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Objective: To describe how the community from El Faro neighborhood identifies its community assets, uses them to face life's challenges through the capacity of collective agency; and by generating community development processes, applying the salutogenic theory that considers people as active subjects, with the capacity to conserve and generate health and well-being, through the use of their own resources called health assets., Methods: A map of community assets was made in 2018 in el Faro neighborhood, an informal settlement of Medellín, Colombia, following the phases recommended by other authors and from a qualitative, participatory approach that delves into the health situation of the community., Results: In this process were identified 12 individual community assets, 12 collective, 13 institutional and 10 in the environment. The main community asset among the 47 described was community participation, from the agency capacity, mainly of its leaders who participating in their own organizations encourage development, identity construction and well-being., Conclusion: Asset mapping has served to identify intangible assets for the community and, in turn, this recognition has been useful in strengthening the agency's capacity for community development. This is a territory transformed by community reflection processes allowing to understand situations of exclusion and poverty, seeking to create a more livable place and developing a community capacity to solve their own problems, through solidarity and community support., (Copyright © 2020 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: The molecular reclassification of the order Trichosporonales placed the medically relevant Trichosporon species into three genera of the family Trichosporonaceae: Cutaneotrichosporon, Trichosporon, and Apiotrichum. From the clinical and epidemiological standpoint, it is important to identify any species of the family Trichosporonaceae because they present different antifungal susceptibility profiles. In Mexico, little is known about trichosporonosis etiology because the fungi are identified through phenotypic methods., Aims: To identify at a molecular level 12 yeast isolates morfologically compatible with Trichosporon, obtained from patients with superficial infections., Methods: The yeast isolates were obtained from patients with white piedra, onychomycosis, and hand and foot dermatomycosis, and were identified morphologically and genotypically (sequencing of the IGS1 region and phylogenetic analysis using the Maximum Likelihood Method). The phylogenetic analysis included 40 yeast sequences from the order Trichosporonales and one from Cryptococcus neoformans as outgroup., Results: Based on the molecular analysis, we identified three (25%) Trichosporon inkin isolates, two (16.7%) Trichosporon asteroides, two (16.7%) Cutaneotrichosporon mucoides, and one each (8.3%) of Trichosporon aquatile, Trichosporon asahii, Apiotrichum montevideense, Cutaneotrichosporon cutaneum, and Cutaneotrichosporon jirovecii., Conclusions: The molecular characterization of the isolates showed a broad diversity of species within the order Trichosporonales, particularly among onychomycosis. It is essential to identify these yeasts at the species level to delve into their epidemiology., (Copyright © 2021 Asociación Española de Micología. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Nannizzia nana is a zoophilic dermatophyte that affects animals like pigs, boars and, exceptionally, humans, in whom it causes tinea capitis, as well as tinea corporis and onychomycosis., Case Report: Case 1. A previously healthy 8 year-old boy presented to our clinic with a 1-month evolution dermatosis that affected scalp, developing a pseudoalopecic tumor lesion with abundant seropurulent material. The patient had worked in a pig farm. Case 2. A previously healthy 6 year-old girl, sister of the aforementioned child, presented to our clinic with a dermatosis characterized by multiple erythematous-scaly plaques that affected her face, trunk and arms. N. nana was the fungus isolated on culture in both cases. The children were treated with oral griseofulvin and topical ketoconazole that led to clinical and mycological cures., Conclusions: N. nana dermatophytosis, although being rare in humans, can be treated as other cases of dermatophytosis., (Copyright © 2019 Asociación Española de Micología. Publicado por Elsevier España, S.L.U. All rights reserved.)

Cutaneous metastases appear in 0.6% to 10.4% of malignant tumors and account for 2% of all cutaneous tumors. Metastasis to the skin may arise from progression of a known primary tumor or provide the first sign of an unsuspected one. Acral metastases are particularly unusual. Most derive from bone tumors. Clinical signs vary and the lesions generally resemble infection or inflammation, leading to diagnostic delays. When metástasis involves the fingers, the primary tumor is usually lung carcinoma. In contrast, toe involvement usually derives from a tumor in the genitourinary tract. A pathologic diagnosis in these cases is necessary and will suggest the location of the primary tumor. We report 2 cases of metástasis to the fingers. One is the first report of acral metástasis of a myoepithelial carcinoma of the breast. The other concerns acral metástasis as the first sign of lung carcinoma., (Copyright © 2017 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To determine the effectiveness of a program of cognitive stimulation of the elderly residents in Social Protection Centers in Cartagena, 2014., Methods: Quasi-experimental study with pre and post tests in control and experimental groups. A sample of 37 elderly residents in Social Protection Centers participated: 23 in the experimental group and 14 in the control group. A survey and a mental evaluation test (Pfeiffer) were applied. The experimental group participated in 10 sessions of cognitive stimulation., Results: The paired t-test showed statistically significant differences in the Pfeiffer test, pre and post intervention, compared to the experimental group (P=.0005). The unpaired t-test showed statistically significant differences in Pfeiffer test results to the experimental and control groups (P=.0450). The analysis of the main components showed that more interrelated variables were: age, diseases, number of errors and test results; which were grouped around the disease variable, with a negative association., Conclusions: The intervention demonstrated a statistically significant improvement in cognitive functionality of the elderly. Nursing can lead this type of intervention. It should be studied further to strengthen and clarify these results., (Copyright © 2016 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.)

This study presents a systematic review of the literature on the etiology of superficial and invasive candidiasis in Mexico reported from 2005 to 2015. The data have shown that Candida albicans is the most prevalent species with an increasing tendency of the non-C. albicans Candida species, as reported in other countries. The use of phenotypical methods in the identification of the yeasts limits the identification at the species level, particularly in species that are part of complexes, this is important because the identification only at the genus level leads to inadequate treatment due to the different susceptibility to the antifungals among species. In addition, this finding reveals the need to implement in clinical laboratories the molecular methods for the correct identification of the species involved, and the antifungal susceptibility tests to prevent the etiological changes associated with a poor therapeutic management., (Copyright © 2017 Asociación Española de Micología. Publicado por Elsevier España, S.L.U. All rights reserved.)

Despite their relatively low prevalence, vascular diseases of the liver represent a significant health problem in the field of liver disease. A common characteristic shared by many such diseases is their propensity to cause portal hypertension together with increased morbidity and mortality. These diseases are often diagnosed in young patients and their delayed diagnosis and/or inappropriate treatment can greatly reduce life expectancy. This article reviews the current body of evidence concerning Budd-Chiari syndrome, non-cirrhotic portal vein thrombosis, idiopathic portal hypertension, sinusoidal obstruction syndrome, hepatic vascular malformations in hereditary haemorrhagic telangiectasia, cirrhotic portal vein thrombosis and other rarer vascular diseases including arterioportal fistulas. It also includes a section on the diagnostic imaging of vascular diseases of the liver and their treatment from a haematological standpoint (study of thrombotic diathesis and anticoagulation therapy). All recommendations are based on published studies extracted from PubMed. The quality of evidence and strength of recommendations were rated in accordance with the GRADE system (Grading of Recommendations, Assessment Development and Evaluation). In the absence of sufficient evidence, recommendations were based on the opinion of the committee that produced the guide., (Copyright © 2017 Elsevier España, S.L.U., AEEH y AEG. All rights reserved.)

Objective: To characterize maxillofacial fractures due to traffic accidents in patients attending the Hospital Universitario San Vicente Fundación (Medellin-Colombia) from 1998 to 2010., Methods: A descriptive study (n =1609) was carried out with information from the medical records of patients meeting the inclusion criteria established by the general objective of the study. The variables consisted of sex, age, year, type and number of fractures, and type of vehicle. A descriptive analysis of the variables was performed and the frequency of fractures due to traffic accidents was calculated according to year and sex. Crude and adjusted odds ratios (aOR) were estimated to establish associations among age, type of vehicle, and the presence of two or more fractures with stratification by sex., Results: The frequency of maxillofacial fractures due to traffic accidents increased in 2007 (men: n=198, women: n=35) and decreased from 2008 to 2010 in both sexes. Fractures were more frequent in persons aged <35 years (80%) and in men (82%). The highest frequency of fractures was observed in motorists. Male users of motorcycles (aOR=1.41; confidence interval 95% [95%CI]: 1.02- 1.94) and bicycles (aOR=1.61; 95%CI: 1.01- 2.56) were more likely to report two or more fractures compared with pedestrians, after adjustment for other variables., Conclusions: Most maxillofacial fractures occurred in men and in motorists. Future studies should analyze other determinants affecting the epidemiology of maxillofacial fractures. Strategies should be designed to improve the use of protective elements and drivers' knowledge and practices., (Copyright © 2014 SESPAS. Published by Elsevier Espana. All rights reserved.)

Background: There are many stereotypes and prejudices about the sexual lives of the elderly. However, there are no validated and reliable tools for measuring these in the Latin-American context., Objective: To determine the internal consistency, dimensionality, differential item functioning (DIF) by gender and stability of the Attitudes towards Sexuality in the Elderly Questionnaire (ASEQ) in adults over 60 years-old in Cartagena, Colombia., Method: A validation study was designed that included a sample of 130 participants without cognitive impairment attending a Life Center. The ages ranged between 60 and 90 years (mean, 73.7±8.0), and there were 61.5% females. Internal consistency was calculated using Cronbach alpha and McDonald omega, exploratory factor analysis (EFA) (dimensionality), DIF by gender (item response theory) with Kendall correlation, and stability (reproducibility) with Pearson correlation and intraclass correlation coefficient (ICC)., Results: The ASEQ showed high internal consistency on the first application (α=.83 and ω=.87) and in the second one (α=.85 and ω=.89). AFE showed two salient factors (prejudices and limitations) that explained 42.6% of the total variance. The IDF presented appropriate coefficients, with the exception of item 14 that showed a high value (τ=.37). ASEQ showed high stability (r=.82 and ICC=.89; 95% confidence interval, 0.83- 0.92; P<.001)., Conclusions: ASEQ is a two-dimensional and reliable scale in older adults attending a Life Center in Cartagena, Colombia. New studies are required to evaluate the performance in a representative sample., (Copyright © 2014 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.)

The prevalence of coccidioidomycosis in endemic areas has been observed to increase daily. To understand the causes of the spread of the disease and design strategies for fungal detection in clinical and environmental samples, scientists have resorted to molecular tools that allow fungal detection in a natural environment, reliable identification in clinical cases and the study of biological characteristics, such as reproductive and genetic structure, demographic history and diversification. We conducted a review of the most important molecular markers in the epidemiology of Coccidioides spp. and the diagnosis of coccidioidomycosis. A literature search was performed for scientific publications concerning the application of molecular tools for the epidemiology and diagnosis of coccidioidomycosis. The use of molecular markers in the epidemiological study and diagnosis of coccidioidomycosis has allowed for the typing of Coccidioides spp. isolates, improved understanding of their mode of reproduction, genetic variation and speciation and resulted in the development specific, rapid and sensitive strategies for detecting the fungus in environmental and clinical samples. Molecular markers have revealed genetic variability in Coccidioides spp. This finding influences changes in the epidemiology of coccidioidomycosis, such as the emergence of more virulent or antifungal resistant genotypes. Furthermore, the molecular markers currently used to identify Coccidioides immitis and Coccidioides posadasii are specific and sensitive. However, they must be validated to determine their application in diagnosis. This manuscript is part of the series of works presented at the "V International Workshop: Molecular genetic approaches to the study of human pathogenic fungi" (Oaxaca, Mexico, 2012)., (Copyright © 2013 Revista Iberoamericana de Micología. Published by Elsevier Espana. All rights reserved.)

Systemic treatment for psoriasis has radically changed since the emergence of new biological therapies. One of these biological agents is etanercept. Until recently, the use of etanercept for treatment of moderate-to-severe psoriasis in Spain was only approved in an intermittent way or in cycles of treatment (not exceeding 24 weeks). However, from September 2009, its administration has been also approved in a continuous way for patients who require it. This decision is based on the results of several studies that evaluate the efficacy and safety of etanercept administrated in short and long term and in a continuous or intermittent therapy. One of these studies is Crystel study, what evaluates the efficacy and safety of continuous and paused etanercept regimens in psoriasis patients for 54-week-period. Crystel study results showed that both continuous and paused etanercept therapies improved PGA and PASI scores and patient satisfaction rates, no unexpected adverse effects were observed. Therefore, doctors may use one treatment or another according to patients needs.

Unlabelled: Coronary artery disease (CAD) is the leading cause of death in many countries. Stress electrocardiogram (ECG) is able to detect myocardial ischemia and also has prognostic value, which may be impaired in presence of electrical baseline abnormalities. Stress myocardial single photon emission tomography (SPECT) has recognized utility yield in assessment of CAD, requiring independent interpretation of ECG and myocardial images., Purpose: To analyze stress ECG interpretation reproducibility among observers with different training level, including pre- and post-graduate medical students, compared to an experienced cardiologist and also with SPECT., Method: We studied 95 patients under CAD evaluation, mean age 61+/-9.3 years (range: 42-85), 56% male. Interobserver correlation kappa (k) between perfusion gated (99m)Tc-Sestamibi SPECT and exercise ECG were calculated as normal/abnormal, presence of necrosis, ischemia or mixed pattern. Interobserver kappa (k) analysis was made., Results: 49.5% stress ECG and 45% SPECT studies were abnormal at the initial report with 62.1% concordance (k: 0.24) for normal/abnormal and 58.9% for ischemia (k: 0.14). Agreement between stress ECG initial report and independent cardiologist was 89.5% (k: 0.78). The correlation between independent observers and the initial report ranged between 62.1% and 48.4%, for baseline ECG between 41.1% and 90.5% considering normal/abnormal, and between 80% and 93.7% (k: 0.59-0.87) for the presence of ischemia., Conclusion: Stress ECG interpretation presented adequate interobserver reproducibility with greater agreement in the most experienced observers, confirming the importance of training.

Introduction and Objectives: Pyeloplasty has always been the treatment of choice for ureteropelvic junction obstruction at our center, where a laparoscopic approach has been used in the last 4 years to perform this procedure. Results of open pyeloplasty (OP) and laparoscopic pyeloplasty (LP) performed at our center in the past 8 years are compared, and our laparoscopic procedure is described., Materials and Methods: Pyeloplasties performed at our center from June 2000 to June 2008 were retrospectively reviewed. Clinical presentation, involved kidney function, operating time, intraoperatory bleeding, presence of kidney stones or crossing vessels, length of hospital stay, possible complications, and results obtained were analyzed in each case., Results: Thirty pyeloplasties were performed, 15 OP and 15 LP (50%). Mean operating time was 167.6 minutes for LP (100-240) and 106 minutes for OP (75-180) (P< .0001). Mean hospital stay was 6.6 days (4-16) for LP and 9.1 days for OP (5-26) (P.05). Intraoperative bleeding was negligible in all patients and no peroperative complications occurred. However, 9 patients (30%) experienced postoperative complications, 5 out of 15 LPs (33.3%) and 4 out of 15 OPs (26.7%) (P.05). Urinary fistula was the most common complication, occurring in 3 of the 30 patients (10%). Procedure was successful in all 15 patients undergoing OP (100%) and in 14 of the 15 patients undergoing LP (93.3%) (P.05)., Conclusions: LP is currently the procedure of choice at our center because of its lower morbidity and similar results to OP, despite the need for a certain laparoscopic skill and a usually longer operating time., (Copyright 2009 AEU. Published by Elsevier España, S.L. All rights reserved.)

Topical therapy continues to be one of the pillars of psoriasis management. Topical corticosteroids and vitamin D analogs are the drugs of choice during the induction phase, and vitamin D analogs continue to be drugs of choice for maintenance therapy. Tazarotene and dithranol are suitable options in patients with certain, specific characteristics. The calcineurin inhibitors can be considered to be second-line treatment for psoriasis of the face and flexures. The efficacy and safety of the fixed-dose combination of betamethasone and calcipotriol in the induction phase is greater than that of either drug alone. The combination of corticosteroids with salicylic acid achieves better results than corticosteroids in monotherapy. None of the drugs evaluated stands out over the others in all clinical situations, and their use must therefore be individualized in each patient and adjusted according to the course of the disease.

Infliximab is a chimeric monoclonal antibody, which specifically binds to tumor necrosis factor (TNF-alpha) and blocks its activity. Based on previous evidence that TNF-alpha has been involved in the pathogenesis of psoriasis, multiple controlled trials have shown that infliximab has provided a high degree of clinical benefit in the treatment of psoriasis and psoriatic arthritis allowing a major and rapid improvement in these patients. We review several clinical trials, which have firmly established both efficacy and safety of Infliximab in the treatment of moderate to severe psoriasis and psoriatic arthritis.

Introduction and Objectives: The correct interpretation of myocardial perfusion single photon emission computed tomography (SPECT) requires knowledge of the technique reproducibility. The objective was analyze the interobserver correlation of different experience in the interpretation of myocardial perfusion SPECT in patients following acute myocardial infarction (AMI) in order to improve the quality of our site., Methods: Sixty cases (56 +/- 11 years, 87 % men) with transmural AMI who had recently undergone successful thrombolysis were included. Resting perfusion with (99m)Tc-sestamibi was performed at one week post-AMI., Analysis: Semiquantitative interpretation using 17 segment-model by 2 independent specialists and 5 observers, was performed blindly. Left ventricular ejection fraction (LVEF) was measured with isotopic ventriculography one month after AMI, with a mean of 38 %., Results: Using independent and then agreed on perfusion analysis, average involved segments/patient was 9.3 +/- 4 and the sum of severity 25 +/- 13. Readings of other observers ranged from 7 +/- 3.7 to 9.4 +/- 3.9 and 16.7 +/- 9.7 to 24.6 +/- 13, respectively, consistent with the reading of the specialists of between 0.779-0.871 (kappa: 0.565-0.741). There was no significant difference when the number of segments were analyzed in 40 % of the cases and for intensity in 60 % of them in more experienced observers. Correlation with consensus reading for the number of segments ranged from 0.84 to 0.94 and for severity from 0.79 to 0.89. Identification of culprit arteries was acceptable, with r values between 0.612 and 0.683 and kappas between 0.629 and 0.656. Correlation of the number of involved segments and severity with LVEF performed one month after AMI was 0.73 and 0.74, respectively., Conclusions: There was good correlation in the interpretation of myocardial perfusion SPECT, with a significantly better fit in more experienced observers. This academic exercise was also helpful in improving our residents' skills in cardiology.

Actinic keratosis is currently considered not to be a precursor of squamous cell carcinoma but, rather, an initial stage of the disease. Furthermore, the incidence of both squamous cell carcinoma and basal cell carcinoma continues to increase. Topical drugs are now becoming widely used in the therapeutic management of nonmelanoma skin cancer and its precursor lesions. Here, we review the various topical drugs that are currently available and discuss their advantages and drawbacks. Therapeutic options include retinoids, 5-fluoracil, diclofenac, imiquimod, and photodynamic therapy.

Introduction: We describe and evaluate the results of our mentor training program for laparoscopic radical Prostatectomy (LRP)., Material and Methods: From March 2004 through December 2005, we have performed 105 (LRP). Three groups have been analysed: Group 1: The mentor as the first surgeon with the trainee acting as the assistant. Group 2: The trainee as the first surgeon with the mentor acting as the assistant. Group 3: The trainee as the first surgeon with another trainee/resident as the assistant. We have evaluated operative, postoperative data and surgical/oncological control., Results: There was no statistical difference in mean operative time in Groups 2 and 3 (200'-198'), but there was a difference from Group 1 (148,4') (p<0,05) we have observed a progressive operative time decrease only in Group 1. Blood loss, surgical-oncological control, pathological stage and hospital stay have been similar in the three groups., Conclusions: Skills for LRP can be effectively and safely taught by the presence of an experienced mentor. Waiting for long term results according to potency and continence, it was not associated to higher patient risk, neither to a worse surgical/oncologic outcome. We consider that this program is reproducible and allows a shorter learning curve.

Introduction: To evaluate the differences between laparoscopic (LRP) and open radical prostatectomy (ORP)., Material and Methods: From 2004 to 2005 180 Radical prostatectomies (RP) were performed, 105 laparoscopical and 75 by an open approach. Different urologists have acted as first surgeon; 51% of them, fully experienced ones in OPR, and 56% in LRP. Differences in operative time, estimated blood loss (difference of pre and post operative hematocrite), and duration of hospitalization were compared. Additionally, we have also analysed surgical and oncologic control of the specimen defined by the following variables: Malignant margins (MM) (positive margin in a pT3 specimen), and benign/malign surgical incision (BSI/MSI)., Results: Groups were similar concerning age, clinical stage and Gleason score, and there are only differences in PSA. Mean operative time was significantly higher in LRP (172 minutes) versus ORP (145 minutes) (p < 0.001). Difference of pre and post operative hematocrite was also higher in the open group (10.7 vs 9.2) (p = 0.03), together with hospital stay, which was one day longer in the ORP group (p = 0.001). ORP group had a higher rate of benign surgical incisions (48.7% vs 26.7%) (p = 0.001). Regarding oncologic results, LRP presented a 5.4% of positive margins, which compared significantly with a 16.9% rate in the open group (p = 0.023). However, no differences concerning malignant surgical incisions were observed., Conclusion: With no differences in clinical and pathological stage, LRP offers a significant reduction of surgical aggressiveness on the specimen, together with a better MM control. We also observe a clear decrease in blood loss and hospital stay. Therefore, we conclude that LRP in our environment is a valid approach of surgical prostate cancer treatment in spite of a longer operative time (27 minutes) and a steep learning curve.

A 39-year-old female patient who consulted due to onycholysis, subungual hyperkeratosis and presence of exudate in the big toe of the right foot. The lesions appeared during oncology treatment of bilateral breast cancer with lymphatic metastases with paclitaxel every three weeks and capecitabine daily. Clinical manifestations are due to the involvement of the nail bed caused by the chemotherapy. These should be known and taken into account due to the increased use of this type of cytotoxic agents.