Resumen Introducción Datos previos sugieren que los estudiantes del cuidado a la salud, como es el caso de enfermería, podrían tener un riesgo diferencial de presentar síndrome de burnout debido al estrés al que están sometidos, no obstante, la evidencia aun es escaza y no concluyente. Objetivo Evaluar la asociación entre la formación académica en enfermería con el síndrome de burnout en estudiantes universitarios de Hidalgo, México. Método Estudio trasversal analítico realizado en una muestra de 566 estudiantes universitarios (56% eran estudiantes de enfermería y el resto de las áreas diferentes a la salud). Para determinar la presencia de síndrome de burnout se utilizó la versión en español de la escala Maslach Burnout Inventory-Student Survey, conformada por las subescalas: agotamiento, eficacia académica y despersonalización. La asociación entre las variables de interés se evalúo mediante modelos de regresión logística ajustados por confusores. Resultados En la subescala de despersonalización los estudiantes de enfermería tuvieron mayores posibilidades de presentar síndrome de burnout medio/alto en comparación con los de las otras formaciones académicas (razón de momios ajustada [RMa] = 2.08; intervalo de confianza [IC] al 95% = [1.34, 3.22]). Además, la asociación fue más fuerte entre aquellos que cursaban el tercer y cuarto año escolar (RMa = 3.58; IC 95% = [1.62, 7.89]) a diferencia de los que cursaban los primeros dos años escolares (RMa = 1.20; IC 95% = [.71, 2.03]). Discusión y conclusión Es importante que las universidades brinden a los estudiantes de enfermería herramientas que les permitan sobrellevar las situaciones estresantes durante su formación académica y su futura vida profesional.

Abstract Introduction Previous data suggest that healthcare students, such as nursing students, might have a differential risk of presenting burnout syndrome caused by the stress they are subjected to. However, the evidence is still scarce and inconclusive. Objective To evaluate the association between nursing training and burnout syndrome among undergraduate students in Hidalgo, Mexico. Method A cross-sectional analytical study was conducted on 566 undergraduate students (56% were nursing students and the rest were non-healthcare students). Burnout syndrome was identified using the Spanish version of the Maslach Burnout Inventory-Student Survey, consisting of subscales: emotional exhaustion, depersonalization, and diminished academic efficacy. The association between the variables of interest was evaluated using logistic regression models adjusted for confounders. Results In the depersonalization subscale, nursing students, compared with non-healthcare students, had an adjusted Odds Ratio (aOR) of moderate/high burnout syndrome of 2.08 (95% confidence interval [CI] = [1.34, 3.22]). In addition, the association was stronger among students in the third and fourth school years (aOR = 3.58; 95% CI = [1.62, 7.89]) compared with those in the first and second school years (aOR = 1.20; 95% CI = [.71, 2.03]). Discussion and conclusion It is necessary that universities provide nursing students with tools that allow them to cope with stressful situations during their academic training and their future life as health professionals.

ABSTRACT In Mexico, organophosphorus, carbamates and pyrethroid pesticides are used as part of the program for the control of diseases transmitted by the Aedes aegypti mosquito. Therefore, sprayer operators represent one of the populations with a higher risk of occupational exposure to these compounds. This study aimed to analyze the working conditions that increase the opportunity for pesticide exposure in workers employed in the program to control the adult A. aegypti mosquito in the state of Morelos, and how these conditions shape the work habits and their safety practices. We performed a qualitative study on the Health Services of Morelos workers involved in the vector-borne diseases control program. Data was obtained through focus groups and ethnographic records during April and May 2014. According to the gathered information from participants, the work environment and precarious working conditions modulate risk behaviors in pesticide handling by representing concrete barriers that hinder the adoption of safety measures. Hence, it is imperative to create working conditions aimed at reducing the incidence of pesticide exposure in health workers who perform chemical control of vector-borne diseases.

RESUMEN En México se utilizan plaguicidas organofosforados, carbamatos y piretroides en el programa de manejo de enfermedades trasmitidas por Aedes aegypti, por lo que los trabajadores que laboran en dichos programas como fumigadores constituyen una de las poblaciones con mayor riesgo de exposición ocupacional a estos compuestos. El objetivo de este estudio fue analizar las condiciones de trabajo que incrementan la oportunidad de exposición a plaguicidas en el personal responsable del control del mosquito adulto A. aegypti en Morelos y cómo aquéllas moldean las prácticas de estos trabajadores. Se llevó a cabo un estudio cualitativo en 68 trabajadores de los Servicios de Salud de Morelos adscritos al programa de control de vectores. La información sobre condiciones de trabajo, percepción y prácticas de riesgo se obtuvo mediante grupos focales y registro etnográfico durante abril y mayo del 2014. De acuerdo con la información obtenida, el contexto de trabajo y las condiciones laborales precarias modulan las conductas de riesgo en el manejo de plaguicidas al representar barreras concretas que dificultan la adopción de medidas de seguridad. Los resultados de este estudio muestran la importancia de generar condiciones laborales destinadas a reducir la oportunidad de exposición a plaguicidas en el personal de salud que realiza tareas de control químico de enfermedades transmitidas por vector.

Resumen Objetivo: Resumir la evidencia científica sobre las alteraciones renales asociadas con la infección por SARS-CoV-2. Material y métodos: Se realizó una revisión rápida con la metodología Cochrane. Resultados: La enfermedad renal crónica (ERC) preexistente en pacientes con SARS-CoV-2 varió de 1 a 38% y la lesión renal aguda (LRA), de 2.9 a 86.4%. El pronóstico de la infección fue peor en pacientes con ERC y en aquellos con reserva renal remanente (RRR) intacta que desarrollaron LRA. El riesgo de muerte fue mayor (riesgo relativo combinado = 1.49; IC95%: 1.09-2.04) en pacientes infectados por SARS-CoV-2 con ERC preexistente. Los marcadores de RRR mostraron alteraciones en pacientes con SARS-CoV-2 graves y fatales; el marcador más utilizado fue la creatinina sérica. Conclusiones: La evidencia científica muestra la relevancia de la evaluación y monitoreo permanente de la RRR en pacientes hospitalizados por SARS-CoV-2 para mejorar el pronóstico de aquellos con ERC preexistente, así como de aquellos sin ERC que desarrollan LRA.

Abstract: Objective: To summarize the scientific literature on kidney abnormalities associated with SARS-CoV-2 infection. Materials and methods: It was conducted a rapid review using the Cochrane methodology. Results: Pre-existing chronic kidney disease (CKD) in SARS-CoV-2 infected patients ranged from 1-38% and acute kidney injury (AKI) ranged from 2.9-86.4%. The prognosis of patients with SARS-CoV-2 infection was worse among those with CKD and those with normal remnant kidney function (RKF) that developed AKI. The risk of death was higher (pooled risk ratio =1.49; 95%CI: 1.09-2.04) among SARS-CoV-2 infected patients with pre-existing CKD. The RKF markers showed alterations among severe and non-surviving SARS-CoV-2 patients; the most common marker was serum creatinine. Conclusions: The scientific evidence shows the relevance of the evaluation and permanent monitoring of the RKF in SARS-CoV-2 hospitalized patients to improve the prognosis of those with pre-existing CKD as well as the prognosis of those without CKD who develop AKI.

Resumen: Objetivo: Resumir la evidencia científica sobre efectos maternos y neonatales del Covid-19 durante el embarazo. Material y métodos Se realizó una revisión rápida Cochrane y un metaanálisis de proporciones y razones de momios (RM). Resultados: Los eventos maternos más comunes fueron la ventilación mecánica invasiva y admisión a la unidad de cuidados intensivos (UCI); las complicaciones del embarazo fueron el sufrimiento fetal y la ruptura prematura de membranas; las comorbilidades fueron la obesidad y el asma. Las cesáreas indicadas por Covid-19 fueron frecuentes (51%). Los eventos neonatales comunes fueron bajo peso y prematuridad; se identificaron neonatos SARS-CoV-2 positivos (14%). Las embarazadas con Covid-19 experimentaron más cesáreas (RM combinada=6.7) y partos pretérmino (RM combinada=2.9); los neonatos experimentaron más admisiones a la UCI neonatal (RM combinada=5.9). Conclusión: La evidencia sobre los efectos adversos del Covid-19 durante el embarazo es limitada. No se pueden descartar riesgos a la salud del binomio, particularmente debido a las cesáreas y prematuridad.

Abstract: Objective: To summarize the scientific evidence of adverse health effects of Covid-19 during pregnancy. Materials and methods We conducted a Cochrane rapid review. Meta-analysis of proportions and odds ratios (OR) were performed. Results: Frequent maternal events included invasive mechanic ventilation and admission to the intensive care unit (ICU); pregnancy complications were fetal distress and premature rupture of membranes; common comorbidities were obesity and asthma. Deliveries by cesarean section (C-section) due to Covid-19 were frequent (51%). The most frequent neonatal outcomes were low birthweight and prematurity; we identified cases of SARS-CoV-2 positive neonates (14%). Pregnant women with Covid-19 were more likely to deliver by C-section (pooled OR=6.7) and prematurely (pooled OR=2.9); neonates were more likely to be admitted to the neonatal ICU (pooled OR=5.9). Conclusion: The available evidence on Covid-19 during pregnancy is limited. Therefore, we cannot disregard adverse health effects on the mother-child pair, particularly those related to C-sections and premature deliveries.

ABSTRACT The identification of IgG4-related disease as a distinct immune-mediated condition encompassing disorders that were traditionally seen as idiopathic has been a revolution in the diagnostic and therapeutic algorithm in several medical fields. This condition usually involves multiple organs (isolated organ involvement is uncommon except in the pancreas) with characteristic histopathological findings. We report a case that was assessed due to abdominal pain and subsequently diagnosed with IgG4-related sclerosing mesenteritis. A comprehensive work-up of the case ruled out other conditions and a diagnosis of IgG4-related sclerosing mesenteritis was made according to radiographic and histopathological criteria.

RESUMEN La distinción de la enfermedad relacionada con IgG4 como una entidad inmunomediada que engloba patologías consideradas clásicamente como idiopáticas ha supuesto una revolución en el algoritmo diagnóstico y terapéutico en diferentes especialidades médicas. Esta entidad suele implicar a diversos órganos (la afectación de un órgano aislado, a excepción del páncreas, es infrecuente), lo cual determina unos hallazgos histopatológicos característicos. Presentamos el caso de un paciente valorado por dolor abdominal que, tras estudio exhaustivo y habiendo descartado otras etiologías, fue diagnosticado de mesenteritis esclerosante IgG4 cumpliendo criterios radiológicos e histopatológicos.

The soil fauna includes a variety of organisms involved in many soil processes, affecting the vegetation growth and the productivity. The objective was to study the abundance and composition of the macrofauna in three different environments with differences land uses, soil characteristics and vegetation composition, of a forest nursery located in Recreo Sur (Santa Fe, Argentina). Fifteen blocks of soil were extracted from each environment in spring 2013 and autumn 2014 following the TSBF standard method. Density, families number and functional groups per environment were determined. A total of 5344 organisms were collected, representing 17 orders and 56 families. Macrofauna’s average density showed differences between environments (P < 0.05), especially Parquizado, with the highest value (966 ind.m-2). Family numbers were higher in Pastizal (43) following Plantación (31) and Parquizado (29). The most representative taxa of all organisms collected were Hymenoptera (47.93%), Haplotaxida (26.83%), Isopoda (8.29%), Coleoptera (7.20%), Chilopoda (3.07%) and Araneae (2.35%). Functional groups showed differences (P <0.05), the most abundant were soil engineers (745 ind.m-2) and detritivorous (151 ind.m-2) in Parquizado and herbivores in Pastizal (28 ind.m-2). Predators group showed no differences between environments (P > 0.05). Our results show that macrofauna’s communities varied, not only in relation to land use but also by the plant composition present in the forest nursery environments.

La edafofauna comprende una gran variedad de organismos que intervienen en numerosos procesos del suelo, afectando tanto el crecimiento de la vegetación como el mantenimiento de la productividad. El objetivo del trabajo fue estudiar la abundancia y composición de la macrofauna en relación a tres ambientes con uso del suelo, características edáficas y composición vegetal diferentes, localizados en el vivero forestal de Recreo Sur (Santa Fe, Argentina). Se extrajeron de cada ambiente 15 bloques de suelo en primavera 2013 y otoño 2014 siguiendo el método estándar TSBF. Se determinaron densidad, número de familias y grupos funcionales por ambiente. Se colectaron un total de 5344 individuos pertenecientes a 17 órdenes y 56 familias. La densidad media de la macrofauna mostró diferencias entre ambientes (P< 0,05), destacándose Parquizado con el valor más alto (966 ind.m-2). El número de familias fue mayor en Pastizal (43) siguiendo Plantación (31) y Parquizado (29). Los taxa más representativos fueron Hymenoptera (47,93%), Haplotaxida (26,83%), Isopoda (8,29%), Coleoptera (7,20%), Chilopoda (3,07%) y Araneae (2,35%). Los grupos funcionales mostraron diferencias por ambiente (P< 0,05), siendo los más abundantes los ingenieros del suelo (745 ind.m-2) y los detritívoros (151 ind.m-2) en Parquizado y herbívoros en Pastizal (28 ind.m-2). El grupo depredadores no mostró diferencias entre ambientes (P> 0,05). Nuestros resultados muestran que las comunidades de macrofauna variaron, no sólo en relación al uso del suelo sino también por la composición vegetal presente en los ambientes del vivero forestal.

Este estudo avaliou diferenças nas assembleias de peixes existentes a montante e a jusante dois tipos de bueiros, um em cada um de dois diferentes riachos Neotropicais. A composição e a estrutura da ictiofauna foram avaliadas e seus possíveis padrões espaciais. As amostragens para a ictiofauna foram realizadas mensalmente, entre novembro de 2009 e outubro de 2010, com diversos apetrechos de pesca. Durante o período foram coletados 2.220 indivíduos, sendo 901 peixes nos trechos do riacho Lopeí - bueiro circular e 1.310 peixes nos trechos do riacho Pindorama - bueiro quadrado, pertencentes a 33 espécies. As capturas foram similares nos trechos de montante e jusante no bueiro circular, enquanto que para o bueiro quadrado a abundância de peixes foi um pouco superior no trecho a montante em relação à jusante. Os Characiformes predominaram no trecho a montante de ambos os bueiros. Por outro lado, os Siluriformes foram abundantes no trecho a jusante do bueiro circular, com abundâncias similares entre os trechos do bueiro quadrado. A riqueza e a diversidade de espécies diferiram entre os trechos do bueiro circular (maior valor a jusante), enquanto que os valores foram similares para os trechos do bueiro quadrado. As espécies mais abundantes foram Astyanax altiparanae, A. paranae, A. fasciatus, Ancistrus sp. e Hypostomus sp., porém com diferenças constatadas na ocorrência das duas últimas espécies: estas foram mais abundantes a jusante do bueiro circular, e similares nos trechos do bueiro quadrado. As variações na abundância, riqueza e diversidade constatadas entre trechos a montante e a jusante, em particular do bueiro circular no riacho Lopeí, sugerindo que os movimentos de peixes são restritos de forma mais intensa neste bueiro, especialmente para Siluriformes. A queda de água na saída do bueiro circular provavelmente cria barreira à passagem dos peixes, especialmente para aqueles peixes que não tem capacidade de saltar, onde a erosão a jusante pode levar a empoleiramento. Estudos sobre projetos de bueiro ou instalações apropriadas são fundamentais considerando que a melhoria destas estruturas pode restaurar a conectividade de populações e comunidades de peixes em riachos.

This study assessed differences in fish assemblages existing upstream and downstream two types of culverts, one on each of two different Neotropical streams. We analyzed the composition and structure of the ichthyofauna and tested for spatial patterns. Fish sampling was carried out monthly between November 2009 and October 2010 using different fishing gears. We collected 2,220 fish of 33 species; 901 in stretches of the Lopeí stream - circular culvert and 1,310 in stretches of the Pindorama stream - box culvert. Fish abundance was similar in upstream and downstream stretches of the circular culvert, whereas it was slightly higher in the upstream than downstream stretch for the box culvert. Characiformes predominated in the upstream stretch of both culverts. On the other hand, Siluriformes was abundant in the downstream stretch of the circular culvert, with similar abundance in the stretches of the box culvert. Species richness and diversity (Shannon-Weiner Index) were higher in the downstream stretch of the circular culvert, but they were similar in both stretches of the box culvert. The most abundant species were Astyanax altiparanae, A. paranae, A. fasciatus, Ancistrus sp., and Hypostomus sp. The last two species were more abundant in the downstream stretch of the circular culvert, and similar in stretches of the box culvert. Our study indicated variations in the species abundance, richness, and diversity between upstream and downstream stretches in particular of the circular culvert in the Lopeí stream, suggesting that fish movements are restrained more intensively in this culvert, especially for Siluriformes. The drop in the circular culvert outlet probably created passage barriers especially for those fish that has no ability to jump, where downstream erosion could lead to culvert perching. Studies on appropriate road crossing design or installation are fundamental whereas improvements in these structures can restore the connectivity of fish populations and communities in streams.

The anatomy of the biliary tract have frequent variations. Normal anatomy is described in about half of cases. The varieties of the bile ducts should be known by physicians and hepatobiliary surgeons specializing in diagnostic imaging, in order to optimize performance in their respective areas. To this end 690 cholangiographies (538 intra-operative, 90 resonances, and 62 trans-catheter bile) were prospectively studied. We used the classification of Blumgart and the results were as follows: type A: 284 (41.16%), B: 178 (25.80%). C1: 110 (15.94%), C2: 38 (5.51%)., D1: 8 (1.16%), D2: 23 (3.33%), E1: 18 (2.61%) , E2: 27 (3.91%), F: 4 (0.58%). As conclusion, it is important to note that: a) intra-operative cholangiography should be systematic, on the one hand, to exclude cholelithiasis and, on the other hand, to detect and predict anatomical changes before resective surgery and b) cholangioresonance is an ideal preoperative study in potential living donors of organs.

La anatomía de las vías biliares presenta frecuentes variaciones. La anatomía "normal" se describe en aproximadamente la mitad de los casos. Las variedades de las vías biliares deben ser conocidas por los médicos especialistas en diagnóstico por imágenes y cirujanos hepatobiliares, a fin de optimizar su desempeño en sus respectivas áreas. Con ese fin fueron estudiadas en forma prospectiva 690 colangiografías (538 intra-operatorias; 90 resonancias; y 62 trans-catéteres biliares). Se utilizó la clasificación de Blumgart y los resultados fueron: tipo A: 284 (41,16%); B: 178 (25,80%). C1: 110 (15,94%); C2: 38 (5,51%).; D1: 8 (1,16%); D2: 23 (3,33%); E1: 18 (2,61%); E2: 27 (3,91%); F: 4 (0,58%). Como conclusiones, es importante señalar que: a) la colangiografía intra-operatoria debe ser sistemática, por un lado, para descartar litiasis coledociana; y por el otro, para detectar variaciones anatómicas y predecirlas antes de las cirugías resectivas; y b) la colangiorresonancia es ideal como estudio preoperatorio en posibles donantes vivos de órganos.

The A. summarizes clinical records of four lepers treated with Leprolin “Souza-Araujo”, as follow: ist – Male, 28 years old, lepromatous case, treated during about 3 years, who received 80 injections of the antigen, being 52 by vene, 18 by muscle and 10 intradermally. Total about 100 cm³. Results: Absence of clinical signs, routine examinations negative for acidfast bacilli. Histopathology: from lepromatous became incaracteristic, with a few bacilli. Mitsuda test from negative became positive. 2nd – Male, 33 ys. old, lepromatous case. From September 1944 to February 1948 received 110 intravenous injections (57 cm³) and 10 cm³ perineurally to control neurites. His Mitsuda test was negative in 1944 and in 1945 became positive and remained so until 1948 (4 times controlled). Since Sept. 1946 became bacillus negative in his mucous, ear lobe and lymph nodes. Out of his lepromatous symptoms remained only mild atrophy of his hands. 3rd- Male, 30 ys. old, lepromatous case, treated since 1944. From 1946 to Feb. 1948 received 80 intravenous injections (high dosage: from 2 to 5 cm³), total 310 cm³ and 140 cm³ intramuscularly. His Mitsuda test was negative in 1943; became positive (from 1945 till 1948) after Leprolin treatment. Bacilloscopy became negative even in sections. Histopathology: the lesions from lepromatous changed to tuberculoid. 4th – Male, 17 years old, lepromatous case, received, from Dec. 1944 to Feb. 1948 only 88 intravenous injections of small doses of Leprolin (0,1 to 1,0 cm³). His Mitsuda remained negative from 1944 to 1946 and in 1947 became positive. Routine examinations negative for bacilli. Histopathology: the lepromataus lesions regressed to incaracteristic, without bacillus.

The A.A. started a new series of experiments upon the transmission of Leprosy to man by means of one of the more widespread hematophagi of the hinterland of Brazil, the Triatomidae. Two species of these insects were found naturally infected with Hansen's bacillus in huts of lepers in the interior of the State of Minas Gerais and one of the writers (S.A.) upon feeding the same insects on lepromatous cases could obtain two strains of acid-fast bacilli cultures smearing Lowenstein medium with the intestinal contains of the same. The first phase of the experiments lasted five months and the results, partially positive, are here describe. More than one hundred Triatomidae (Triatoma infestans and Panstrongylus megistus) bred in the Institute Oswaldo Cruz and fed in normal pigeons until convenient growth were put on lepromatous lesions, which they sucked many times, and them after one or more days they were put to be fed on selected regions of the skin of four negativated cases of leprosy. The arguments in favour and against the possibility of obtaining new lesions of leprosy in such burnet out patients were discussed. The A.A. are not authorized to draw any definite conclusions, but the few facts registered are worth of divulgation, in orther that other workers send their suggestions. Three out of the four volunteers showed moderate local reactions between 1 to 4 days after being sucked by the infected insectes. After five months experiments subcutanous lymph were obtained from the points where the insects have bitten. A very few acid-fast bacilli were found in such material. The patients, being kept in separation from infectious cases, will be followed up during months or a year in order to be detected any suspicious experimental lesions of leprosy.