Resumen Introducción La pandemia de COVID-19 provocó el cese de las actividades académicas desde el formato presencial al confinamiento de las clases virtuales, de las que poco se ha estudiado sobre su efecto en la salud mental. Objetivo Determinar los niveles de depresión, ansiedad y estrés en estudiantes de medicina de México y Colombia durante la pandemia de COVID-19; además de comparar depresión, ansiedad y estrés por género, nivel educativo y país. Método Se realizó un estudio transversal con 426 estudiantes de medicina. Los datos se recopilaron mediante una encuesta en línea que contenía el cuestionario DASS-21. Resultados Las puntuaciones generales de depresión, ansiedad y estrés fueron 6.7 ± 1.2, 8.8 ± 1.2 y 5.6 ± 1.2, respectivamente. Las mujeres tuvieron puntajes generales significativamente más altos para depresión (.24-fold increase), ansiedad (.25-fold increase) y estrés (.40-fold increase). El riesgo de ansiedad y estrés por año escolar mostró que los años básicos se asociaron con puntajes más altos que los estudiantes en años los avanzados (.25 y .38-fold increase). Para las mujeres, cursar años básicos mostró un mayor riesgo de depresión en comparación con los estudiantes varones (.38-fold increase). Por último, los estudiantes mexicanos tuvieron un mayor riesgo de depresión y ansiedad (p ≤ .022 y p ≤ .004, respectivamente) pero no de estrés (p ≤ .402) en comparación con los estudiantes Colombianos. Discusión y conclusión Se observó ansiedad y depresión significativas en estudiantes de medicina mexicanos y colombianos. Los factores asociados a un mayor riesgo de depresión y ansiedad fueron; ser estudiante en años básicos además de ser mujer.

Abstract Introduction The COVID-19 pandemic caused the cessation of academic activities from the face-to-face format to confinement and virtual classes, in which little is studied about its effect on mental health. Objective Determine levels of depression, anxiety, and stress in medical students in Mexico and Colombia during the COVID-19 pandemic. Furthermore, depression, anxiety, and stress were compared by gender, education status, and country. Method A cross-sectional study was carried out with 426 medical students. Data was collected using an online survey containing the Depression, Anxiety, Stress Scale (DASS-21) questionnaire. Results Overall scores for depression, anxiety, and stress were 6.7 ± 1.2, 8.8 ± 1.2, and 5.6 ± 1.2, respectively. Females had significantly higher overall scores for depression (.24-fold increase), anxiety (.25-fold increase), and stress (.40-fold increase) than males (p ≤ .01). The risk for anxiety and stress by school year showed that basic years were associated with higher scores than advanced years (.25 and .38-fold increase, respectively). For females, starting medical school did show an increased risk of depression when compared to male students in their basic years (.38-fold increase). Lastly, students from Mexico had an increased risk for depression and anxiety (p ≤ .022 and p ≤ .004, respectively) but not for stress (p ≤ .402), when compared to students from Colombia. Discussion and conclusion Significant anxiety and depression were observed in medical students from Mexico and Colombia. Factors associated with an increased risk of depression and anxiety are students in their basic years as well as being female.

RESUMEN. Introducción: El comportamiento de la accidentabilidad durante la pandemia (2020-2021) fue distinto para cada país; además, se observó cambios en las características de los accidentes de trabajo. Objetivos: Describir el comportamiento y los fatores asociados a la accidentabilidad laboral atendida en el Servicio de Emergencia de un hospital del Seguro Social de Perú de Lima Metropolitana, durante la pandemia de la COVID-19. Material y Métodos: Estudio transversal analítico, que revisó la data de los reportes de accidentes que llegaron a un hospital del seguro social peruano, se tomó como variable principal al período de ocurrencia, según eso se obtuvo estadísticos descriptivos y analíticos. Resultados: De los 5753 accidentes analizados, los años con más accidentes fueron el 2018 (45,7%) y el 2019 (23,1%), durante la pandemia (2020 - 2021) hubo 26,0% de la totalidad de accidentes. En el modelo multivariado se encontró que en la pandemia hubo más accidentes por aplastamiento (RPa: 2,1; IC95%: 1,5-2,9; valor p<0,001) y de agresiones por arma (RPa: 1,2; IC95%: 1,1-1,4; valor p=0,005). Los accidentes más prevalentes fueron por trauma interno (RPa: 1,6; IC95%: 1,1-2,3; valor p=0,025), por torcedura (RPa: 1,2; IC95%: 1,0-1,4; valor p=0,025) y por fracturas (RPa: 1,5; IC95%: 1,1-1,9; valor p=0,002). Las zonas más afectadas fueron la región lumbosacra (RPa: 1,4; IC95%: 1,1-1,8; valor p=0,009) y los dedos (RPa: 1,1; IC95%: 1,0-1,3; valor p=0,046). Conclusión: Durante la pandemia, hubo más accidentes por aplastamiento, por agresiones, por trauma interno, por torcedura, por fracturas, en la región lumbosacra y en los dedos.

ABSTRACT Introduction: The behavior of the accident rate during the pandemic (2020-2021) was different for each country; In addition, changes in the characteristics of work accidents were observed. Objective: To describe the behavior of occupational accidents attended in the Emergency Service of a Peruvian Social Security hospital in Metropolitan Lima, during the COVID-19 pandemic. Material and Methodo: Cross-sectional study, which reviewed the data from accident reports that arrived at a Peruvian social security hospital, taking the period of occurrence as the main variable, according to which descriptive and analytical statistics were obtained. Results: Of the 5,753 works accidents analyzed, the years with the most accidents were 2018 (45.7%) and 2019 (23.1%), during the pandemic (2020-2021) there were 26.0% of all accidents. In the multivariate model, it was found that during the pandemic there were more accidents due to crushing (aPR: 2,1; 95% CI: 1,5-2,9; value p<0,001) and attacks by weapons (aPR: 2,1; IC95%: 1,5-2,9; value p<0,001). The most prevalent accidents due to internal trauma (aPR: 1.6; 95%CI: 1.1-2.3; p value=0.025), sprain (aPR: 1.2; 95%CI: 1.0-1.4; p value=0.025) and fractures (aPR: 1.5; 95% CI: 1.1-1.9; p value=0.002). The most affected areas were the lumbosacral region (aPR: 1.4; 95% CI: 1.1-1.8; p value=0.009) and in fingers (aPR: 1.1; 95% CI: 1.0-1.3; p value=0.046). Conclusion: During the pandemic, there were more accidents due to crushing, assaults, internal trauma, sprains, fractures, in the lumbosacral region and in the fingers.

ABSTRACT Introduction: Low back pain continues to be one of the main symptoms in personnel carrying out loads, but this was not widely investigated in the context of COVID-19. Objective: To determine the socio-occupational factors associated with low back pain in technicians and nurses of critical medical services who treated COVID-19 patients. Material and Methods: Cross-sectional analytical study. Through a virtual survey, information was collected from the nursing staff of the general ICU, COVID-19 ICU and Traumatology services of a Social Security hospital in Lima-Peru. The main variable was low back pain, this was crossed with other variables of interest through descriptive and analytical statistics. Results: Of the 265 responses, 62% (165) reported having low back pain. In the multivariate model, it was found that there was a greater suffering from low back pain according to having more years of work (RPa: 1,03; CI: 95%: 1,01-1,06; p-value=0,008) and if they had previously had a work disability (RPa: 1.45; 95% CI: 1.25-1.68; p-value=<0.001), on the other hand, the older the respondents, the less low back pain (RPa: 0.97; CI95%: 0.95-0.99; p value=0.0013), adjusted for five variables. Discussion: The majority of respondents had low back pain, being associated with more years of work, having previously had a work disability and age. This situation may be repeating itself in similar populations, so occupational health services should carry out evaluations and interventions to improve this reality.

RESUMEN. Introducción: La lumbalgia sigue siendo uno de los principales síntomas en el personal de salud que asiste y traslada pacientes, sobre todo con el incremento de casos durante la pandemia de la COVID-19. Objetivo: Determinar los factores socio-laborales asociados a la lumbalgia en técnicas y enfermeras de servicios críticos que atendieron pacientes COVID-19. Material y Métodos: Estudio transversal analítico. A través de una encuesta virtual se recolectó información del personal de enfermería de los servicios de UCI general, UCI COVID-19 y Traumatología de un hospital del Seguro Social en Lima-Perú. La variable principal fue la lumbalgia, esta se cruzó con otras variables de interés mediante estadística descriptiva y analítica. Resultados: De las 265 respuestas, el 62% (165) manifestó tener un dolor lumbar. En el modelo multivariado, se encontró que hubo mayor padecimiento de lumbalgia según el tener más años de trabajo (RPa: 1,03; IC95%: 1,01-1,06; valor p=0,008) y si antes habían tenido una incapacidad laboral (RPa: 1,45; IC95%: 1,25-1,68; valor p<0,001), en cambio, a mayor edad de las encuestadas hubo menos lumbalgia (RPa: 0,97; IC95%: 0,95-0,99; valor p=0,013), ajustado por cinco variables. Discusión: La mayoría de encuestadas tuvo lumbalgia, estando asociado a más años de trabajo, haber tenido previamente una incapacidad laboral y a la edad. Esta situación puede que se esté repitiendo en poblaciones similares, por lo que, los servicios de salud ocupacional deberán realizar evaluaciones e intervenciones para mejorar esta realidad.

RESUMEN. Introducción: La lumbalgia sigue siendo uno de los principales síntomas en el personal de salud que asiste y traslada pacientes, sobre todo con el incremento de casos durante la pandemia de la COVID-19. Objetivo: Determinar los factores socio-laborales asociados a la lumbalgia en técnicas y enfermeras de servicios críticos que atendieron pacientes COVID-19. Material y Métodos: Estudio transversal analítico. A través de una encuesta virtual se recolectó información del personal de enfermería de los servicios de UCI general, UCI COVID-19 y Traumatología de un hospital del Seguro Social en Lima-Perú. La variable principal fue la lumbalgia, esta se cruzó con otras variables de interés mediante estadística descriptiva y analítica. Resultados: De las 265 respuestas, el 62% (165) manifestó tener un dolor lumbar. En el modelo multivariado, se encontró que hubo mayor padecimiento de lumbalgia según el tener más años de trabajo (RPa: 1,03; IC95%: 1,01-1,06; valor p=0,008) y si antes habían tenido una incapacidad laboral (RPa: 1,45; IC95%: 1,25-1,68; valor p<0,001), en cambio, a mayor edad de las encuestadas hubo menos lumbalgia (RPa: 0,97; IC95%: 0,95-0,99; valor p=0,013), ajustado por cinco variables. Discusión: La mayoría de encuestadas tuvo lumbalgia, estando asociado a más años de trabajo, haber tenido previamente una incapacidad laboral y a la edad. Esta situación puede que se esté repitiendo en poblaciones similares, por lo que, los servicios de salud ocupacional deberán realizar evaluaciones e intervenciones para mejorar esta realidad.

ABSTRACT Introduction: Low back pain continues to be one of the main symptoms in personnel carrying out loads, but this was not widely investigated in the context of COVID-19. Objective: To determine the socio-occupational factors associated with low back pain in technicians and nurses of critical medical services who treated COVID-19 patients. Material and Methods: Cross-sectional analytical study. Through a virtual survey, information was collected from the nursing staff of the general ICU, COVID-19 ICU and Traumatology services of a Social Security hospital in Lima-Peru. The main variable was low back pain, this was crossed with other variables of interest through descriptive and analytical statistics. Results: Of the 265 responses, 62% (165) reported having low back pain. In the multivariate model, it was found that there was a greater suffering from low back pain according to having more years of work (RPa: 1,03; CI: 95%: 1,01-1,06; p-value=0,008) and if they had previously had a work disability (RPa: 1.45; 95% CI: 1.25-1.68; p-value=<0.001), on the other hand, the older the respondents, the less low back pain (RPa: 0.97; CI95%: 0.95-0.99; p value=0.0013), adjusted for five variables. Discussion: The majority of respondents had low back pain, being associated with more years of work, having previously had a work disability and age. This situation may be repeating itself in similar populations, so occupational health services should carry out evaluations and interventions to improve this reality.

RESUMO Objetivo: A atividade da paraoxonase1 está associada à degeneração macular relacionada à idade. Dois polimorfismos (L55M e Q192R) mostraram aumentar a atividade da paraoxonase1 e foram implicados no desenvolvimento da degeneração macular relacionada à idade. Os estudos que examinaram esses polimorfismos apresentaram resultados conflitantes: nenhum efeito, risco aumentado ou diminuído. Assim, esta meta-análise foi realizada para determinar o efeito desses polimorfismos na degeneração macular relacionada à idade. Métodos: Foi feita uma busca nos bancos de dados PubMed, EBSCO, LILACS e SCOPUS, bem como nas bibliografias compiladas das publicações, buscando-se estudos caso-controle que tivessem analisado os polimorfismos da paraoxonase1 e a degeneração macular relacionada à idade. Os dados foram analisados com software Comprehensive Meta-Analysis, versão 2.2, e NCSS Statistical, versão 2020. As distribuições de genótipos foram extraídas e, dependendo do nível de heterogeneidade, modelos de efeitos fixos ou aleatórios foram utilizados para calcular razões de probabilidade (RPs) combinadas, com intervalos de confiança de 95% (IC 95%) para os modelos genéticos heterozigoto, homozigoto, dominante, recessivo e alélico. Resultados: Em geral, nenhum dos modelos genéticos demonstrou associação significativa para o polimorfismo L55M. Entretanto, em populações não asiáticas, foi determinada uma associação significativa para os modelos genéticos heterozigoto e dominante (RPfaixa=1,24-1,27, p<0,05). Para a população asiática, os modelos heterozigoto, dominante e alélico mostraram um fator benéfico ou protetor (RPfaixa=0,29-0,35, p<0,05). Para o polimorfismo Q192R, nenhum dos modelos genéticos demonstrou qualquer associação significativa. Porém, quando a coorte foi agrupada por etnia, determinou-se uma associação significativa na população asiática para os modelos genéticos recessivo e alélico (RPfaixa=1,63-2,08, p<0,05). Contudo, nenhuma associação foi observada para a população não asiática. Não houve risco identificável quando a coorte foi estratificada em exsudativa e não exsudativa. Conclusões: Determinamos que o polimorfismo L55M da paraoxonase1 de fato aumenta o risco de desenvolvimento de degeneração macular relacionada à idade em populações não asiáticas, enquanto que em populações asiáticas, esse polimorfismo tem um efeito protetor. Porém, para o polimorfismo Q192R da paraoxonase1, apenas a população asiática demonstrou risco de desenvolver degeneração macular relacionada à idade.

ABSTRACT Purpose: Paraoxonase-1 activity is associated with age-related macular degeneration. Two polymorphisms (L55M and Q192R) were shown to increase paraoxonase-1 activity and have been implicated in the development of age-related macular degeneration. The results of studies that have examined these polymorphisms are conflicting, showing no effect, as well as increased or decreased risk. Therefore, this meta-analysis was conducted to determine the effect of these polymorphisms on age-related macular degeneration. Methods: PubMed, EBSCO, LILACS, and Scopus databases, as well as and the retrieved bibliographies of publications were searched for case-control studies that examined for paraoxonase-1 polymorphisms and age-related macular degeneration. Data were analyzed using the Comprehensive Meta-Analysis Version 2.2 and the NCSS Statistical Version 2020 software. Genotype distributions were extracted and, depending on the level of heterogeneity, fixed effects or random effects models were used to calculate pooled odds ratios (ORs) with 95% confidence intervals (95% CIs) for the heterozygous, homozygous, dominant, recessive, and allelic genetic models. Results: Overall, for the L55M polymorphism, none of the genetic models demonstrated a significant association. However, for non-Asian populations, a significant association was determined for the heterozygous and dominant genetic models (ORrange=1.24-1.27, p<0.05). For the Asian population, the heterozygous, dominant, and allelic genetic models demonstrated a benefit/protective factor (ORrange=0.29-0.35, p<0.05). For the Q192R polymorphism, none of the genetic models demonstrated a significant association. However, when the cohort was grouped by ethnicity, a significant association was determined in the Asian population for the recessive and allelic genetic models (ORrange=1.63-2.08, p<0.05). However, for the non-Asian population, there was no association observed. Also, there was no identifiable risk when the cohort was stratified into exudative and non-exudative cases. Conclusions: The paraoxonase-1L55M polymorphism increases the risk of developing age-related macular degeneration in non-Asian populations, whereas in Asian populations, the polymorphism exerts a protective effect. However, for the paraoxonase-1 Q192R polymorphism, only the Asian population demonstrated a risk of developing age-related macular degeneration.

Abstract: The Big Naked-backed Bat, Pteronotus gymnonotus, is one of the 15 species currently recognized of this genus, with relatively few specimens in scientific collections, besides being poorly studied. It has a geographical distribution spanning from México through Central America and reaching Perú and Brazil, in which it occupies a variety of habitats from desert to tropical forests below 400 meters above sea level. Here, we report the records that demonstrate its presence, and data about its natural history in southeastern México, the northernmost part of its geographic distribution range. Between June 2002 and July 2018, we captured specimens in 44 bat roosts located in southeastern México, including the Parque Estatal Agua Blanca, Macuspana, Tabasco; Grutas de Martínez de la Torre, Matías Romero Avendaño, Oaxaca; and in Cueva de Villa Luz, Tapijulapa, Tabasco. In the three locations mentioned, we recorded the occurrence of P. gymnonotus individuals, whose taxonomic identification at species level was corroborated by both morphological data and genetic analyses. Previously, the only records of P. gymnonotus in México were from only four specimens scattered across time, so these new recorded locations confirm the presence of this species in the country. In addition to this, in Agua Blanca State Park and Villa Luz Cave we found a reproductive resident population. The record from Grutas de Martínez de la Torre is located in the middle of the Tehuantepec Isthmus, a well known biogeographical barrier for many taxa in the transitional area to the Pacific lowland’s region. We suggest that the occurrence of P. gymnonotus in México is also associated with large remnants of evergreen and gallery forests, located in the lowland areas along the Gulf of México and in the north and east of the Tehuantepec Isthmus.

Resumen: El gran murciélago de espalda desnuda, Pteronotus gymnonotus, es una de las 15 especies actualmente reconocidas del género, de la cual existen pocos registros en colecciones científicas, además de ser poco estudiada. Tiene una distribución geográfica que se expande desde México a lo largo de América Central hasta el Perú y el Brasil, ocupando una variedad de hábitats desde el desierto hasta las selvas tropicales por debajo de los 400 metros sobre el nivel del mar. Se reportan los registros que atestiguan su presencia y datos sobre su historia natural, en el sureste de México, la parte más septentrional de su intervalo de distribución geográfica. Entre junio de 2002 y julio de 2018 capturamos murciélagos en 44 refugios localizados en el sureste de México. Encontramos individuos de P. gymnonotus en tres localidades: el Parque Estatal Agua Blanca, Macuspana, Tabasco; Grutas de Martínez de la Torre, Matías Romero Avendaño, Oaxaca y en la Cueva de Villa Luz, Tapijulapa, Tabasco. La identificación a nivel de especie fue corroborada con datos morfológicos y análisis genéticos. Anteriormente, los registros de P. gymnonotus en México correspondían sólo a cuatro ejemplares dispersos en el tiempo, por lo que su registro para estas nuevas localidades confirma definitivamente la presencia de esta especie en el país. Además, en el Parque Estatal de Agua Blanca y en la Cueva de Villa Luz encontramos una población residente reproductivamente activa. El registro correspondiente a las Grutas de Martínez de la Torre se encuentra en el centro del Istmo de Tehuantepec, zona que es bien conocida por ser una barrera biogeográfica para muchos taxones y en la zona de transición a la región de las tierras bajas del Pacífico. Sugerimos que la presencia de P. gymnonotus en México también está asociada a grandes remanentes de bosques siempre verdes y de galería, situados en las zonas bajas a lo largo del Golfo de México y en el norte y el este del Istmo de Tehuantepec.

Abstract: Bats have a great variety of wing morphologies that determines the bat’s flight performance, and this in turn conditions the forage aerosphere and the food it can obtain. Several studies have shown differences in wing morphology, flight performance, and forage aerospheres among species from different trophic guilds. However, for species that share a guild this is not entirely clear. It is possible that these species have differences in their diet and show changes in wing morphology that modify their flight performance and forage areas. Determining this will allow a better understanding of spatial segregation among species that share a trophic guild. These studies allow the identification of species assemblages based on wing morphological differences and flight performance that would not be distinguished only by guild membership. Our goal was to define the species assemblages that make up a community of Neotropical cave dwelling bats based on their trophic guild, flight performance, and forage zone. A community of Neotropical cave dwelling bats from a cave in Veracruz, Mexico was analyzed. The diet of each species was determined by means of their stomach contents and bibliographic review. In addition, aspect ratio, wing loading and tip index were calculated. Based on the wing characteristics and diet, multivariate groupings and orders were performed, as well as to define the assemblages present. According to the wing characteristics and the dietary composition, four groups of species were found that represent four different flight characteristics in terms of agility and maneuverability. There was agreement between diet and wing characteristics, and the four trophic groups were identified through canonical correspondence analysis. Correlating wing morphology, diet and forage area allows us to adequately define the assemblages of a community of bats. Regarding the hypothesis, it was found that species that share a food guild show differences in the composition of their food and wing morphology, which generate differences in flight performance and forage areas. Four assemblages differing in forage aerospheres among three trophic guilds are described: understory and facultative artrhopodivorous, semi-clearing hematophages, and facultative nectarivores. Finally, spatial segregation between the species of the families Mormoopidae and Natalidae was recognized.

Resumen: Los murciélagos presentan gran variedad de morfologías alares que determina el desempeño de vuelo del murciélago y condiciona la aerósfera de forraje y alimento que puede conseguir. Varios estudios han demostrado diferencias en morfología alar, desempeños de vuelo y aerósferas de forraje entre especies de diferentes gremios tróficos. Sin embargo, para especies que comparten un gremio esto no es del todo claro. Es posible que estas especies tengan diferencias en su dieta a pesar de pertenecer al mismo gremio trófico, y manifiesten cambios en la morfología alar, desempeño de vuelo y zonas de forraje. Analizar esto permiten entender la segregación espacial entre especies que comparten un gremio trófico, además de identificar ensambles de especies con base en diferencias morfológicas alares y desempeño de vuelo. Nuestro objetivo fue definir los ensambles de especies que integran una comunidad de murciélagos cavernícolas neotropicales con base en su gremio trófico, desempeño de vuelo y zona de forraje. Se analizó una comunidad de murciélagos cavernícolas neotropicales en Veracruz, México. La dieta de cada especie se determinó por medio de sus contenidos estomacales y revisión bibliográfica. Además, se calculó relación de aspecto, carga alar e índice de punta. Con base en las características alares y la dieta, se realizaron ordenaciones multivariadas para definir los ensambles presentes. Se encontraron cuatro grupos de especies que representan cuatro desempeños de vuelo distintos en cuanto a agilidad y maniobrabilidad. Hubo concordancia entre la dieta y las características alares en el análisis canónico de correspondencia. Correlacionar morfología alar, dieta y zona de forraje permite definir adecuadamente los ensambles de una comunidad de murciélagos. Con respecto a la hipótesis, se encontró que especies que comparten un gremio alimenticio muestran diferencias en la composición de sus alimentos y morfología alar, lo que genera diferencias en desempeños de vuelo y zonas de forraje. Se describen cuatro ensambles que difieren en aerósferas de forraje entre tres gremios tróficos: artropodívoros de sotobosque y facultativos, hematófagos de zonas semidespejadas y nectarívoros facultativos. Por último, se reconoció la segregación espacial entre las especies de las familias Mormoopidae y Natalidae.

Abstract Introduction Our aim was to evaluate the dietary intake and anthropometric indices in medical students with positive family history of type 2 diabetes (FH-T2D)(+) and without FH-T2D(-). Material and Methods 144 students were analyzed in this cross-sectional, observational study, conducted during the 2017-2018 school year using interviews and 7-day food diary. The participants were characterized anthropometrically. Waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR), corrected mid-arm muscle area (MAMA), fat arm index (FAI), and tricipital skinfold (TSF) were calculated. Results We found that 79.2% (95%CI:72.5-85.8) had FH-T2D. BMI was significantly higher in the participants with FH-T2D than without (23.7±3.8 vs. 25.0±3.7, respectively; p<0.05). No significant differences were determined in the indices based on central fat distribution (WHtR and WHR), peripheral distribution (FAI and TSF), or muscle mass (MAMA), when stratified by FH-T2D. Regarding dietary intake, when comparing participants with and without FH-T2D, respectively, we observed low/none legume consumption [30% (95%CI:21.4-38.2) vs. 23% (95%CI:8.2-38.5)], diets high in proteins [38.6% (95%CI:29.7-47.5) vs. 46.7% (95%CI:28.8-64.5)], low in carbohydrates [84.2% (95%CI:77.5-90.9) vs. 83.3% (95%CI:70.0-96.7)], and insufficient energy intake [64% (95%CI:55.2-72.8) vs. 56.7% (95%CI:38.9-74.4)], where the alterations in the dietary pattern were more detrimental for the FH-T2D(+) group. Lastly, the participants with FH-T2D consumed mainly late in the day [60% (95%CI:50.6-68.6) vs. 54% (95%CI:35.5-71.2)]. Conclusions Even though there were minimal significant differences with the consumption by food categories, those students with FH-T2D presented with a poor, little varied and unbalanced dietary pattern with energy consumption mainly at night. These factors, if prolonged, could increase the risk of developing type 2 diabetes.

Resumen Introducción Nuestro objetivo fue evaluar la ingesta dietética y los índices antropométricos en estudiantes de medicina con historia familiar positiva de diabetes tipo 2 (FH-T2D)(+) y sin antecedentes familiares FH-T2D(-). Material y Métodos 144 estudiantes fueron analizados en este estudio transversal y observacional realizado durante el año escolar 2017-2018 mediante entrevistas y un diario de alimentos de 7 días. Los participantes se caracterizaron antropométricamente. Se calculó el ínidce cintura-cadera (WHR) y el índice cintura-altura (WHtR), el área muscular corregida de la mitad del brazo (MAMA), el índice de grasa del brazo (FAI) así como el pliegue cutáneo tricipital (TSF). Resultados El 79,2% (95%CI:72,5-85,8) tenían FH-T2D. El IMC fue significativamente mayor en los participantes con FH-T2D que en aquellos sin FH-T2D (23,7±3,8 vs. 25,0±3,7, respectivamente; p<0,05). No se determinaron diferencias significativas en los índices basados en la distribución de grasa central (WHtR y WHR), la distribución periférica (FAI y TSF) o la masa muscular (MAMA), cuando se estratificó por FH-T2D. Al comparar la ingesta dietética de participantes con y sin FH-T2D, respectivamente, observamos un consumo bajo/ninguno de leguminosas [30% (95%CI:21,4-38,2) frente a 23% (95%CI:8,2-38,5)], dietas altas en proteínas [38,6% (95%CI:29,7-47,5) frente a 46,7% (95%CI:28,8-64,5)], bajas en carbohidratos [84,2% (95%CI:77,5-90,9) frente a 83,3% (95%CI:70,0-96,7)], y la ingesta de energía insuficiente [64% (95%CI:55,2-72,8) frente a 56,7% (95%CI:38,9-74,4)], donde las alteraciones en el patrón de la dieta fueron más perjudiciales para el grupo FH-T2D(+). Los participantes con FH-T2D consumieron al final del día [60% (95%CI:50,6-68,6) frente a 54% (95%CI:35,5-71,2)]. Conclusiones Aunque hubo diferencias mínimas significativas con el consumo por categorías de alimentos, aquellos estudiantes con FH-T2D presentaron un patrón dietético deficiente, poco variado y desequilibrado con un consumo de energía principalmente por la noche. Estos factores, si se prolongan, podrían aumentar el riesgo de desarrollar diabetes tipo 2.

Resumo Fundamento: O desafio atual da cirurgia cardiovascular (CCV) é melhorar resultados em pacientes cada vez mais graves. Nesse sentido, Programas de Melhoria Contínua da Qualidade (PMCQ) tem impactado os resultados. Objetivo: Avaliar a evolução da incidência e mortalidade das CCV, assim como os resultados atuais do Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor). Métodos: Análise dos resultados das CCV realizadas no InCor entre jan-1984 e jun-2019. Foram observadas as tendências dos volumes cirúrgicos e da mortalidade em 5 períodos 1º (1984-1989), 2º (1990-1999), 3º (2000-2007), 4º (2008-2015) e 5º (2016-2019). O PMCQ foi estabelecido entre 2015-2016. A análise incluiu o total de cirurgias e a evolução dos procedimentos mais frequentes. Resultados: Foram realizadas 105.599 CCV, com uma média anual de 2.964 procedimentos e mortalidade de 5,63%. Comparando o 4º com o 5º período, o volume global médio de cirurgias foi de 2.943 para 3.139 (p = 0,368), cirurgias de revascularização miocárdica (CRM) de 638 para 597 (p = 0,214), valvas cardíacas de 372 para 465 (p = 0,201) e cardiopatias congênitas de 530 para 615 (p = 0,125). A mortalidade média global passou de 7,8% para 5% (p < 0,0001), nas cirurgias de revascularização miocárdica de 5,8% para 3,1% (p < 0,0001), nas cirurgias valvares de 14% para 7,5% (p < 0,0001) e nas cirurgias de cardiopatias congênitas de 12,1% para 9,6% (p < 0,0001). Conclusão: Embora haja uma tendência recente ao aumento dos volumes cirúrgicos, houve uma diminuição significativa da mortalidade cirúrgica nos grupos analisados. Após o estabelecimento do PMCQ, as taxas de mortalidade se aproximaram a dos padrões internacionais.

Abstract Background: The current challenge of cardiovascular surgery (CVS) is to improve the outcomes in increasingly severe patients. In this respect, continuous quality improvement (CQI) programs have had an impact on outcomes. Objective: To assess the evolution of the incidence and mortality due to CVS, as well as the current outcomes of the Hospital das Clínicas Heart Institute of the University of São Paulo Medical School (InCor-HCFMUSP). Methods: An outcome analysis of CVSs performed at the InCor, between January 1984 and June 2019. We observed the surgical volume and mortality rates in 5 time periods: 1st (1984-1989), 2nd (1990-1999), 3rd (2000-2007), 4th (2008-2015) and 5th (2016-2019). The CQI program was implemented between 2015 and 2016. The analysis included the total number of surgeries and the evolution of the most frequent procedures. Results: A total of 105,599 CCVs were performed, with an annual mean of 2,964 procedures and mortality of 5,63%. When comparing the 4th and the 5th periods, the average global volume of surgeries was increased from 2,943 to 3,139 (p = 0.368), bypass graft (CABG), from 638 to 597 (p = 0.214), heart valve surgery, from 372 to 465 (p = 0.201), and congenital heart disease surgery, from 530 to 615 (p = 0.125). The average global mortality went from 7.8% to 5% (p < 0.0001); in CABG surgery, from 5.8% to 3.1% (p < 0.0001); in heart valve surgery, from 14% to 7.5% (p < 0.0001) and in congenital heart disease surgery, from 12.1% to 9.6% (p < 0.0001). Conclusion: In spite of a recent trend towards increased surgical volume, there was a significant decrease in operative mortality in the groups studied. After the implementation of the CQI program, the mortality rates were closer to international standards.

Resumen Introducción: se ha descrito la coexistencia de trastornos gastrointestinales funcionales (c-TGF) en lactantes y preescolares (LactPre); sin embargo, hay poca literatura sobre los principales c-TGF y sus características. Objetivo: describir la prevalencia y posibles asociaciones de c-TGF en un mismo LactPre latinoamericano. Metodología: estudio de prevalencia en LactPre de Colombia, Ecuador, Nicaragua y Panamá de consulta externa y urgencias, a quienes, según los criterios de Roma III en español, se identificaron regurgitación, síndrome de rumiación, síndrome del vómito cíclico, cólico, diarrea funcional, estreñimiento funcional y disquecia. Se tuvieron en cuenta la edad, el sexo y el origen. La estadística incluyó t de Student, chi cuadrado, prueba exacta de Fisher, análisis uni y multivariados y el cálculo de los OR e IC 95%, siendo una p <0,05 significativa. Resultados: se analizaron 2417 niños (2,4±19,8 meses de edad, 51,3% masculinos, con diagnóstico de por lo menos algún TGF del 35,7%). Se presentó c-TGF en el 3,6%, siendo el principal el síndrome de rumiación del lactante (SRL) más estreñimiento funcional (EF). Hubo predomino del género masculino en los lactantes y ser colombiano. Conclusión: la principal c-TGF en este grupo de LactPre de Latinoamérica es el SRL más EF, presentándose principalmente en el sexo masculino y en lactantes menores de 24 meses.

Abstract Introduction: Coexistence of functional gastrointestinal disorders (FGID) in infants and preschool children has been described, but there is little literature on the main types of FGID coexistence or their characteristics. Objective: This study describes the prevalence and possible associations of FGID coexistence among Latin American infants and preschool children. Methodology: This is a prevalence study of infants and preschool children conducted in Colombia, Ecuador, Nicaragua and Panama. Children included were outpatients and emergency patients who were identified according to the Rome III Criteria in Spanish as suffering from regurgitation, rumination syndrome, cyclic vomiting syndrome, colic, functional diarrhea, functional constipation and/or dyspepsia. Age, sex and origin of patients were registered. Statistical analyses included Student’s T test, chi squared test, Fisher’s exact test, univariate analysis, multivariate analysis and calculation of odds ratios and 95% confidence intervals with p <0.05 set as significant. Results: Two thousand four hundred and seventeen children were included. Their age range was 2.4 months to 19.8 months of age, and 51.3% were male. The proportion of patients with a diagnosis of at least one FGID was 35.7%. FGID coexistence was found in 3.6% of the patients. The most frequent combination was rumination syndrome plus functional constipation. There were predominances of males, infants and Colombian children in the total sample. Conclusion: The most commonly coexisting FGIDs in this group of Latin America infants and preschool children were infant rumination syndrome and functional constipation which were found together most frequently among boys who were under 24 months old.

Abstract Our objective was to determine the association between the methylenetetrahydrofolate reductase polymorphisms (C677T and A1298C) and the risk of developing acute lymphoblastic leukemia (ALL), chronic myeloid leukemia (CML), acute myeloid leukemia (AML), and multiple myelomas (MM) in Latinos. PubMed, SCOPUS, EBSCO, LILACS, and other Latin-specific databases were searched for case-control studies that investigated the association between these polymorphisms and hematologic malignancies until November 2017. Genotype distributions were extracted and either fixed-effects or random-effects models were used to calculate the pooled crude odds ratios (ORs) for the heterozygous, homozygous, dominant, recessive, and allelic genetic models. No publication bias was detected by the Begg-Mazumdar’s test and Egger’s test. From 290 publications, we identified 15 studies on the C677T polymorphism and 13 studies on the A1298C polymorphism. We observed a significant decrease in risk for the C677T polymorphism (OR range=0.54-0.75, p<0.01) and a significant increase in risk for the A1298C polymorphism (OR range=1.28-2.52, p<0.05) in developing ALL for all genetic models. No associations were determined for CML, AML, or MM for either polymorphism. This meta-analysis demonstrated that the A1298C polymorphism was associated with an increased risk of developing ALL, whereas the C677T polymorphism was associated with a decreased risk (protective factor) in the Latino population.

INTRODUCTION The steadily increasing prevalence of diabetes globally has captured researchers’ attention. Cuban production of scientific articles on diabetes has not been studied from a bibliometric perspective. OBJECTIVE Characterize the production and impact of research and review articles on diabetes by Cuban authors in journals listed in the Scopus bibliographic database, as well as related collaboration among Cuban institutions and between Cuban and non-Cuban institutions. METHODS A bibliometric analysis was conducted using 2000–2017 data from the Scopus database. The following search strategy was used: descriptor (diabetes), country (Cuba), publication source (journal), article type (original research, review article). Bibliographic indicators of production, visibility, impact and collaboration were examined. RESULTS Cuba contributed 3.2% of Latin American production and 0.1% of global production related to diabetes. Within Cuba’s scientific production (610 articles, 538 original research and 72 review), 85.9% had a Cuban corresponding author (Cuban leadership). In articles with international collaboration (22.9%), however, most (67.9%) had non-Cuban corresponding authors. A total of 47% (287) were articles involving a single institution. Only 11.1% were published in top-ranked journals, and 14.4% were cited >10 times. Cubans were lead authors on 0.3% of the most frequently cited (top 10%) articles on diabetes in Scopus. A total of 38.4% of this production appeared in low-impact journals and 57.9% in Cuban journals. Articles published in English accounted for 30% of total and obtained higher impact in terms of citations than articles in Spanish. The strongest networks for scientific collaboration were those that connected Cuban and US researchers. CONCLUSIONS Cuban scientists conduct research on diabetes, but their work is not highly visible in the peer-reviewed literature, particularly in top-ranked journals. The problem is not simply one of publishing more, but of knowing how and where to publish. It is urgent that Cuban universities training health professionals at all levels include instruction on scientific writing.

RESUMO Racional: A gastrectomia laparoscópica tem numerosas vantagens perioperatórias, mas a sobrevivência em longo prazo após este procedimento tem sido menos estudada. Objetivo: Comparar resultados de sobrevivência, oncológica e perioperatória entre a gastrectomia completamente laparoscópica vs. aberta para câncer gástrico precoce. Método: Este estudo foi retrospectivo e os principais resultados foram a sobrevivência global e específica de cinco anos, contagem de linfonodos e taxa de ressecção R0. Resultado secundário foi a morbidade pós-operatória. Resultados: Foram incluídos 116 pacientes (59% homens, idade 68 anos, comorbidades 73%, IMC 25) que foram submetidos a 50 gastrectomias laparoscópicas e 66 gastrectomias abertas. As características demográficas, a localização do tumor, o tipo de operação, a extensão da dissecção dos linfonodos e do estágio não diferiram significativamente entre os grupos. A taxa geral de complicações foi semelhante em ambos os grupos (40% vs. 28%, p=ns) e complicações classificadas Clavien 2 (36% vs. 18%, p=0,03), respiratórias (9% vs. 0%, p=0,03) e as da parede abdominal (12% vs. 0%, p=0,009) foram significativamente menores após a gastrectomia laparoscópica. A contagem de linfonodos (21 contra 23, p=ns) e a taxa de ressecção R0 (100% vs. 96%; p=ns) não diferiram significativamente entre os grupos. A sobrevida global de cinco anos (84% vs. 87%, p=0,31) e a sobrevida específica (93% vs. 98%, p=0,20) não diferiram significativamente entre os grupos de gastrectomia laparoscópica e aberta. Conclusão: Estes resultados suportam resultados oncológicos similares e sobrevida em longo prazo para pacientes com câncer gástrico precoce após gastrectomia laparoscópica e gastrectomia aberta. Além disso, a abordagem laparoscópica está associada com morbidade menos grave e menor ocorrência de complicações respiratórias e da parede abdominal.

ABSTRACT Background: Laparoscopic gastrectomy has numerous perioperative advantages, but the long-term survival of patients after this procedure has been less studied. Aim: To compare survival, oncologic and perioperative outcomes between completely laparoscopic vs. open gastrectomy for early gastric cancer. Methods: This study was retrospective, and our main outcomes were the overall and disease-specific 5-year survival, lymph node count and R0 resection rate. Our secondary outcome was postoperative morbidity. Results: Were included 116 patients (59% men, age 68 years, comorbidities 73%, BMI 25) who underwent 50 laparoscopic gastrectomies and 66 open gastrectomies. The demographic characteristics, tumour location, type of surgery, extent of lymph node dissection and stage did not significantly differ between groups. The overall complication rate was similar in both groups (40% vs. 28%, p=ns), and complications graded at least Clavien 2 (36% vs. 18%, p=0.03), respiratory (9% vs. 0%, p=0.03) and wound-abdominal wall complications (12% vs. 0%, p=0.009) were significantly lower after laparoscopic gastrectomy. The lymph node count (21 vs. 23 nodes; p=ns) and R0 resection rate (100% vs. 96%; p=ns) did not significantly differ between groups. The 5-year overall survival (84% vs. 87%, p=0.31) and disease-specific survival (93% vs. 98%, p=0.20) did not significantly differ between the laparoscopic and open gastrectomy groups. Conclusion: The results of this study support similar oncologic outcome and long-term survival for patients with early gastric cancer after laparoscopic gastrectomy and open gastrectomy. In addition, the laparoscopic approach is associated with less severe morbidity and a lower occurrence of respiratory and wound-abdominal wall complications.

RESUMO Objetivo Determinar a confiabilidade de um instrumento de coleta de dados não laboratoriais, Encuesta de Identificación de Sujetos Metabólicamente Comprometidos en Fase-I (pesquisa de identificação de indivíduos com comprometimento metabólico em fase I, ESF-I) para identificar síndrome metabólica em uma população da região central do México. Métodos Foram coletados parâmetros clínicos e bioquímicos de 232 participantes da pesquisa entre 1° de junho de 2012 e 31 de agosto de 2013. O estudo se baseou em três definições de síndrome metabólica (definição harmonizada do Painel de Especialistas do Programa Nacional de Educação em Colesterol dos Estados Unidos [NCEP]; Painel para Tratamento de Adultos III [ATPIII]; e Federação Internacional de Diabetes [FIL]) para alocar os participantes em um grupo normal ou em um grupo com síndrome metabólica (SM). A previsibilidade do instrumento foi determinada pela área sob a curva ROC (característica de operação do receptor) (AUC). O índice de Youden foi calculado e o escore mais alto foi considerado o valor ideal de corte. O coeficiente kappa de Cohen (κ) foi calculado para determinar o grau de concordância entre o questionário ESF-1 (pontuação máxima de 15 em 15 itens) e a síndrome metabólica. Resultados Foi determinado que 53,8% a 60,7% dos participantes apresentavam SM. A pontuação média no instrumento foi significativamente maior no grupo SM com cada uma das definições usadas (4,0 vs. 8,0, P<0,05). O questionário ESF-I foi preditivo com a definição harmonizada (AUC 0,841; IC 95% 0,790–0,892), com a definição do ATPIII (AUC 0,827; IC 95% 0,774–0,880) e com a definição da FIL (AUC 0,836; IC 95% 0,785–0,887). Um valor de corte de 7 foi determinado para cada definição e a coorte foi recategorizada de acordo com os resultados do instrumento. Foi observada uma forte concordância entre o questionário ESF-I e o grupo SM (harmonizada: precisão = 77,6%, κ = 0,554; ATPIII: precisão = 74,1%, κ = 0,489; FIL: precisão = 74,6%, κ = 0,495, P<0,001). Conclusão O questionário ESF-I é capaz de identificar pacientes com síndrome metabólica, possibilitando o diagnóstico precoce, um número menor de consultas e um custo menor com uma aplicação mais simples.

ABSTRACT Objective To determine the reliability of a non-laboratorial questionnaire, the Encuesta de Identificación de Sujetos Metabólicamente Comprometidos en Fase-I (ESF-I) for identifying Metabolic Syndrome among a population in central Mexico. Methods Clinical and biochemical parameters were collected for 232 participants from 1 June 2012 – 31 August 2013. Three definitions of Metabolic Syndrome (Harmonizing, National Cholesterol Education Program Expert Panel and Adult Treatment Panel III [ATPIII], and International Diabetes Federation [IDF]) were used to allocate subjects to either the normal or Metabolic Syndrome positive (MetS+) group. The predictability of the questionnaire was determined by the Area-Under-the-Receiver-Operating Characteristic curve (AUC). Youden's index was calculated and the highest score was considered the optimal cutoff value. Cohen´s kappa (κ) was calculated to determine the level of agreement between the ESF-I questionnaire (max score: 15 based on 15 items) and Metabolic Syndrome. Results From 53.8% – 60.7% of the participants were determined to be MetS+. The average questionnaire score was significantly higher in the MetS+ group for each definition (4.0 vs. 8.0, P < 0.05). The ESF-I questionnaire was predictive for the Harmonizing definition (AUC = 0.841, 95%CI: 0.790 – 0.892), the ATPIII definition (AUC = 0.827, 95%CI: 0.774 – 0.880), and the IDF definition (AUC = 0.836, 95%CI: 0.785 – 0.887). A cutoff value of 7 was determined for each definition; therefore, the cohort was re-categorized based on questionnaire results. There was a strong agreement between the ESF-I questionnaire and MetS (Harmonizing: accuracy = 77.6%, κ = 0.554; ATPIII: accuracy = 74.1%, κ = 0.489; IDF: accuracy = 74.6%, κ = 0.495, P < 0.001). Conclusion The ESF-I questionnaire can identify MetS+ patients, and therefore, lead to earlier diagnoses, reduced number of consultations, and lower costs with easier application.

RESUMEN Objetivo Determinar la fiabilidad de un cuestionario en el que no se recurre al diagnóstico de laboratorio, la Encuesta de Identificación de Sujetos Metabólicamente Comprometidos en Fase-I (ESF-I), para detectar el síndrome metabólico en una población de la región central de México. Métodos Se recogieron parámetros clínicos y bioquímicos de 232 participantes desde el 1 de junio del 2012 al 31 de agosto del 2013. Se usaron tres definiciones de síndrome metabólico (la unificadora, la del Grupo de Expertos en el Tratamiento de Adultos [ATPIII] del Programa Nacional de Educación sobre el Colesterol y la de la Federación Internacional de la Diabetes [FID]) para asignar los participantes al grupo normal o al grupo de síndrome metabólico positivo (SMet+). Se determinó la previsibilidad del cuestionario con el área bajo la curva de eficacia diagnóstica (curva ROC). Se calculó el índice de Youden y la puntuación más alta se consideró el valor de corte óptimo. El coeficiente (k) de Cohen se calculó para determinar el grade de acuerdo entre el cuestionario ESF-I (máxima puntuación: 15 sobre 15 ítems) y el síndrome metabólico. Resultados Del 53,8 % al 60,7 % de los participantes se asignaron al grupo SMet+. La puntuación promedio del cuestionario fue significativamente mayor en el grupo de SMet+ para cada definición (4,0 vs. 8.0, P < 0.05). El cuestionario ESF-I fue predictivo para la definición unificadora (AUC = 0,841, 95 % CI: 0,790 – 0,892), la definición ATPIII (AUC = 0,827, 95 % CI: 0,774 – 0,880) y la definición de la FID (AUC = 0,836, 95 % CI: 0,785 – 0,887). Se determinó un el valor de corte óptimo de 7 para cada definición; por lo tanto, se reclasificó la cohorte según los resultados del cuestionario. Hubo una gran coincidencia entre el cuestionario ESF-I y SMet (unificadora: exactitud = 77,6 %, κ = 0,554; ATPIII: exactitud = 74,1 %, κ = 0,489; FID: exactitud = 74,6%, κ = 0,495, P < 0,001). Conclusiones El cuestionario ESF-I puede detectar pacientes con SMet+ y, por lo tanto, conducir a diagnósticos más tempranos, reducir la cantidad de consultas y reducir los costos con una aplicación más fácil.