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Introduction: Drug use is a health problem that occurs more frequently in the young population; its prevalence increases every day. Currently, there is concern about the perception of risk of drug use in university students. Objective: Describe the risk perception of drug consumption in university students from the Manabí province in Ecuador. Methods: Descriptive and cross-sectional research; universe of 787 university students from the Manabí province in Ecuador. The sample was made up of 259 students. The survey was used as a data collection technique. The School Surveys on Drug Abuse from the United Nations Office on Drugs and Crime were used as a research instrument. Descriptive statistics were used to process the data. Results: An average age of 22.37 years was obtained, predominance of the female sex (65.25 %) and students who consume some type of drug (79.92 %). 91.30 % reported consumption of legal drugs (tobacco 43.63 % and alcohol 61.39 %); 31.26 % used medicinal drugs and 23.29 % used illicit drugs; Of them, 85.42 % reported marijuana use. 32.04 % had a low perception of the risk of drug use. Conclusions: In the group of university students from the Manabí province who are investigated, there is an increase in the consumption of licit, medicinal and illicit drugs due to a poor perception of the risk of consumption of these substances.

Objetivo. Analizar la aplicación de la entomoterapia y su potencial en Panamá. Métodos. El estudio es un breve análisis de la aplicación de la entomoterapia a nivel mundial y el establecimiento de un listado de 20 potenciales especies de artrópodos que se podrían utilizar para este fin en Panamá, compilándose un total de 26 artículos científicos de bases de datos digitales asociados a la temática. Resultados. La entomoterapia abarca el estudio del uso medicinal de insectos y otros artrópodos en continentes como África, Amércia, Asia, Europa y Oceanía. Aunque existen amplias referencias del uso de los insectos y otros artrópodos para tratamientos médicos dentro de las tradiciones de diversos grupos humanos, en Panamá la información asociada a esta temática es muy limitada, a pesar de ser un país diverso tanto en cultura como en especies de artrópodos, principalmente de insectos. Conclusiones. Se presentan 20 ejemplos de artrópodos utilizados en entomoterapia en diversas regiones del mundo y algunos en Panamá, con potencial para ser utilizados en estudios farmacológicos para el tratamiento de determinadas patologías en el país.

Objetivo. Identifcar el complejo de especies de larvas urticantes del género Automeris Hübner, 1819 (Lepidoptera: Saturniidae), asociadas al cultivo de guandú, Cajanus cajan (L.), que representan un riesgo para la salud de los productores agrícolas en Panamá. Métodos. El estudio es de naturaleza descriptiva y exploratoria. Durante el segundo semestre del año 2022 se realizaron exploraciones en áreas cultivadas con guandú en las provincias de Coclé, Herrera, Veraguas y Chiriquí. Se llevó un registro fotográfco y se realizaron recolectas de especímenes, los cuales fueron sacrifcados con agua hirviendo para luego ser depositados en viales de vidrio con etanol al 70 %. La identifcación se realizó en el laboratorio, consultando literatura especializada. Resultados. Se identifcaron tres especies de larvas del género Automeris asociadas al cultivo de guandú: Automeris zozine Druce, 1886, y Automeris dagmarae Brechlin & Meister, 2011, en la provincia de Chiriquí; Automeris io Fabricius, 1775, en la provincia de Coclé. El género Automeris pertenece a la subfamilia Hemileucinae; la cual comprende varias especies de larvas venenosas que pueden poner en riesgo la salud de las personas, como Lonomia obliqua Walker, 1855, conocida comúnmente como la oruga asesina. Conclusiones. Se identifcaron tres especies de larvas urticantes del género Automeris (Lepidoptera: Saturniidae: Hemileucinae), las cuales representan un riesgo para la salud de los productores

Objetivo. Conocer la percepción de la entomofagia como una alternativa alimenticia saludable en Panamá. Métodos. Se realizó un muestreo no probabilístico, dirigido a 100 personas con edades entre 18 y 65 años, nivel de instrucción de secundaria completa en adelante, proporción 1:1 hombres y mujeres, residentes de áreas urbanas y periurbanas, siendo el 44 % servidores públicos. Se les compartió un formulario electrónico con las siguientes preguntas: ¿qué insectos conoce que son comestibles?, ¿qué benefcios conoce del consumo de insectos?, ¿ha comido insectos alguna vez?, ¿incluiría insectos en su dieta?, ¿por qué sí o no los incluiría? Los datos fueron analizados con los programas Microsoft Excel y PSPP. Resultados. El 58 % de los encuestados conocían que los grillos y saltamontes son comestibles; el 45 % reconoció como benefcios saludables de ingerir insectos las proteínas y otros nutrientes, pero un porcentaje similar desconoce dichos benefcios; el 20 % afrmó haber comido insectos alguna vez y el 25 % los incluiría en su dieta. La cultura, el asco y la falta de interés fueron los motivos principales por los cuales la mayoría desestimó el consumo de insectos, mientras que los que sí consumirían insectos lo harían para mejorar su salud, para probar cosas nuevas y si tienen buena preparación. El análisis de conglomerados de K medias conformó 11 grupos, destacando el grupo 9, como consumidor ideal. Conclusiones. Para mejorar la percepción de la entomofagia como alternativa alimenticia saludable en Panamá es necesario ilustrar mejor a las personas e innovar en el procesamiento de alimentos preparados con insectos.

Abstract Bacteria present a promising delivery system for treating human diseases. Here, we engineered the genome‐reduced human lung pathogen Mycoplasma pneumoniae as a live biotherapeutic to treat biofilm‐associated bacterial infections. This strain has a unique genetic code, which hinders gene transfer to most other bacterial genera, and it lacks a cell wall, which allows it to express proteins that target peptidoglycans of pathogenic bacteria. We first determined that removal of the pathogenic factors fully attenuated the chassis strain in vivo. We then designed synthetic promoters and identified an endogenous peptide signal sequence that, when fused to heterologous proteins, promotes efficient secretion. Based on this, we equipped the chassis strain with a genetic platform designed to secrete antibiofilm and bactericidal enzymes, resulting in a strain capable of dissolving Staphylococcus aureus biofilms preformed on catheters in vitro, ex vivo, and in vivo. To our knowledge, this is the first engineered genome‐reduced bacterium that can fight against clinically relevant biofilm‐associated bacterial infections.

Minimal change disease (MCD) is the most common type of idiopathic nephrotic syndrome in childhood and represents about 15% cases in adults. It is characterized by massive proteinuria, edema, hypoalbuminemia, and podocyte foot process effacement on electron microscopy. Clinical and experimental studies have shown an association between MCD and immune dysregulation. Given the lack of inflammatory changes or immunocomplex deposits in the kidney tissue, MCD has been traditionally thought to be mediated by an unknown circulating factor(s), probably released by T cells that directly target podocytes leading to podocyte ultrastructural changes and proteinuria. Not surprisingly, research efforts have focused on the role of T cells and podocytes in the disease process. Nevertheless, the pathogenesis of the disease remains a mystery. More recently, B cells have been postulated as an important player in the disease either by activating T cells or by releasing circulating autoantibodies against podocyte targets. There are also few reports of endothelial injury in MCD, but whether glomerular endothelial cells play a role in the disease remains unexplored. Genome-wide association studies are providing insights into the genetic susceptibility to develop the disease and found a link between MCD and certain human haplotype antigen variants. Altogether, these findings emphasize the complex interplay between the immune system, glomerular cells, and the genome, raising the possibility of distinct underlying triggers and/or mechanisms of proteinuria among patients with MCD. The heterogeneity of the disease and the lack of good animal models of MCD remain major obstacles in the understanding of MCD. In this study, we will review the most relevant candidate mediators and mechanisms of proteinuria involved in MCD and the current models of MCD-like injury.

Introduction: Minthostachys mollis is medicinal plant frequently used because of its anti-inflammatory and antibacterial properties. Objective: Identify the chemical composition of the essential oil from Minthostachys mollis and evaluate its antimicrobial properties against oral pathogens. Methods: The essential oil was extracted from the fresh leaves and branches of the plant by steam distillation method, and Gas Chromatography-Mass Spectrometry were performed to identify the principal constituents of the essential oils. Repetitions for the antimicrobial assay were calculated with the Epi info TM program. The antimicrobial activity was tested against Enterococcus faecalis ATCC 29212, Porphyromonas gingivalis ATCC 33277 and Candida albicans ATCC 10231 by disc diffusion assay and microdilution method, the minimum inhibitory concentration, minimum bacterial concentration and minimum fungal concentration were recorded. Results: The main compounds found were menthone (32.9%) and eucalyptol (28.1%). The essential oil of M. mollis demonstrated inhibition zones against E. Faecalis, P. gingivalis and C. albicans of 15.13 ± 0.39, 17.96 ± 0.21, and 20.82 ± 0.63 mm, respectively. There were significant differences on the inhibition zones between the three strains tested, being C. albicans the most sensible microorganism (p < 0.05). The minimum inhibitory concentration ranged from 1.05 to 2.11 µg/mL, the minimum bacterial concentration ranged from 2.11 to 4.23 µg/mL, and the minimum fungal concentration was 1.05 µg/mL. Conclusions: The essential oil of Minthostachys mollis showed as principal compounds menthone and eucalyptol and it has an important antimicrobial activity against E. faecalis, P. gingivalis and C. albicans.

Summary: Background: Drug resistance threatens global tuberculosis control. We aimed to examine mortality in patients with tuberculosis from high-burden countries, according to concordance or discordance of results from drug susceptibility testing done locally and whole-genome sequencing (WGS). Methods: In this multicentre cohort study, we collected pulmonary Mycobacterium tuberculosis isolates and clinical data from individuals with tuberculosis from antiretroviral therapy programmes and tuberculosis clinics in Côte d'Ivoire, Democratic Republic of the Congo, Kenya, Nigeria, Peru, South Africa, and Thailand, stratified by HIV status and drug resistance. Sites tested drug susceptibility using routinely available methods. WGS was done on Illumina HiSeq 2500 in the USA and Switzerland, and TBprofiler was used to analyse the genomes. We included individuals aged 16 years or older with pulmonary tuberculosis (bacteriologically confirmed or clinically diagnosed). We analysed mortality in multivariable logistic regression models adjusted for sex, age, HIV status, history of tuberculosis, and sputum positivity. Findings: Between Sept 1, 2014, and July 4, 2016, of 634 patients included in our previous analysis, we included 582 patients with tuberculosis (median age 33 years [IQR 27–43], 225 [39%] women, and 247 [42%] HIV-positive). Based on WGS, 339 (58%) isolates were pan-susceptible, 35 (6%) monoresistant, 146 (25%) multidrug-resistant, and 24 (4%) pre-extensively drug-resistant (pre-XDR) or XDR. The analysis of mortality was based on 530 patients; 63 (12%) died and 77 (15%) patients received inappropriate treatment. Mortality ranged from 6% (18 of 310) in patients with pan-susceptible tuberculosis to 39% (nine of 23) in patients with pre-XDR or XDR tuberculosis. The adjusted odds ratio for mortality was 4·92 (95% CI 2·47–9·78) among undertreated patients, compared with appropriately treated patients. Interpretation: In seven countries with a high burden of tuberculosis, we observed discrepancies between drug resistance patterns obtained locally and WGS. The underdiagnosis of drug resistance resulted in inappropriate treatment and higher mortality. WGS can provide accurate and detailed drug resistance information required to improve the outcomes of drug-resistant tuberculosis in high-burden settings. Our results support WHO's call for point-of-care tests based on WGS. Funding: National Institutes of Allergy and Infectious Diseases, Swiss National Science Foundation, and Swiss National Center for Mycobacteria.

Introduction: The essential oil of Minthostachys mollis has demonstrated to have important antimicrobial properties. Objective: To chemically characterize the fractions obtained from the essential oil of Minthostachys mollis and to evaluate the antimicrobial activity against Streptococcus mutans, Lactobacillus acidophilus, Enterococcus faecalis, Porphyromonas gingivalis and Candida albicans. Material and Methods: The petroleum ether, dichloromethane and methanol fractions of the AE of M. mollis were chemically characterized by gas chromatography coupled to mass spectrometry. The repetitions of the antimicrobial test were calculated using the EPIDAT v.4.2 program. The antimicrobial activity was performed by the disk diffusion method and the minimum inhibitory concentration was calculated by the microdilution method. The data were analyzed using the ANOVA test (p=0.05). Results: The main constituents of the petroleum ether, dichloromethane and methanol fractions were cis-Menthone (39,8 %), thymol (31,2 %) and α-Terpineol (43,6 %), respectively. All strains were sensitive to the three fractions, although C. albicans was the most sensitive strain, registering inhibition halos of 14,73±0.57 mm for the methanol fraction, 20,91±0.55 mm for petroleum ether and 20.38±0.58 mm for dichloromethane, finding significant differences when compared to 0,12 % Chlorhexidine and Nystatin (p

Introducción. Los docentes de nivel primario están expuestos a riesgos físicos que pueden controlar mediante un programa de ejercicios, el cual busca promover mejoras para su salud de manera oportuna. Objetivos. Determinar el efecto de un programa de ejercicios en los síntomas músculo esqueléticos en docentes de nivel primario. Métodos. Se realizó un estudio experimental, donde se aplicó el cuestionario de Cornell. Resultados. Los docentes presentaron una mediana de 52 años de edad. Al inicio se encontró que los síntomas músculo esqueléticos más frecuentes de todos los docentes se encontraban en cuello (50,8%), espalda baja (41,5%), pie izquierdo (35,4%) y pie derecho (33,9%); en la comparación final entre los grupos, se observó que la intensidad obtuvo diferencias significativas de valor de p

Objective: The objective of this study was to assess the association of carotid intima-media thickness (CIMT), and also the presence of atheromatous plaque, with biological and targeted synthetic disease-modifying antirheumatic drugs, in an established cohort of patients with rheumatoid arthritis (RA). Patients and Methods: We conducted a cross-sectional observational study based on a cohort of patients with RA and a registry of healthy controls, in whom the CIMT and presence of atheromatous plaque were assessed by ultrasound. Data were collected on disease activity, lab results and treatments. Descriptive and bivariate analyses were performed and two multivariate linear regression models (with CIMT as the dependent variable) were constructed to identify variables independently associated with CIMT in our sample of patients with RA. Results: A total of 176 individuals (146 patients with RA and 30 controls) were included. A higher percentage of patients than controls had atheromatous plaque (33.8% vs. 12.5%, p = 0.036), but no differences were found in terms of CIMT (0.64 vs. 0.61, p = 0.444). Compared to values in patients on other therapies, the CIMT was smaller among patients on tumour necrosis factor alpha (TNFα) inhibitors (mean [SD]: 0.58 [0.10] vs. 0.65 [0.19]; p = 0.013) and among those on Janus kinase inhibitors (mean [SD]: 0.52 [0.02] vs. 0.64 [0.18]; p < 0.001), while no differences were found as a function of the use of the other therapies considered. The multivariate linear regression analysis to identify factors associated with CIMT in our patients, adjusting for traditional cardiovascular risk factors such as hypertension, high levels of low-density lipoproteins, diabetes mellitus and smoking, showed that male sex, older age and having a greater cumulative erythrocyte sedimentation rate were independently associated with a larger CIMT, while patients on TNFα inhibitors had a CIMT 0.075 mm smaller than those on other treatments. Conclusions: The use of TNFα inhibitors may protect against subclinical atherosclerosis in patients with RA, patients on this biologic having smaller CIMTs than patients on other disease-modifying antirheumatic drugs. Nonetheless, these results should be confirmed in prospective studies with larger sample sizes.

The Krogh-Poulsen Test is a classic instrument to measure dysfunction of the stomatognathic system whose psychometric properties are unknown. This study aimed to evaluate the psychometric properties of the Krogh-Poulsen Test for the diagnosis of temporomandibular disorders (TMDs). A cross-sectional study was designed, including 119 patients (63 patients with TMD and 56 healthy controls). Factorial validity, inter-rater reliability, error of measurement, diagnostic validity of the Krogh-Poulsen Test, and concurrent validity were analyzed. The Krogh-Poulsen Test showed a three-factor structure. The inter-rater agreement could be considered very good with a kappa index of 0.87 (95% CI 0.83–0.90) and Standard Error of Measurement of 0.79. Correlations were strong with other orofacial instruments, moderate with instruments measuring TMD-related disorders such as neck pain, headache, or dizziness, and poor with generic quality of life instruments. The Area Under the Curve ROC was 0.928 showing, for a cut-off point >1, a sensitivity of 90.48 (95% CI 80.4–96.4) and a specificity of 85.71 (95% CI 73.8–93.6) for the diagnosis of TMD disorders. The Krogh-Poulsen Test showed a three-factor structure, very good inter-rater reliability, a strong correlation with other orofacial instruments, and an excellent capacity to discriminate between patients with or without TMD.

Background: Axial spondyloarthritis (axSpA) affects spinal muscles, due to inflammation and structural damage. The mechanical properties of the muscles, such as tone or stiffness, could be altered in axSpA. The aim of this work is to analyze the mechanical properties of cervical and lumbar spine muscles in axSpA patients and their relationship with metrology measures, function, disease activity, structural damage and quality of life. Methods: axSpA patients and age/gender/BMI matched healthy controls were recruited. The muscle mechanical properties (MMPs), such as tone or frequency, stiffness, decrement (linear elastic properties), relaxation and creep (viscoelastic properties), of cervical (semispinalis capitis) and lumbar (erector spinae) muscles were bilaterally measured at rest using myotonometry. Additionally, conventional metrology, BASMI (metrology index), BASDAI (disease activity index), mSASSS (radiological structural damage index) and SF-12 (health-related quality of life questionnaire) were used in the axSpA group. Between-groups comparison, intra-group correlations and multivariable regression analyses were performed to achieve the study aims. Results: Thirty-four axSpA patients (mean age: 46.21 ± 8.53 y) and 34 healthy volunteers (mean age: 43.97 ± 8.49 y) were recruited. Both in cervical and lumbar spine, linear elastic parameters were significantly higher in axSpA patients in comparison with controls, while viscoelastic parameters were significantly lower. Lumbar muscle frequency, stiffness, relaxation, creep and cervical muscle elasticity were fair to strongly correlated (|0.346| < r < |0.774|) with age, functional status, activity of disease, structural damage and quality of life in axSpA patients. Furthermore, moderate to good fitted multivariate models (0.328 < R2 < 0.697) were obtained combining age, conventional metrology, activity of the disease and function for the estimation of cervical and lumbar MMPs. Conclusion: Mechanical properties of spinal muscles of axSpA patients differ from controls. Lumbar and cervical muscles exhibit greater linear elastic properties and lower viscoelastic properties, which are related with age, clinical and psychophysiological features of axSpA.

Axial spondyloarthritis (axSpA) is a rheumatic inflammatory chronic disease that mainly affects the spine, producing inflammation and structural damage at the vertebral level (erosions, syndesmophytes, and bony bridges) [...]

Endothelial dysfunction (ED) is well known as a process that can lead to atherosclerosis and is frequently presented in radiographic axial spondyloarthritis (r-axSpA) patients. Here, we investigated cellular and molecular mechanisms underlying r-axSpA-related ED, and analyzed the potential effect of peripheral blood mononuclear cells (PBMCs) in promoting endothelial injury in r-axSpA. A total of 30 r-axSpA patients and 32 healthy donors (HDs) were evaluated. The endothelial function, inflammatory and atherogenic profile, and oxidative stress were quantified. In vitro studies were designed to evaluate the effect of PBMCs from r-axSpA patients on aberrant endothelial activation. Compared to HDs, our study found that, associated with ED and the plasma proatherogenic profile present in r-axSpA, PBMCs from these patients displayed a pro-oxidative, proinflammatory, and proatherogenic phenotype, with most molecular changes noticed in lymphocytes. Correlation studies revealed the relationship between this phenotype and the microvascular function. Additional in vitro studies confirmed that PBMCs from r-axSpA patients promoted endothelial injury. Altogether, this study suggests the relevance of r-axSpA itself as a strong and independent cardiovascular risk factor, contributing to a dysfunctional endothelium and atherogenic status by aberrant activation of PBMCs. Lymphocytes could be the main contributors in the development of ED and subsequent atherosclerosis in this pathology.

El virus zika fue aislado por primera vez en 1947, en el bosque Zika, en Uganda, en un mono Rhesus, durante un estudio sobre la transmisión de la fiebre amarilla selvática. En 2007 ocurrió el primer brote importante de la infección en la Isla de Yap en la Micronesia; y a finales de 2013 se inició un brote en la Polinesia Francesa. En mayo de 2015 se registró por primera vez su circulación autóctona en América continental (Brasil). A la fecha 47 países/territorios de las Américas han confirmado casos autóctonos de la infección, habiéndose reportado en el Perú casos en seis departamentos. A comienzos de 2016, siete países o territorios notificaron un aumento de la incidencia de casos de microcefalia tras la aparición de un brote de la infección por el virus zika. A nivel mundial, 23 países o territorios han notificado casos de microcefalia y otras malformaciones del sistema nervioso central posiblemente asociadas a la infección por el virus zika; y en la Región Andina solo Colombia ha presentado casos confirmados. En la Polinesia francesa, durante el brote de zika ocurrido en el 2013-2014, se identificaron 42 casos del síndrome de Guillain-Barré, de los cuales 88% presentaron una enfermedad compatible con la infección por el virus zika. A inicios de 2016, en el contexto de los brotes de la infección por el virus zika. Brasil, Colombia, El Salvador, Surinam y Venezuela notificaron un aumento del síndrome de Guillain Barré.

Axial spondyloarthritis (axSpA) is a chronic rheumatic disease characterized by the presence of inflammatory back pain. In patients with chronic low back pain, the lumbar flexion relaxation phenomenon measured by surface electromyography (sEMG) differs from that in healthy individuals. However, sEMG activity in axSpA patients has not been studied. The purpose of this study was to analyze the flexion relaxation phenomenon in axSpA patients. A study evaluating 39 axSpA patients and 35 healthy controls was conducted. sEMG activity at the erector spinae muscles was measured during lumbar full flexion movements. sEMG activity was compared between axSpA patients and the controls, as well as between active (BASDAI ≥ 4) and non-active (BASDAI < 4) patients. The reliability (using intraclass correlation coefficients (ICC)), criterion validity and discriminant validity using the area Under the curve (AUC) for the inverse flexion/relaxation ratio (1/FRR) were evaluated. Significant differences (p < 0.05) were observed between axSpA patients and the control group in lumbar electric activity, especially during flexion, relaxation, and extension and in FRR and 1/FRR (0.66 ± 0.39 vs. 0.25 ± 0.19, respectively). In addition, significant differences were found between active and non-active but also between non-active and healthy subjects. The sEMG showed good reliability (ICC > 0.8 for 1/FRR) and criterion validity. ROC analysis showed good discriminant validity for axSpA patients (AUC = 0.835) vs. the control group using 1/FRR. An abnormal flexion/relaxation phenomenon exists in axSpA patients compared with controls. sEMG could be an additional objective tool in the evaluation of patient function and disease activity status.

La Revista Anales de la Facultad de Medicina, órgano oficial de la Facultad de Medicina San Fernando de la Universidad Nacional Mayor de San Marcos fue publicada por primera vez en 1918. El año 1995 reapareció después de algunos años de ausencia, bajo la dirección del entonces Decano de la Facultad de Medicina Dr. José Piscoya Arbañil. La mayor parte del Comité Editorial de entonces conformó el Comité Editorial que, desde el año 2000, bajo la conducción del Dr. José Pacheco Romero, ha continuado publicando la Revista con permanencia, puntualidad, visibilidad e impacto, cumpliendo el presente año 2015 quince años de gestión. A pesar de las limitaciones de recursos editoriales y financiamiento, la Revista recibió el apoyo de los diferentes Decanos y del Vicerrectorado de Investigación, habiendo sido incorporada en importantes indizadoras, así como ha digitalizado todos los artículos de Anales desde 1918 que aparecen de manera virtual en internet, con sus respectivos doi, lo que brinda más visitas, descargas y citaciones.

Objetives. The aim of this study is to evaluate the association between the time of outsourced work and the development of pneumoconiosis in Peruvian miners who attended the “Centro Nacional de Salud Ocupacional y Protección al Ambiente para la Salud” between 2008 and 2011. Materials and methods. Retrospective case-control study. Cases were defined as workers diagnosed of pneumoconiosis under standardized criteria. Outsourced work was defined as the time (in months) of work in a company that does not own the primary mining project. The project owner company was registered in the Mining Companies Directory (Ministerio de Energía y Minas). We used multiple logistic regression with crude and adjusted ORs. Results. The study comprised 391 cases and 1519 controls. In both groups, most of the study subjects had a level of education lower than complete high school and were born and currently lived in the Peruvian highlands. There was statistically significant association between more frequency of pneumoconiosis and working 10 or more years in an outsourced company (OR: 1.50; 95%CI: 1.05-1.14; p=0.026). Miners with pneumoconiosis were more likely not to have education (OR: 3.07; 95%CI: 1.55–6.08; p=0.001), be currently living at the Peruvian highlands (OR: 1.40; 95%CI: 1.10-1.78; p=0.007) and to have more than 20 years of underground work history (OR: 8.92; 95%CI: 4.53-18.25; p0.001). Conclusions. A statistically significant association was found between neumoconiosis and the time of outsourced work. Not having education, residing in the Peruvian highlands and the time of underground work were associated risk factors.

Portable inertial measurement units (IMUs) are beginning to be used in human motion analysis. These devices can be useful for the evaluation of spinal mobility in individuals with axial spondyloarthritis (axSpA). The objectives of this study were to assess (a) concurrent criterion validity in individuals with axSpA by comparing spinal mobility measured by an IMU sensor-based system vs. optical motion capture as the reference standard; (b) discriminant validity comparing mobility with healthy volunteers; (c) construct validity by comparing mobility results with relevant outcome measures. A total of 70 participants with axSpA and 20 healthy controls were included. Individuals with axSpA completed function and activity questionnaires, and their mobility was measured using conventional metrology for axSpA, an optical motion capture system, and an IMU sensor-based system. The UCOASMI, a metrology index based on measures obtained by motion capture, and the IUCOASMI, the same index using IMU measures, were also calculated. Descriptive and inferential analyses were conducted to show the relationships between outcome measures. There was excellent agreement (ICC > 0.90) between both systems and a significant correlation between the IUCOASMI and conventional metrology (r = 0.91), activity (r = 0.40), function (r = 0.62), quality of life (r = 0.55) and structural change (r = 0.76). This study demonstrates the validity of an IMU system to evaluate spinal mobility in axSpA. These systems are more feasible than optical motion capture systems, and they could be useful in clinical practice.

Objetivo. Conocer las condiciones de higiene y seguridad del proceso de trabajo de estiba y su relación con el estado de salud de los trabajadores que realizan esta actividad. Materiales y métodos. Se realizó un estudio observacional en trabajadores de estiba de papa de los mercados mayoristas de Huancayo, Perú (3350 msnm). Se realizó una valoración antropométrica según parámetros internacionales, se evaluaron las condiciones laborales por observación directa y ergonómicas usando el método REBA y OWAS. Se realizó un examen clínico y traumatológico, y se evaluó la satisfacción laboral y los niveles de ansiedad y depresión con la escala de Zung. Resultados. Se evaluaron 105 trabajadores, 72,4% fueron estibadores, 25,7% cabeceadores y 1,9% transportistas manuales de carga, su estatura promedio fue de 159,9 ± 5,8 cm, manipulan sacos de 150 kg y diariamente pueden movilizar entre 10 a 20 toneladas. Se encontraron posturas inadecuadas como flexión de cuello > 60º, flexión elevada de brazos, flexión de tronco > 60º y flexión de tronco con movimientos de rotación, calificando esta actividad de riesgo ergonómico muy alto. 55% presentaron lumbalgia, 42% hiperxifosis dorsal, 62% refirieron estar satisfechos con su trabajo, no tenían síntomas depresivos 77% y de ansiedad 62%. Conclusiones. El proceso de trabajo de estiba es riesgoso para la salud de los trabajadores, debido al peso extremadamente excesivo que manejan, por lo que se debe reglamentar la reducción del peso de la carga a estándares internacionales (55 kg). Es necesario adoptar medidas, especialmente en lo que concierne a la capacitación de buenas técnicas en el transporte y manejo de carga.

Objetivo: evaluar la reproducibilidad prueba-reprueba y el nivel de acuerdo entre mediciones de las pruebas 30 seg (30-s) Arm Curl y 30-s Chair Stand en una muestra de adultos mayores de Bucaramanga. Materiales y métodos: se realizó un estudio de evaluación de tecnologías diagnósticas. Ambas pruebas fueron administradas en dos oportunidades por el mismo evaluador a 111 adultos mayores de 59 años (70,4 ± 7,3), con un intervalo de 4 a 8 días. En el análisis se determinó la reproducibilidad prueba-reprueba mediante el coeficiente de correlación intraclase, CCI= 2,1 con sus respectivos intervalos de confianza de 95% (IC 95%). El nivel de acuerdo se estableció mediante el método de Bland y Altman. Resultados: la reproducibilidad prueba-reprueba para el 30-s Arm Curl test fue muy buena, con un CCI= 0,88 y para el 30-s Chair Stand test fue buena,con un CCI= 0,78. Así, el acuerdo fue muy bueno para las dos pruebas de resistencia muscular. Los límites de acuerdo de 95% estuvieron entre -3,8 y 3,2 repeticiones para la prueba 30-s ChairStand y entre -3,1 y 2,8 repeticiones para la prueba 30-s Arm Curl. Conclusión: las pruebas 30-s Arm Curl y 30-s Chair Stand tienen buena reproducibilidad y nivel de acuerdo para evaluar resistencia muscular en adultos mayores funcionalmente independientes.

A fibrilhação auricular (FA) é a arritmia mais prevalente em Medicina Familiar, que afecta 1-2% da população geral e 5% da população com idade superior a 65 anos. Os doentes com esta arritmia têm maior risco de mortalidade e de morbilidade, nomeadamente de acidente vascular cerebral (AVC). Neste artigo procura-se reflectir sobre a aplicação das recomendações internacionais na terapêutica da FA à prática do médico de família (MF), sobretudo no que diz respeito à anticoagulação. Para esse fim, são apresentados dois casos clínicos de doentes com FA. Em ambas as situações, eram primeiras consultas com o autor, nas quais se avaliou a adequação da terapêutica instituída e se fizeram ajustes na terapêutica da FA. Expõem-se alguns dados da literatura que serviram para fundamentar as decisões tomadas nestes dois doentes. De acordo com as normas internacionais, o controlo da frequência cardíaca associada à anti-coagulação crónica é a estratégia de actuação na maioria dos doentes com FA. Quando se pretende o controlo da frequência cardíaca, os fármacos de primeira linha são os beta-bloqueadores e os bloqueadores de canais de cálcio. Por fim, porque a anticoagulação oral não é uma terapêutica isenta de risco, existem escalas que categorizam em grupos de risco para eventos tromboembólicos. Estas escalas podem auxiliar na decisão da terapêutica anti-trombótica. Reflecte-se ainda sobre o significado das recomendações internacionais atendendo à especificidade da medicina familiar. O MF, enquanto prestador de cuidados globais e continuados tem um papel privilegiado para aferir se, ao longo de anos de cuidados, a terapêutica da FA se mantém de acordo com a melhor evidência disponível. Por outro lado, ao conhecer o doente e o seu contexto pode, por exemplo, mobilizar a família para o controlo de uma terapêutica que precisa de

Uma análise de pontos fracos da nossa prática clínica, mas também algumas respostas de oferta de melhores cuidados.

Una de las situaciones preocupantes que afronta el sistema universitario estatal es el inminente retiro en los próximos años de un gran número de sus profesores. En la Universidad Nacional, por ejemplo, se estima que en el período comprendido/entre 1998 y 2002 se pueden pensionar 1.122 profesores, lo que significa el 35.7% de su planta docente. Particularmente en la Sede de Santafé de Bogotá se pueden pensionar 735 profesores, lo que representa el 34,2% de todo el profesorado de la Sede, cifras que incluyen 103 profesores de la Facultad de Medicina, aproximadamente el 29% del profesorado de la Facultad.

Abstract Background Etoricoxib is a highly selective COX-2 inhibitor which was evaluated for the treatment of rheumatoid arthritis (RA). Methods Double-blind, randomized, placebo and active comparator-controlled, 12-week study conducted at 67 sites in 28 countries. Eligible patients were chronic NSAID users who demonstrated a clinical worsening of arthritis upon withdrawal of prestudy NSAIDs. Patients received either placebo, etoricoxib 90 mg once daily, or naproxen 500 mg twice daily (2:2:1 allocation ratio). Primary efficacy measures included direct assessment of arthritis by counts of tender and swollen joints, and patient and investigator global assessments of disease activity. Key secondary measures included the Stanford Health Assessment Questionnaire, patient global assessment of pain, and the percentage of patients who achieved ACR20 responder criteria response (a composite of pain, inflammation, function, and global assessments). Tolerability was assessed by adverse events and routine laboratory evaluations. Results 1171 patients were screened, 891 patients were randomized (N = 357 for placebo, N = 353 for etoricoxib, and N = 181 for naproxen), and 687 completed 12 weeks of treatment (N = 242 for placebo, N = 294 for etoricoxib, and N = 151 for naproxen). Compared with patients receiving placebo, patients receiving etoricoxib and naproxen showed significant improvements in all efficacy endpoints (p Conclusions In this study, etoricoxib 90 mg once daily was more effective than placebo and similar in efficacy to naproxen 500 mg twice daily for treating patients with RA over 12 weeks. Etoricoxib 90 mg was generally well tolerated in RA patients.

Objetivos. Evaluar la asociación entre el tiempo de trabajo tercerizado y el desarrollo de neumoconiosis en trabajadores mineros peruanos atendidos en el Centro Nacional de Salud Ocupacional y Protección al Ambiente para la Salud entre 2008 y 2011. Materiales y métodos. Estudio de casos y controles retrospectivo no pareado. Los casos incluyeron trabajadores diagnosticados de neumoconiosis, según criterios estandarizados. Trabajo tercerizado se definió como meses de trabajo en empresa no titular. Las empresas titulares están registradas en el Directorio Minero del Perú (Ministerio de Energía y Minas). Se realizó regresión logística múltiple con OR crudos y ajustados. Resultados. El estudio incluyó 391 casos y 1519 controles. En ambos grupos, la mayoría tenían estudios menores a secundaria completa y habían nacido y vivían en la sierra. Trabajar 10 o más años en una empresa tercerizadora se asoció significativamente con mayor frecuencia de neumoconiosis (OR 1,50; IC 95%:1,05-2,14; p=0,026). Los casos presentaron mayor probabilidad de no tener ningún tipo de estudio (OR: 3,07; IC 95%:1,55-6,08; p=0,001), residir en la sierra peruana (OR 1,40; IC 95%:1,10-1,78; p=0,007) y haber trabajado más de 20 años en subsuelo (OR 8,92; IC 95%: 4,53-18,25; p

Objetivos. Evaluar la asociación entre el tiempo de trabajo tercerizado y el desarrollo de neumoconiosis en trabajadores mineros peruanos atendidos en el Centro Nacional de Salud Ocupacional y Protección al Ambiente para la Salud entre 2008 y 2011. Materiales y métodos. Estudio de casos y controles retrospectivo no pareado. Los casos incluyeron trabajadores diagnosticados de neumoconiosis, según criterios estandarizados. Trabajo tercerizado se definió como meses de trabajo en empresa no titular. Las empresas titulares están registradas en el Directorio Minero del Perú (Ministerio de Energía y Minas). Se realizó regresión logística múltiple con OR crudos y ajustados. Resultados. El estudio incluyó 391 casos y 1519 controles. En ambos grupos, la mayoría tenían estudios menores a secundaria completa y habían nacido y vivían en la sierra. Trabajar 10 o más años en una empresa tercerizadora se asoció significativamente con mayor frecuencia de neumoconiosis (OR 1,50; IC 95%:1,05-2,14; p=0,026). Los casos presentaron mayor probabilidad de no tener ningún tipo de estudio (OR: 3,07; IC 95%:1,55-6,08; p=0,001), residir en la sierra peruana (OR 1,40; IC 95%:1,10-1,78; p=0,007) y haber trabajado más de 20 años en subsuelo (OR 8,92; IC 95%: 4,53-18,25; p