Abstract Objective: To determine the initial management and in-hospital mortality of patients with acute coronary syndrome who attended referral hospitals in Paraguay. Method: Observational, multicenter study, in patients over 18 years with a confirmed diagnosis of acute coronary syndrome. Results: 780 patients were included from May 2015 to February 2016; the mean age was 64.1 ± 12.3 years, 64.1% male. The clinical presentation was acute coronary syndrome with ST elevation in 40.1% and without elevation in 59.9%. In patients with ST elevation there is a high percentage of late attendance, more than 12 h of evolution in 49.8%; those with less than 12 h of evolution underwent reperfusion in 52.2% of the cases, received fibrinolytics in 36.3% of the cases, and primary percutaneous coronary intervention 15.9%. In-hospital mortality for acute coronary syndrome was 10.3%, with ST-segment elevation was 12.8%, and without ST-segment elevation was 8.6%. Conclusions: The management of acute coronary syndrome in Paraguay needs a comprehensive approach, which promotes earlier care, and increases the implementation of reperfusion therapies in the health services network, in order to improve the therapeutic response rates and decrease hospital mortality.

Resumen Objetivo: Determinar el tratamiento inicial y la mortalidad intrahospitalaria de pacientes con síndrome coronario agudo que acudieron a centros hospitalarios de referencia de Paraguay. Método: Estudio observacional y multicéntrico en pacientes mayores de 18 años con diagnóstico confirmado de síndrome coronario agudo. Resultados: Se incluyó a 780 pacientes desde mayo de 2015 hasta febrero de 2016; la edad media fue de 64.1 ± 12.3 años y el género masculino representó el 64.1%. La presentación clínica fue la de síndrome coronario agudo con elevación del ST en 40.1% y sin elevación del ST en 59.9%. En pacientes con elevación del ST se observó un alto porcentaje de consultas tardías, mayor de 12 h de evolución en 49.8%; en aquéllos con menos de 12 h de evolución se indicó la reperfusión en 52.2%, el 36.3% recibió fibrinolíticos y 15.9% intervención coronaria percutánea primaria. La mortalidad hospitalaria del síndrome coronario agudo fue de 10.3%, con elevación del segmento ST en 12.8% y sin elevación del segmento ST en 8.6%. Conclusiones: El tratamiento del síndrome coronario agudo en el Paraguay requiere un abordaje integral, que promueva consultas más tempranas y aumente la institución de tratamientos de reperfusión en la red de servicios de salud; el objetivo es mejorar los índices de respuesta terapéutica y disminuir la mortalidad hospitalaria.

The aim of this study was evaluate the in vitro antifungal activity of crude extracts from Eugenia uniflora, Libidibia ferrea and Psidium guajava. The extracts were obtained by turbo-extraction using water (AQ) or acetone-water (AC-W) (7:3, v/v) as solvents and lyophilized to obtain the crude extracts (CE). The CE were characterized by UV-Vis, TLC and HPLC. The activity of CEs was investigated against clinical isolates of Candida spp. and the Minimum Inhibitory Concentration (MIC), MIC50 and MIC90 were determinated. The analysis by TLC showed that all CEs presented polyphenols (flavonoids and tannins). The CEs from E. uniflora showed higher amount of polyphenols (30.35 ± 2.15%, AC-W) and the HPLC analysis revealed the tannins in all extracts. The CEs of E. uniflora showed MIC range from 1.9 to 500.0 µg/mL, and lower values of MIC50 and MIC90 against non-albicans Candida isolates. Regarding L. ferrea and P. guajava, the results showing MIC from 3.9 to 1000.0 µg/mL (CE-AQ) against C. albicans. The results demonstrate antifungal performance from CE against various species of Candida spp., suggesting that the herbal species may be use as new potential antifungal agents. Additionally, the polyphenol content can play a pivotal role in the antifungal properties of CE.

ABSTRACT The physical infrastructure is a fundamental aspect for any higher-level educational institution, in which the teaching-learning processes are performed. Therefore, the physical conditions of these educational spaces are substantial for learning. For the authorization of the physical educational infrastructure in the countries, the executive architecture project is not enough, but depends on the fulfillment of requirements established by regulatory institutions of each country. In Paraguay, the National Higher Education Council (CONES) is in charge of enabling higher education educational projects. For which, it has a Guide for the Preparation of Educational Projects that establishes requirements that must be met in four aspects, with physical infrastructure being one of them. The Physical Aspect of the guide is quite extensive and at the same time confusing due to the way it describes and structures its content. This identified difficulty prevents recognizing essential requirements for the correct design of all physical educational infrastructure. In order to solve this problem, the purpose of this investigation was to determine the indicators and sources of verification necessary for the Physical Infrastructure of Higher Education Educational Projects in Paraguay. In this way, several similar regulations of Latin American countries were studied, of which those of Peru, Mexico and ARCU-SUR were considered as more complete, simple and explicit and were used to contrast with the Paraguayan norm. This task concluded with the development of a table specifying seven essential components for all Educational Projects, an additional component for those related to Health, and another component for Educational Projects with expansion. Finally, it was possible to determine twenty-five indicators with fifty-five sources of verification. These elements are intended to help Higher Education Institutions and professional architects develop a correct aspect of Physical Infrastructure for Higher Education Educational Projects. It will also facilitate the regulatory body to carry out objective and precise evaluations of said projects.

RESUMEN La infraestructura física es un aspecto fundamental para toda institución educativa de nivel superior, en ella se concretan los procesos de enseñanza-aprendizaje. Por ello, las condiciones físicas de dichos espacios educativos son sustanciales para el aprendizaje. Para la habilitación de la infraestructura física educativa en los países, no basta con el proyecto ejecutivo de arquitectura, sino que depende del cumplimiento de requisitos establecidos por instituciones reguladoras de cada país. En Paraguay el encargado de habilitar proyectos educativos de Educación Superior es el Consejo Nacional de Educación Superior (CONES). Para lo cual, cuenta con una Guía de Elaboración de Proyectos Educativos que establece requisitos que deben ser cumplidos en cuatro aspectos, siendo el de infraestructura física uno de ellos. El Aspecto Físico de la guía es bastante extenso y a la vez confuso por la forma en que describe y estructura su contenido. Esta dificultad identificada impide reconocer requisitos imprescindibles para el diseño correcto de toda infraestructura física educativa. Con miras a resolver este problema, el propósito de esta investigación fue determinar los indicadores y las fuentes de verificación necesarios para la Infraestructura Física de Proyectos Educativos de Educación Superior en Paraguay. De esta manera, se estudiaron varias regulaciones similares de países de América Latina, de los cuales, las de Perú, México y de ARCU-SUR se consideraron como más completas, sencillas y explícitas y fueron utilizadas para contrastar con la norma paraguaya. Esta tarea concluyó con el desarrollo de una tabla donde se especifican siete componentes indispensables para todos los Proyectos Educativos, un componente adicional para los relacionados con la Salud y otro componente para los Proyectos Educativos con ampliación. Finalmente, se logró determinar veinticinco indicadores con cincuenta y cinco fuentes de verificación. Se pretende que estos elementos ayuden a las Instituciones de Educación Superior y a los profesionales arquitectos a desarrollar un correcto aspecto de Infraestructura Física de Proyectos Educativos de Educación Superior. Asimismo, que facilite al ente regulador a realizar evaluaciones objetivas y precisas de dichos proyectos.

ABSTRACT Objective: To evaluate the effects of auricular acupuncture on pain intensity, its impact on daily activities, the relief provided by the intervention, and the pain threshold in people with back musculoskeletal disorders. Methods: Randomized clinical trial carried out with people randomly allocated into three groups: treatment, placebo, and control. Evaluations were performed using the Brief Pain Inventory and a digital algometer before (initial) and after (final) the treatment and after a 15-day follow-up period. Results: The sample was 110 people. There was a decrease in pain intensity in the treatment and placebo groups as revealed by the comparison between the initial and final evaluations (p<0.05), and in the treatment group in the comparison between the initial and follow-up evaluations (p<0.05). A decreased impact of pain on daily activities in the treatment and placebo groups over time was found (p<0.05). At the final evaluation, the impact of pain was lower in the treatment group (p<0.05). Auricular acupuncture did not increase the pain threshold. Conclusion: Auricular acupuncture presented positive effects by reducing the chronic pain intensity and its impact on daily activities in people with back musculoskeletal disorders. Brazilian Clinical Trials Registry: RBR-5X69X2

RESUMEN Objetivo: Evaluar los efectos de la auriculoacupuntura sobre la intensidad del dolor, su interferencia en las actividades cotidianas, el alivio proporcionado por la intervención y el umbral de dolor en personas con disturbios musculoesqueléticos en la espalda. Método: Ensayo clínico randomizado, realizado con personas aleatorizadas en tres grupos: tratado, placebo y control. Las evaluaciones se llevaron a cabo usando el Breve Inventario del Dolor y un algómetro digital antes (inicial) y tras el tratamiento (final), en un período de seguimiento de 15 días (follow-up). Resultados: Participaron 110 personas. Hubo reducción en la intensidad del dolor en los grupos tratado y placebo entre las evaluaciones inicial y final (p<0,05), y en el grupo tratado entre la evaluación inicial y el follow-up (p<0,05). También ocurrió disminución de la interferencia del dolor en las actividades cotidianas en los grupos tratado y placebo a lo largo del tiempo (p<0,05). En la evaluación final, la interferencia del dolor fue menor en el grupo tratado (p<0,05). La auriculoacupuntura no fue suficiente para aumentar el umbral de dolor. Conclusión: La auriculoacupuntura presentó efectos positivos al reducir la intensidad del dolor crónico y su interferencia en las actividades cotidianas en personas con disturbios musculoesqueléticos en la espalda. Registro Brasileño de Ensayos Clínicos: RBR-5X69X2

RESUMO Objetivo: Avaliar os efeitos da auriculoacupuntura sobre a intensidade da dor, a sua interferência nas atividades cotidianas, o alívio proporcionado pela intervenção e o limiar de dor em pessoas com distúrbios musculoesqueléticos nas costas. Método: Ensaio clínico randomizado, realizado com pessoas randomizadas em três grupos: tratado, placebo e controle. As avaliações foram realizadas usando o Inventário Breve de Dor e um algômetro digital antes (inicial) e após o tratamento (final), em um período de seguimento de 15 dias (follow-up). Resultados: Participaram 110 pessoas. Houve redução na intensidade da dor nos grupos tratado e placebo entre as avaliações inicial e final (p<0,05), e no grupo tratado entre a avaliação inicial e o follow-up (p<0,05). Também ocorreu diminuição da interferência da dor nas atividades cotidianas nos grupos tratado e placebo ao longo do tempo (p<0,05). Na avaliação final, a interferência da dor foi menor no grupo tratado (p<0,05). A auriculoacupuntura não foi suficiente para aumentar o limiar de dor. Conclusão: A auriculoacupuntura apresentou efeitos positivos ao reduzir a intensidade da dor crônica e sua interferência nas atividades cotidianas em pessoas com distúrbios musculoesqueléticos nas costas. Registro Brasileiro de Ensaios Clínicos: RBR-5X69X2

RESUMO Objetivo: Avaliar os efeitos da auriculoacupuntura sobre a intensidade da dor, a sua interferência nas atividades cotidianas, o alívio proporcionado pela intervenção e o limiar de dor em pessoas com distúrbios musculoesqueléticos nas costas. Método: Ensaio clínico randomizado, realizado com pessoas randomizadas em três grupos: tratado, placebo e controle. As avaliações foram realizadas usando o Inventário Breve de Dor e um algômetro digital antes (inicial) e após o tratamento (final), em um período de seguimento de 15 dias (follow-up). Resultados: Participaram 110 pessoas. Houve redução na intensidade da dor nos grupos tratado e placebo entre as avaliações inicial e final (p<0,05), e no grupo tratado entre a avaliação inicial e o follow-up (p<0,05). Também ocorreu diminuição da interferência da dor nas atividades cotidianas nos grupos tratado e placebo ao longo do tempo (p<0,05). Na avaliação final, a interferência da dor foi menor no grupo tratado (p<0,05). A auriculoacupuntura não foi suficiente para aumentar o limiar de dor. Conclusão: A auriculoacupuntura apresentou efeitos positivos ao reduzir a intensidade da dor crônica e sua interferência nas atividades cotidianas em pessoas com distúrbios musculoesqueléticos nas costas. Registro Brasileiro de Ensaios Clínicos: RBR-5X69X2

ABSTRACT Objective: To evaluate the effects of auricular acupuncture on pain intensity, its impact on daily activities, the relief provided by the intervention, and the pain threshold in people with back musculoskeletal disorders. Methods: Randomized clinical trial carried out with people randomly allocated into three groups: treatment, placebo, and control. Evaluations were performed using the Brief Pain Inventory and a digital algometer before (initial) and after (final) the treatment and after a 15-day follow-up period. Results: The sample was 110 people. There was a decrease in pain intensity in the treatment and placebo groups as revealed by the comparison between the initial and final evaluations (p<0.05), and in the treatment group in the comparison between the initial and follow-up evaluations (p<0.05). A decreased impact of pain on daily activities in the treatment and placebo groups over time was found (p<0.05). At the final evaluation, the impact of pain was lower in the treatment group (p<0.05). Auricular acupuncture did not increase the pain threshold. Conclusion: Auricular acupuncture presented positive effects by reducing the chronic pain intensity and its impact on daily activities in people with back musculoskeletal disorders. Brazilian Clinical Trials Registry: RBR-5X69X2

RESUMEN Objetivo: Evaluar los efectos de la auriculoacupuntura sobre la intensidad del dolor, su interferencia en las actividades cotidianas, el alivio proporcionado por la intervención y el umbral de dolor en personas con disturbios musculoesqueléticos en la espalda. Método: Ensayo clínico randomizado, realizado con personas aleatorizadas en tres grupos: tratado, placebo y control. Las evaluaciones se llevaron a cabo usando el Breve Inventario del Dolor y un algómetro digital antes (inicial) y tras el tratamiento (final), en un período de seguimiento de 15 días (follow-up). Resultados: Participaron 110 personas. Hubo reducción en la intensidad del dolor en los grupos tratado y placebo entre las evaluaciones inicial y final (p<0,05), y en el grupo tratado entre la evaluación inicial y el follow-up (p<0,05). También ocurrió disminución de la interferencia del dolor en las actividades cotidianas en los grupos tratado y placebo a lo largo del tiempo (p<0,05). En la evaluación final, la interferencia del dolor fue menor en el grupo tratado (p<0,05). La auriculoacupuntura no fue suficiente para aumentar el umbral de dolor. Conclusión: La auriculoacupuntura presentó efectos positivos al reducir la intensidad del dolor crónico y su interferencia en las actividades cotidianas en personas con disturbios musculoesqueléticos en la espalda. Registro Brasileño de Ensayos Clínicos: RBR-5X69X2

ABSTRACT Objectives: to assess the action of ear acupuncture on disability and tissue temperature in people with chronic pain in the spinal column. Method: a clinical trial with a sample of 110 people, randomized into three groups: Treatment, Placebo and Control. The assessment instruments were the Rolland Morris Disability Questionnaire (RMDQ) and a thermographic camera, administered before the first treatment session, one week after and 15 days after (follow-up) the fifth session of ear acupuncture. In the analysis of the data, the Kruskal Wallis, Student-Newman Keuls and Wilcoxon tests were applied. Results: there was a significant reduction in disability in the Treatment and Placebo groups between the initial and final assessments (p<0.05) and between the initial assessments and follow-up (p<0.05). In the final assessment, the Treatment group presented improvement of disability when compared with the Placebo and Control groups (p<0.05). There was an increase in mean tissue temperature of the dorsal region between the initial and follow-up assessments in Treatment and Control groups (p<0.05), and between the final assessments and follow-up in the Treatment and Placebo groups (p<0.05). Conclusion: ear acupuncture was efficacious in reducing disability and increasing tissue temperature in people with chronic pain in the spinal column. Brazilian Register of Clinical Trials (RBR-5X69X2).

RESUMEN Objetivos: evaluar la acción de la auriculoacupuntura en la incapacidad y en la temperatura del tejido de personas con dolor crónico en la columna vertebral. Método: ensayo clínico con muestra de 110 personas, asignadas aleatoriamente en tres grupos: Tratado, Placebo y Control. Los instrumentos de evaluación fueron el Cuestionario de Incapacidad de Rollad Morris y una cámara termográfica, aplicados antes de la primera sesión de tratamiento, una semana después y quince días después (follow up) de la quinta sesión de auriculoacupuntura. En el análisis de los datos se aplicaron las pruebas Kruskal-Wallis, Student-Newman Keuls y Wilcoxon. Resultados: hubo reducción significativa de la incapacidad en los grupos Tratado y Placebo, entre las evaluaciones inicial y final (p<0,05) y entre las evaluaciones inicial y follow up (p<0,05). En la evaluación final, el grupo Tratado presentó mejoría de la incapacidad si comparado al Placebo y al Control (p<0,05). Hubo aumento en la temperatura media del tejido de la región dorsal entre las evaluaciones inicial y follow up en el Tratado y Control (p<0,05), y entre las evaluaciones final y follow up en el Tratado y Placebo (p<0,05). Conclusión: la auriculoacupuntura fue eficaz en reducir la incapacidad y en aumentar la temperatura del tejido en personas con dolor crónico en la columna vertebral. Registro Brasileño de Ensayos Clínicos (RBR-5X69X2).

RESUMO Objetivos: avaliar a ação da auriculoacupuntura na incapacidade e na temperatura tissular de pessoas com dor crônica na coluna vertebral. Método: ensaio clínico com amostra de 110 pessoas, randomizadas em três grupos: Tratado, Placebo e Controle. Os instrumentos de avaliação foram o Questionário de Incapacidade de Rolland Morris e uma câmera termográfica, aplicados antes da primeira sessão de tratamento, uma semana após e 15 dias após (follow up) à quinta sessão de auriculoacupuntura. Na análise dos dados, aplicaram-se os testes Kruskal-Wallis, Student-Newman-Keuls e Wilcoxon. Resultados: houve redução significativa da incapacidade nos grupos Tratado e Placebo entre as avaliações inicial e final (p<0,05) e entre as avaliações inicial e follow up (p<0,05). Na avaliação final, o grupo Tratado apresentou melhora da incapacidade se comparado ao Placebo e ao Controle (p<0,05). Houve aumento na temperatura média tissular da região dorsal entre as avaliações inicial e follow up no Tratado e Controle (p<0,05). Entre as avaliações final e follow up no Tratado e Placebo (p<0,05). Conclusão: a auriculoacupuntura foi eficaz para reduzir a incapacidade e aumentar a temperatura tissular em pessoas com dor crônica na coluna vertebral. Registro Brasileiro de Ensaios Clínicos (RBR-5X69X2).

RESUMO Objetivos: avaliar a ação da auriculoacupuntura na incapacidade e na temperatura tissular de pessoas com dor crônica na coluna vertebral. Método: ensaio clínico com amostra de 110 pessoas, randomizadas em três grupos: Tratado, Placebo e Controle. Os instrumentos de avaliação foram o Questionário de Incapacidade de Rolland Morris e uma câmera termográfica, aplicados antes da primeira sessão de tratamento, uma semana após e 15 dias após (follow up) à quinta sessão de auriculoacupuntura. Na análise dos dados, aplicaram-se os testes Kruskal-Wallis, Student-Newman-Keuls e Wilcoxon. Resultados: houve redução significativa da incapacidade nos grupos Tratado e Placebo entre as avaliações inicial e final (p<0,05) e entre as avaliações inicial e follow up (p<0,05). Na avaliação final, o grupo Tratado apresentou melhora da incapacidade se comparado ao Placebo e ao Controle (p<0,05). Houve aumento na temperatura média tissular da região dorsal entre as avaliações inicial e follow up no Tratado e Controle (p<0,05). Entre as avaliações final e follow up no Tratado e Placebo (p<0,05). Conclusão: a auriculoacupuntura foi eficaz para reduzir a incapacidade e aumentar a temperatura tissular em pessoas com dor crônica na coluna vertebral. Registro Brasileiro de Ensaios Clínicos (RBR-5X69X2).

ABSTRACT Objectives: to assess the action of ear acupuncture on disability and tissue temperature in people with chronic pain in the spinal column. Method: a clinical trial with a sample of 110 people, randomized into three groups: Treatment, Placebo and Control. The assessment instruments were the Rolland Morris Disability Questionnaire (RMDQ) and a thermographic camera, administered before the first treatment session, one week after and 15 days after (follow-up) the fifth session of ear acupuncture. In the analysis of the data, the Kruskal Wallis, Student-Newman Keuls and Wilcoxon tests were applied. Results: there was a significant reduction in disability in the Treatment and Placebo groups between the initial and final assessments (p<0.05) and between the initial assessments and follow-up (p<0.05). In the final assessment, the Treatment group presented improvement of disability when compared with the Placebo and Control groups (p<0.05). There was an increase in mean tissue temperature of the dorsal region between the initial and follow-up assessments in Treatment and Control groups (p<0.05), and between the final assessments and follow-up in the Treatment and Placebo groups (p<0.05). Conclusion: ear acupuncture was efficacious in reducing disability and increasing tissue temperature in people with chronic pain in the spinal column. Brazilian Register of Clinical Trials (RBR-5X69X2).

RESUMEN Objetivos: evaluar la acción de la auriculoacupuntura en la incapacidad y en la temperatura del tejido de personas con dolor crónico en la columna vertebral. Método: ensayo clínico con muestra de 110 personas, asignadas aleatoriamente en tres grupos: Tratado, Placebo y Control. Los instrumentos de evaluación fueron el Cuestionario de Incapacidad de Rollad Morris y una cámara termográfica, aplicados antes de la primera sesión de tratamiento, una semana después y quince días después (follow up) de la quinta sesión de auriculoacupuntura. En el análisis de los datos se aplicaron las pruebas Kruskal-Wallis, Student-Newman Keuls y Wilcoxon. Resultados: hubo reducción significativa de la incapacidad en los grupos Tratado y Placebo, entre las evaluaciones inicial y final (p<0,05) y entre las evaluaciones inicial y follow up (p<0,05). En la evaluación final, el grupo Tratado presentó mejoría de la incapacidad si comparado al Placebo y al Control (p<0,05). Hubo aumento en la temperatura media del tejido de la región dorsal entre las evaluaciones inicial y follow up en el Tratado y Control (p<0,05), y entre las evaluaciones final y follow up en el Tratado y Placebo (p<0,05). Conclusión: la auriculoacupuntura fue eficaz en reducir la incapacidad y en aumentar la temperatura del tejido en personas con dolor crónico en la columna vertebral. Registro Brasileño de Ensayos Clínicos (RBR-5X69X2).

RESUMO: Com o objetivo de detectar e identificar Campylobacter spp. em carcaças de frango de corte utilizando três metodologias distintas - ensaio imunoenzimático VIDAS®30, Reação em Cadeia da Polimerase (PCR) e PCR em tempo real - foram coletadas e analisadas 43 carcaças de frango resfriadas e 43 congeladas. Quatro carcaças refrigeradas (4,6%) foram consideradas positivas para Campylobacter spp. pelo VIDAS®30 e nenhuma amostra positiva foi identificada quando utilizada a técnica de PCR. Porém, ao analisar as carcaças pela metodologia da PCR em tempo real, foi observada uma maior incidência de Campylobacter spp., com 45 amostras (52,3%) positivas, sendo que Campylobacter jejuni foi a espécie mais frequentemente encontrada nas amostras (88,8%). Não foi observada diferença na frequência do micro-organismo entre carcaças de frangos resfriadas e congeladas. Concluiu-se que a técnica de PCR em tempo real apresentou maior sensibilidade na detecção de Campylobacter spp. em carcaças de frangos de corte e que foi encontrada elevada presença de carcaças contaminadas, especialmente por C. jejuni.

ABSTRACT: In order to detect and identify Campylobacter spp. in broiler chicken carcasses, and to compare detection methods, 43 chilled and 43 frozen carcasses were collected and analyzed. Three methodologies were evaluated: an automated Enzyme Linked Fluorescent Assay (ELFA) VIDAS®30, Polymerase Chain Reaction (PCR) and real-time PCR. Only four chilled carcasses (4.6%) were considered positive for Campylobacter spp. by VIDAS®30 and no sample was positive when the conventional PCR technique was used. However, real-time PCR showed a higher incidence of contamination by Campylobacter spp. in broiler carcasses, with 45 (52.3%) positive samples. C. jejuni was the species most frequently reported in the samples (88.8%). No differences in the frequencies of Campylobacter spp. were observed between the chilled and frozen broiler carcasses. In conclusion, real-time PCR was the most sensitive method for the detection of Campylobacter spp. in chilled or frozen broiler carcasses, which were mainly contaminated by C. jejuni.

OBJECTIVE: Cardiovascular diseases are the leading cause of mortality in the world. Although most of them are preventable, their prevalence continues to increase. The objective of this study was to estimate the prevalence of cardiovascular risk factors in an urban ambulatory adult hospital population in Asunción, Paraguay. METHODS: A cross-sectional study was undertaken in the population of patients enrolled in the AsuRiesgo prospective study on the prevention of cardiovascular disease, which focuses on promoting a healthy lifestyle. Patients 18 years of age or older who were encountered in doctors' waiting rooms in a tertiary care hospital were invited to participate. Each patient's clinical history, body measurements, and laboratory test results were obtained. RESULTS: A total of 18 287 patients aged 51 ± 16 years were recruited. Of this group, 67.5% were female, with an average bodyweight of 77.5 ± 16.2 kg and a body mass index 29.7 ± 5.9 kg/m². The prevalence rates of a history of myocardial infarction, stroke, diabetes mellitus, and hypertension were 2.6%, 3%, 13.3%, and 53%, respectively, and the rates of smoking, unhealthy diet, sedentary lifestyle, and psychological stress were 29.3%, 41.2%, 58.2%, and 56.6%. The overall prevalence of obesity and overweight was 79.6%; the rates of prehypertension and systemic hypertension were 39% and 25%, respectively; and the prevalence of metabolic syndrome was 34.7%. CONCLUSIONS: Although the prevalence rates of smoking, systemic hypertension, and diabetes mellitus were low, those for obesity, sedentary lifestyle, psychological stress, unhealthy diet, and metabolic syndrome were very high. This finding demonstrates the need for global action to prevent disability and death from ischemic heart and cerebrovascular disease. It is urgent to implement programs to address these challenges on a national scale.

OBJETIVO: Las enfermedades cardiovasculares son la principal causa de mortalidad en el mundo. Aunque la mayoría son prevenibles, su prevalencia sigue aumentando. El objetivo de este estudio fue estimar la prevalencia de factores de riesgo cardiovascular en una población hospitalaria ambulatoria urbana y adulta de Asunción, Paraguay. MÉTODOS: Se realizó un análisis transversal de todos los pacientes incluidos en el estudio prospectivo de prevención cardiovascular AsuRiesgo dirigido al cambio del estilo de vida a un estilo de vida saludable. Se invitó a participar a personas de 18 y más años de edad que se encontraban en las zonas de espera de consultorios de un hospital terciario. Se obtvuvo información anamnésica, antropométrica y de laboratorio. Resultados: Se incluyeron 18 287 pacientes de 51 ± 16 años de edad, de los cuales 67,5% fueron mujeres. La media de peso corporal fue 77,5 ± 16,2 kg y el índice de masa corporal, 29,7 ± 5,9 kg/m². Las prevalencias de antecedentes de infarto de miocardio, accidente vascular cerebral, diabetes mellitus e hipertensión fueron, respectivamente, 2,6, 3, 13,3 y 53%, y las del hábito de fumar, dieta no saludable, sedentarismo y estrés psicológico, 29,3, 41,2, 58,2 y 56,6%. Por último, la prevalencia global de obesidad y sobrepeso fue 79,6%, las de prehipertensión e hipertensión arterial sistémica, 39 y 25%, respectivamente, y la del síndrome metabólico, 34,7%. CONCLUSIONES: Si bien las prevalencias del hábito de fumar, hipertensión arterial sistémica y diabetes mellitus fueron bajas, las de obesidad, sedentarismo, estrés psicológico, dieta no saludable y síndrome metabólico fueron muy elevadas, lo cual justifica una acción global para prevenir discapacidades o fallecimientos por enfermedad isquémica cardiaca o cerebral. La implementación urgente de los programas con estos fines a escala nacional es imperativa.

Fundamentos: As doenças cardiovasculares são, atualmente, as maiores causas de óbito e incapacitação em todo o mundo. Objetivos: Avaliar os efeitos de um programa educativo básico para prevenção cardiovascular em uma população de pacientes ambulatoriais não selecionados. Métodos: Todos os participantes frequentaram um programa educativo de mudança para um estilo de vida saudável. Foram realizadas avaliações à admissão no estudo e durante o acompanhamento. Foram avaliados sintomas, hábitos, parâmetros do ATP III para síndrome metabólica e parâmetros da American Heart Association 2020 para saúde cardiovascular. Resultados: Foram incluídos no estudo 15.073 participantes com idade ≥ 18 anos. Foi feita a análise de dados dos 3.009 pacientes que completaram a segunda avaliação. Foram documentados perda de peso (de 76,6 ± 15,3 para 76,4 ± 15,3 kg, p = 0,002), melhora da dispneia aos esforços graus II-NYHA (de 23,4% para 21,0%) e III (de 15,8% para 14,0%), e redução na proporção de fumantes ativos atuais (de 3,6% para 2,9%, p = 0,002). Houve melhora na proporção de pacientes com níveis de triglicérides > 150 mg/dL (de 46,3% para 42,4%, p < 0,001) e de colesterol LDL > 100 mg/dL (de 69,3% para 65,5%, p < 0,001). Houve melhora ≥ 20% na métrica AHA 2020 no nível classificado como ruim para tabagismo (-21,1%), alimentação (-29,8%), e nível de colesterol (23,6%). Foi documentada grande evasão como indicador substituto para baixa adesão de paciente nas primeiras 5 consultas, sendo 80% entre a primeira e a segunda avaliação, 55,6% entre a segunda e a terceira, 43,6% entre a terceira e a quarta, e 38% entre a quarta e a quinta. Conclusão: Um programa educativo básico e simples pode melhorar os sintomas e fatores de risco cardiovasculares modificáveis, mas conta com pouca adesão por parte dos pacientes.

Background: Cardiovascular diseases are the current leading causes of death and disability globally. Objective: To assess the effects of a basic educational program for cardiovascular prevention in an unselected outpatient population. Methods: All participants received an educational program to change to a healthy lifestyle. Assessments were conducted at study enrollment and during follow-up. Symptoms, habits, ATP III parameters for metabolic syndrome, and American Heart Association’s 2020 parameters of cardiovascular health were assessed. Results: A total of 15,073 participants aged ≥ 18 years entered the study. Data analysis was conducted in 3,009 patients who completed a second assessment. An improvement in weight (from 76.6 ± 15.3 to 76.4 ± 15.3 kg, p = 0.002), dyspnea on exertion NYHA grade II (from 23.4% to 21.0%) and grade III (from 15.8% to 14.0%) and a decrease in the proportion of current active smokers (from 3.6% to 2.9%, p = 0.002) could be documented. The proportion of patients with levels of triglycerides > 150 mg/dL (from 46.3% to 42.4%, p < 0.001) and LDL cholesterol > 100 mg/dL (from 69.3% to 65.5%, p < 0.001) improved. A ≥ 20% improvement of AHA 2020 metrics at the level graded as poor was found for smoking (-21.1%), diet (-29.8%), and cholesterol level (-23.6%). A large dropout as a surrogate indicator for low patient adherence was documented throughout the first 5 visits, 80% between the first and second assessments, 55.6% between the second and third assessments, 43.6% between the third and fourth assessments, and 38% between the fourth and fifth assessments. Conclusion: A simple, basic educational program may improve symptoms and modifiable cardiovascular risk factors, but shows low patient adherence.

The study of stem cells has evolved rapidly in recent decades. The importance is given to the concept that these cells are potentially able to become any cell type and have the power of self-renewal throughout the life of the organism. Mesenchymal stem cells (MSCs) can be isolated from various organs of the body such as bone marrow, adipose tissue, synovium, muscle and dermis, deciduous teeth, umbilical cord, placenta, liver, spleen and thymus. After their isolation in vitro, mesenchymal stem cells have the capacity to differentiate into various mesenchymal lineages and various tissues after the use of appropriate cultures. Studies have reported that mesenchymal stem cells from adipose tissue have the potential to differentiate themselves, like the cells commonly studied bone marrow. Adipose tissue is attractive due to its easy access, rapid expansion in vitro and only one collects the large amount of tissue. This review intends to show the protocols for isolation, cell culture and means of commercial cellular differentiation most widely used with emphasis on adipose tissue.

El presente trabajo evaluó la flora normal y patógena asociada a la tilapia (Oreochromis niloticus), ya que no existen estudios previos, a nivel nacional, sobre la calidad microbiológica de este producto. Con este propósito, se determinó el Recuento Total Aerobio (RT), el número de coliformes totales (CT) y coliformes fecales (CF), Enterococcus sp., Aeromonas sp., bacterias lácticas y la presencia de Listeria sp y Salmonella spp. a partir de la superficie externa de la tilapia. Se recolectaron 50 muestras provenientes de las zonas de San Carlos y Cañas y se transportaron en frío hasta el Laboratorio de Microbiología de Alimentos y Aguas de la Facultad de Microbiología, Universidad de Costa Rica, donde se efectuaron los análisis señalados según la metodología presentada por la American Publilc Health Association, 1998. Los resultados obtenidos confirman, desde el punto de vista microbiológico, la frescura de las tilapias al momento de su análisis, sin embargo, los niveles de coliformes encontrados fueron inaceptables para el consumo humano. No se logró aislar Listeria sp., pero el aislamiento de Salmonella spp. confirmó la contaminación fecal de las aguas de crianza de la tilapia, aparte de su importancia a nivel de salud pública. También se encontró que la tilapia presenta un número elevado de Aeromonas sp. como parte de su flora normal, por lo que se recomienda incluir este género dentro de las normas de calidad para pescado fresco. Según los datos obtenidos, no existe diferencia significativa (95% de confianza) entre el RT, los niveles de CT y CF, Enterococcus sp y Aeromonas sp. a partir de la tilapia proveniente de los criaderos de las zonas de San Carlos y Cañas.

SUMMARY Bacteriological evaluation of fresh tilapia (Oreochromis niloticus) coming from the northern region of Costa Rica. The following work presents an evaluation of the normal and pathogenic flora associated to tilapia (Oreochromis niloticus), since there are no previous national studies referred to the microbiological quality of this product. The total aerobic plate count, lactic bacteria, Enterococcus sp and Aeromonas sp and fecal and total coliform count, and the presence of Listeria sp and Salmonella spp from the external surface of tilapias were evaluated. A total of 50 samples, coming from San Carlos and Cañas zones were transported in ice to the Food and Water Microbiology Laboratory, Universidad de Costa Rica, where the laboratory analysis were performed, according to the methodology presented by de American Public Health Association, 1998. The results obtained confirm the microbiological freshness of the product when the analysis was performed, although coliform levels were unacceptable. Listeria sp was not found, but the isolation of Salmonella spp. confirms the fecal contamination of water where the tilapia is grown, aside of the Public Health concern. Also, it was found a high number of Aeromonas sp, as part of its normal flora, so we recommend including this genus in the quality standards for fresh fish. According to the data obtained, there was no significant difference (95% confidence) between the total plate count, fecal and total coliforms, Enterococcus sp. and Aeromonas sp. from the samples coming from the zones of San Carlos and Cañas.