resistance and multi-resistance patterns with the source of the Salmonella strains. These results are evidence of the emergence of resistant Salmonella strains to fluoroquinolones and the necessity of programs for antimicrobial resistance surveillance.

Echerichia coli O157:H7 es considerado un patógeno emergente a nivel mundial y potencialmente fatal en infecciones humanas. El ganado bovino es el reservorio primario de E. coli O157:H7, por lo que el objetivo de esta investigación fue dirigida a determinar la presencia de dicha bacteria en heces de ganado bovino de doble propósito del municipio Miranda, estado Zulia, Venezuela. Se procesaron 309 muestras fecales de 155 vacas y 154 becerros provenientes de 6 fincas. Las muestras fueron analizadas usando técnicas bacteriológicas convencionales, bioquímicas y serológicas, estas últimas con la utilización de monovalentes somáticos O157 y H7, y pruebas de aglutinación con látex para O157. En total se logró el aislamiento de seis cepas (1,94%) positivas a las pruebas de aglutinación para antígeno somático O157 y flagelar H7. Adicionalmente, se detectó una cepa O157 positiva no mótil (O157:NM). No se observó diferencias significativas (P>0,05) en la excreción de E. coli O157:H7 al comparar los dos grupos de animales estudiados. Los animales portadores de esta bacteria no mostraron signos clínicos de enfermedad, por lo que fueron considerados como portadores asintomáticos. En conclusión, los resultados de este estudio demuestran la presencia de E. coli O157:H7 en heces de vacas y becerros en el estado Zulia, los cuales pudieran considerarse como una fuente de exposición directa con este patógeno zoonótico, así como una fuente potencial de contaminación de productos alimenticios de origen bovino.

Escherichia coli O157:H7 is considered a worldwide emerging pathogen which is potentially fatal in humans. Cattle are known as one of the main reservoir of E. coli O157:H7. The aim of this research was to investigate the presence of E. coli O157:H7 in fecal material of dual purpose cattle from the Miranda Municipality at Zulia State, Venezuela. Three-hundred and nine fecal samples of 155 cows and 154 calves from 6 dual purpose farms were processed. Samples were analyzed by conventional bacteriological techniques, biochemical and serological tests, somatic monovalent O157 and flagellar H7. Also, a latex agglutination for somatic antigen O157. A total of six strains (1.94%) positives to the agglutination tests to detect somatic antigen O157 and flagellar H7 were obtained. Additionally a nonmotile O157 strain was also detected (O157:NM). Non significant differences were observed in the shedding of E. coli O157:H7 between cows and calves. The animals who shedding these bacteria did not show clinical signs of illness; therefore, they were considered as asymptomatic carriers. In conclusion, the presence of E. coli O157:H7 in feces from dual purpose cows and calves from this study, revealed that these animals could be considered a feasible source of direct exposure with this zoonotic pathogen, as well as a potential source of contamination of food products derived from those animals.