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Immigration to rural areas in new receiving communities like Maryland's Eastern Shore is growing. Despite a rapid rise in immigration and diminishing health system resources, little attention has been focused on barriers to health care access in this region for immigrants. A total of 33 in-depth key informant interviews with providers and immigrants were conducted. Qualitative analysis employing a constant comparison approach was used to explore emergent themes related to barriers to health care access for a growing immigrant population. Participants perceived limited health care resources, lack of health insurance coverage, high health expenditures, language barriers, and non-citizenship status as barriers to immigrants' access of health care. Findings imply that immigrants living and working on the rural Eastern Shore face serious barriers to health care access. Additional work on immigrant health in rural areas and the impacts of immigration to rural health systems are needed.

Schizophyllum is an important genus of basidiomycetes that, apart from being of genetic and biotechnological interest, is also reported to be a plant and animal pathogen. Schizophyllum commune is the best-known species and the only one reported from clinical specimens thus far, being recovered mainly from the respiratory tract. The aim of this study was to determine the species diversity of 23 clinical isolates of Schizophyllum from the United States using multilocus phylogenetic analysis and their in vitro susceptibilities to six drugs. The markers used for sequencing were the internal transcribed spacer (ITS), a portion of the nuclear large subunit (LSU) of ribosomal DNA, the RNA polymerase II second-largest subunit (RPB2), and the translation elongation factor 1α (EF-1α) gene. The analyses revealed that 22 of the clinical isolates were in the Schizophyllum radiatum clade with high support values and 1 isolate was in the S. commune clade. This is the first report of this species in clinical samples. The two species mentioned above showed very similar morphological features in culture (i.e., white, cottony, unsporulated colonies composed of hyphae with clamp connections), making morphological discrimination between the two impossible. An epitype is designed for S. radiatum, and its sequences have been deposited in GenBank. The antifungal that showed the greatest in vitro activity against the strains tested was shown to be amphotericin B. In general, the strains of S. radiatum showed higher MICs than S. commune.

This study aims to attain the following objectives: determine the impact of Blended Language Learning System in the academic performance of the pupils, distinguish factors that affect the usage of Blended Language Learning System implementation, identify its advantages and disadvantages and know teachers’ perceptions regarding the new pedagogy in teaching Language. The mixed methods explanatory sequential design, where the qualitative data set will be used to clarify and deepen the quantitative findings was employed in the study. The researcher believes that this method will effectively distinguish how the shift from traditional learning to blended learning affected teachers’ pedagogical designs and pupils’ performances. In today’s fast-paced world, teachers often struggle to keep students engaged inside the classroom thus requiring the use of various materials and techniques to develop target competencies. There is a need for educators who are known as digital immigrants, while learners are digital natives, to be flexible and develop teaching styles that would fit into the learning styles of the pupils. With the use of Blended Language Learning System, English language teachers are expected to produce effective communicators who can understand and produce meaningful discourse while enjoying rich and vibrant learning experience. Elementary School Division of Jose Rizal University, the selected site, implemented Blended Language Learning System in the institution for the first time this school year 2015-2016 as part of the newly adapted textbook. Pupils were taught grammar lessons with the use of interactive online activities. A total of 48 pupils in grades 5 and 6, 24 per grade level, were selected as respondents. They were the lower sections’ bottom 7 in English based on their quarterly grades and the star section’s bottom 3. The six Elementary Language teachers were invited to participate in this research as well for the qualitative part of this study. The researcher interpreted data collated in an unbiased manner. For the quantitative phase of the study, the researcher used the mean of the pupils’ 1st quarter grades to get the level of their performance prior BLS. The mean of the 2nd and 3rd quarter grades were also computed to find if the level of the academic performance of the pupils changed after the implementation of BLS. T-test was used for a more comprehensive statistical analysis such as level of significance difference. To get the value of the survey conducted, weighted mean and its verbal description were applied. While for the qualitative phase, descriptive statistics was used to describe the profile of the respondents, pedagogical orientations, face to face and online activities and perceived changes in blended learning. Interviews were also coded as well as the class observations. The researcher vividly described all the observations acquired during the interviews and class observations.

The removal of Cu 2+ , Zn 2+ and Ni 2+ ions from synthetic wastewater with a modified Jameson cell (MJC) was studied using adsorption colloidal flotation (ACF). A colloidal dispersion of Fe (OH) 3 (formed in situ from FeCl 3 ) at pH 11 was used as an adsorbent colloid to ensure full adsorption and precipitation. The precipitates were flocculated with polyacrylamide and hydrophobised with sodium oleate and pine oil as a frother during the flotation stage. In the modified jet cell, the downcomer was sealed at the bottom with a diffuser, and the re-flotation of detached flocs and the probability of bubbles/particles capture was enhanced, which improved the recovery rate. As a result, the modified Jameson cell was more efficient (higher loaded carrier recoveries) than the conventional jet cell (CJC) in removing heavy metals ions. The physico-chemical characteristics, cell design and operating parameters were studied, and the removal efficiency was evaluated by monitoring the final concentration of ions in the treated effluent. The results indicated that the removal efficiencies of the MJC were approximately 95% and 98% for dilute (Cu 2+ , Zn 2+ and Ni 2+ concentration of 2 mg/L) and concentrated wastewater (25 mg/L of each ion), respectively. The optimal parameters included a Fe +3 /ion ratio of 0.5 and a minimum air flow-rate/feed flow-rate ratio of 0.18. The results are discussed in terms of the physical and physico-chemical parameters, and the findings suggested that the proposed flotation technique has great potential for the treatment of wastewater.

Objetivos: Investigar la presencia del hongo levaduriforme Cryptococcus neoformans en heces de palomas domésticas (Columba livia). Material y métodos: Estudio descriptivo transversal realizado en la ciudad de Lima- Perú. Se recolectaron 300 muestras de heces encontradas en los suelos de parques y hospitales. Además se tomó 30 muestras de las cloacas de algunas palomas capturadas. Resultados: Se aisló el hongo en 47 muestras de las que 7 correspondieron al Cryptococcus neoformans var. neoformans pero no se aisló el hongo en cloaca. Las 7 cepas aisladas tuvieron 100% de sensibilidad frente a Anfotericin B, Nistatina y Clotrimazol; además presentaron 100% de resistencia a Fluconazol e Itraconazol y 57% de resistencia a Ketoconazol. Conclusiones: Cryptococcus neoformans se encuentra presente en heces de palomas en Lima Metropolitana Objectives: To evaluate the presence of Cryptococcus neoformans in the stools of domestic dove (Columba livia). Methods: Cross-sectional study carried-out in the city of Lima-Peru. 300 stool samples found in the soil of parks and hospital were collected. In addition, 30 sewage samples were also processed. Results: the fungus was isolated in 47 samples, Cryptococcus neoformans var neoformans was isolated in 7 of these samples, none was isolated from sewage samples. The seven strains showed 100% susceptibility to amphotericin B, nystatin and clotrimazol, but showed 100% resistance to fluconazole and itraconazole and 57% resistance to ketoconazole. Conclusions: Cryptococcus neoformansis found in the stools of domestic dove in metropolitan Lima.

Objetivo Determinar el perfil hematológico de los trabajadores de la minería del oro expuestos crónicamente a los vapores de mercurio metálico en Amalfi, Antioquia. Materiales y Métodos Se incluyeron 41 mineros y siete trabajadores de la compraventa del oro expuestos a los vapores de mercurio metálico (pareados con 48 controles). A cada participante se le realizó hemoleucograma, extendido de sangre periférica y determinación de mercurio en orina de 24 horas. Resultados Los trabajadores de la minería del oro tuvieron una concentración promedio de mercurio en orina de 59,7 μg/L y se observaron múltiples alteraciones cualitativas y cuantitativas en el hemoleucograma, de las cuales los valores de hemoglobina, hemoglobina corpuscular media (HCM) y la concentración de hemoglobina corpuscular media (CHCM) presentaron una diferencia estadísticamente significativa entre el grupo de expuestos y el grupo control (p

Introduccion. Los trastornos de la biogenesis de los peroxisomas se deben a mutaciones en los genes PEX, que codifican peroxinas requeridas para la biogenesis peroxisomica. Clinicamente se expresan como un espectro del sindrome de Zellweger, y hay una amplia variedad fenotipica. Su diagnostico se realiza bioquimicamente y la confirmacion es molecular. El objetivo de este caso ilustrativo es resaltar la importancia de la clinica y de las pruebas bioquimicas en el abordaje de una enfermedad peroxisomica. Caso clinico. Nino de 3 anos con hipotonia neonatal, retraso global del desarrollo y fallo de medro, con un patron en resonancia cerebral de leucodistrofia hipomielinizante, en quien se habia sospechado un trastorno de la biogenesis de los peroxisomas por encontrarse una variante de significado incierto en PEX5, pero su clinica, los estudios bioquimicos y el analisis critico de las pruebas moleculares hacian improbable este diagnostico. Se hace enfasis en el abordaje que deberia tenerse cuando se sospecha un trastorno del espectro del sindrome de Zellweger. Conclusion. En el caso descrito se sospecho un trastorno de la biogenesis de los peroxisomas por una secuenciacion exomica que, al analizarse criticamente junto con la clinica y los hallazgos bioquimicos, hacia muy poco probable una enfermedad peroxisomica. Cuando se tiene sospecha clinica y por neuroimagenes, el abordaje diagnostico principal debe partir del analisis bioquimico. Aunque la confirmacion es molecular, estas pruebas deben interpretarse con precaucion.

Se realizó una revisión bibliográfica sobre el síndrome febril prolongado y su manejo, con el objetivo de observar como se orientan en su evolución médicos de distintos países. Se concluyó que el interrogatorio exhaustivo y el prolijo examen físico realizados diariamente, representaron elementos de gran importancia para el diagnóstico, orientadores de la estrategia a seguir en cuanto a la indicación de disímiles complementarios. Fue unánime el criterio de no prescribir antimicrobianos, si las condiciones del niño así lo permiten, hasta que se conozca la causa, así como la toma de la temperatura por un trabajador sanitario para evitar la fiebre ficticia. Se consideró de gran utilidad en su manejo, calmar la ansiedad familiar, explicando todo lo que acontece, con información precisa y adecuada y una vez egresado continuar un seguimiento, máxime cuando la causa de la fiebre no fue precisada. La relación con el médico de familia y visita de terreno fueron aspectos útiles con impacto en nuestra sociedad. Se tuvo en cuenta el manejo del síndrome febril prolongado en la sala «Antonio Maceo» y las experiencias que derivaron

The objective of this study was to assess the personality profile of a sample of Mexican patients with migraine using the Temperament and Character Inventory (TCI). A cross-sectional study was performed including adult migraine patients identified from the outpatient neurology clinics of two large teaching hospitals in Mexico City. Patients were asked to voluntarily participate in the study. A physician conducted a standardised diagnostic interview adhering to the criteria of the International Headache Society (IHS). Patients were interviewed and administered the TCI. We used two healthy controls groups and a third group of non-migraine pain controls. One hundred and fortytwo subjects with migraine, 108 healthy blood donors, 269 young healthy controls and 30 patients with non-migraine pain (NMP) were included in the study. Patients with migraine had higher scores in the dimension harm avoidance (HA) and all its sub-dimensions (p

Currently, developed countries have been implementing sustainable development policies specifically in Sustainable Consumption and Production (SCP). Therefore, companies consider the products and services life cycle, where Green Procurement (GP) represents a key tool for sustainability in the Supply Chain (SC). Moreover, the future on green policies in countries like Colombia has a long way to go on issues such as energy production, consumption and processes within the supply chain. In the GP area, there are three relevant issues in sustainable development policies in Colombia: 1) issues linked to barriers in the implementation such as tariffs, taxes, incentives and promotion; 2) motivation and drivers for the implementation for both public and private sector and 3) performance impacts related to the models used in order to implement in companies. The latter one is the main interest of this paper. Regarding this work, it identifies the mathematical models most widely used in SC processes, especially the issues associated with purchase processes, selection and hiring of suppliers in large and medium-sized enterprises; public or private. Moreover, the paper analyzes the models regarding their advantages and disadvantages on which some of these can be used in GP processes due its high impact. Finally, a possible mathematical model used in GP processes based on petri nets (PN) for to their characteristics and application in complex systems.

The objective of this investigation was to evaluate gas exchange and cardiopulmonary functional behavior in patients with pulmonary hypertension (PH) before, during and after the change to a prone position. Thirty patients with PH and alterations in gas exchange were included in the study. Gas exchange measurements were performed in four stages: at the baseline supine position and after 30, 120 and 240 minutes in prone position. Also, the patients were evaluated by the six minutes walking test (6MWT) after 30 days in prone position during night's sleep. After four hours in prone position, all patients showed an increase of PaO2 and arterial saturation of oxygen (SaO2), with a decrease of intrapulmonary shunts, improving the gas exchange and therefore the physiological demand imposed by exercise in patients with PH.

La educación, en sus diferentes acepciones, implica un proceso multidireccional, de vinculación con el entorno, la cultura, la conducta y la interacción con la sociedad; ya se trate de educación formal, no formal e informal y en cualquiera de los niveles en el que se le defina, tendrá que ver con estímulos y fases que permitan desarrollar un cambio, un acceder a habilidades y pensamientos nuevos. De acuerdo con esta obra, la educación “en sentido amplio, es el proceso por el cual la sociedad facilita de manera intencionada, este crecimiento en sus miembros” (Orjuela, 2009).

El dolor abdominal recurrente afecta aproximadamente al 12 % de la población pediátrica mundial. La endoscopia con biopsia gástrica y prueba de ureasa han sugerido que este dolor se relaciona con gastritis nodular asociada a infección por Helicobacter pylori (Hp). Se realizó un estudio en 66 niños entre 7 y 15 años de edad y de ambos sexos, ingresados en 9 hospitales cubanos con el objetivo de evaluar el efecto del Q-Ulcer (subcitrato de bismuto coloidal) y metronidazol en pacientes con diagnóstico endoscópico de gastritis crónica asociada a infección por Hp. Se realizó endoscopia, examen histológico y evaluación clínica antes de comenzar el tratamiento y 4 semanas después de haber finalizado. En treinta y cuatro de estos pacientes se erradicó el Hp con remisión de la gastritis. De los 28 pacientes restantes 14 se incluyeron en la categoría de mejorados y 14 en la de sin respuesta, debido a que el microorganismo se mantuvo positivo, aunque en menor densidad. Los eventos adversos se presentaron en aproximadamente la mitad de los niños y fundamentalmente, durante las dos primeras semanas de tratamiento en que la terapia era combinada. Por esta razón, no se puede precisar que fuera el Q-Ulcer el único responsable de la presencia de estos síntomas, ya que a partir de la tercera semana no se presentaron con la misma frecuencia. La terapia combinada de Q-Ulcer y metronidazol garantizó una apreciable mejoría clínica, endoscópica e histológica, a la vez que resultó segura en el tratamiento de niños portadores de gastritis.

Introduccion El presente trabajo sintetiza los resultados del seguimiento realizado a 209 ninos con leucemia linfoblastica aguda (LLA), que fueron tratados con el protocolo 87-01 delDana-Farber Cancer Institute (DFCI) modificado por el Grupo Cooperativo del Instituto Venezolano de los Seguros Sociales (GC-IVSS). El protocolo 87-01 GC-IVSS fue prospectivo y multicentrico para ninos con LLA, recien diagnosticados y sin tratamiento previo. Nuestros objetivos fueron: comparar los resultados de la supervivencia libre de enfermedad (SLE) en los ninos tratados con doxorrubicina (dox) (30 mg/m2) frente a los tratados con epirrubicina (epi) (40 mg/m2), y evaluar los resultados si la dosis de radioterapia (RT) con 18 Gy + metotrexato (mtx) intratecal (IT) y citosina arabinosa (Ara-C) IT en los grupos de alto riesgo (AR) y muy alto riesgo (MAR) era tan efectiva como la de 24 Gy + mtx intratecal tal como se administro en protocolos previos para la prevencion de infiltracion del sistema nervioso central SNC.

We estimate mid-2013/14 season vaccine effectiveness (VE) of the influenza trivalent vaccine in Navarre, Spain. Influenza-like illness cases attended in hospital (n=431) and primary healthcare (n=344) were included. The overall adjusted VE in preventing laboratory-confirmed influenza was 24% (95% CI: ?14 to 50). The VE was 40% (95% CI: ?12 to 68) against influenza A(H1)pdm09 and 13% (95% CI: ?36 to 45) against influenza A(H3). These results suggest a moderate preventive effect against influenza A(H1)pdm09 and low protection against influenza A(H3).

El libro Neumología es un instrumento práctico para los estudiantes de la licenciatura de médico cirujano, como apoyo a la asignatura de “clinopatología del aparato respiratorio”, ya que aunque es sucinto dicha naturaleza le hace atractivo al estudiante que inmerso en un acumulo de conocimientos, es difícil tener profundidad en los temas, por lo que es de suma utilidad, ya que en él se vierten los conocimientos mínimos necesarios, para conocer las patologías que ocurren en el aparato respiratorio teniendo disponible bibliografía actualizada que permiten adentrarse en aspectos más especializados para quien lo considere necesario.Otra ventaja de este libro es que es una nueva edición con actualización en un 80%. Ha sido escrito por médicos mexicanos con amplia experiencia en el estudio y tratamiento de enfermedades respiratorias en los diferentes hospitales de tercer nivel de nuestro país, como los médicos Octavio Rivero Serrano profesor emérito de la facultad de medicina de la UNAM, Francisco Pascual Navarro Reynoso neumólogo y cirujano de tórax ex jefe del servicio de neumología y cirugía del tórax del Hospital General de México, miembros ambos de la academia nacional de medicina y academia mexicana de cirugía.El libro está dividido en 10 partes y un total de 53 capítulos que abarcan desde los aspectos básicos hasta las emergencias respiratorias, incluyendo a las diferentes patologías del aparato respiratorio como cardiopulmonares, enfermedades de naturaleza inmune, infecciosas, ocupacionales, neoplásicas y los factores de riesgo para neumopatía.

Las enfermedades torácicas preocupan a todos los médicos, ya que en el tórax se encuentran órganos vitales como los pulmones y corazón que tienen íntima relación y cavidades como el mediastino que a su vez contienen estructuras que pueden desencadenar afección al aparato respiratorio por ejemplo (deformidades anatómicas como hernias, neoplasias de esófago, de timo, entre otras). Realizar un interrogatorio cuidadoso puede revelar antecedentes de importancia a la enfermedad actual, que además permitirá al clínico dirigir una exploración más específica, a través de las líneas convencionales torácicas. Los principios generales de la inspección, palpación, percusión y auscultación se aplican al aparato respiratorio y durante la inspección es importante considerar la identificación de líneas en el tórax, para realizar una exploración adecuada.La utilidad de las líneas de tórax son las siguientes: Delimitación de estructuras anatómicas del tórax Referencias para colocación de electrodos para toma de ECG Sitios de referencia para realización de procedimientos diagnósticos (punción torácica para recolección de líquido pleural o biopsia) o terapéuticos (colocación de sello de agua) Limitación de Síndromes pleuropulmonares (condensación, derrame pleural, atelectasia, etc.) Comparación de la exploración clínica entre ambos hemitórax. Los objetivos de la práctica de identificación de líneas en el tórax son los siguientes: Identificar líneas convencionales en el tórax. Identificar las regiones en el tórax. Enunciar las patologías que se pueden identificar a través de líneas del tórax. Mencionar las utilidades de las líneas convencionales del tórax.

En la búsqueda de un diagnóstico definitivo, actualmente el médico cuenta con una gran variedad de procedimientos a su disposición para apoyo en la sospecha clínica, incluso en la terapéutica. Existen auxiliares sencillos no invasivos para determinadas patologías y procedimientos invasivos con técnicas especiales, es por ello que el médico debe conocerlas y saber elegir el mejor método diagnóstico, acorde y necesario a la sospecha clínica, con el fin de evitar invadir al paciente con estudios innecesarios, implicando un riesgo elevado de morbimortalidad, además, un alto costo para el paciente e incluso sin beneficio alguno, ya que algunos resultan ser terapéuticos.Un simple examen radiológico de los pulmones y la pleura ha cambiado con la ayuda de la biotecnología, ya que se han creado aparatos innovadores que incluyen imágenes de muy buena calidad y resolución tal como de tomografía computarizada, resonancia magnética nuclear y ultrasonido, entre otras. Estos procedimientos varían considerablemente, no sólo en cuanto a fiabilidad y especificidad de diagnóstico, sino también en términos de la incomodidad y el peligro para el paciente. Conocer las actualidades sobre los auxiliares diagnósticos en patología respiratoria nos llevará a la adecuada aplicación de éstos, comenzando con procedimientos que impliquen poco riesgo y sólo si el paciente requiere, continuar con procedimientos complejos, valorando la morbilidad y la mortalidad potencial.

To investigate factors that could be involved in the emergence of antibiotic resistant S. typhi, we characterized R plasmids and antibiotic resistant S. typhi strains from two outbreaks of typhoid in Peru and Chile. Differences in the Inc HI1 plasmids of Peruvian and Chilean strains were identified by conjugation and incompatibility studies and plasmid DNA characterization. Antibiotic-resistant S. typhi harboring Inc HI1 plasmids belonged to a reduced number of Pst1 and Cla1 ribotypes and IS200 types, in contrast to the high genetic diversity found among epidemic antibiotic-susceptible S. typhi. The low diversity of antibiotic-resistant S. typhi suggests that they may express properties that are related to both their ability to harbor Inc HI1 R plasmids and to disseminate.

La educación médica basada en la simulación clínica, capacita al alumno para identificar los ruidos respiratorios normales y los anormales como las “sibilancias” que le permite integrar diagnósticos clínicos y fortalecer la práctica hospitalaria diaria y con los pacientes. La presente práctica favorece la integración de conocimientos teóricos y prácticos de la asignatura Clinopatología de Aparato Respiratorio. Los objetivos de la práctica de ruidos respiratorios adventicios “sibilancias” son los siguientes: Identificar los ruidos respiratorios normales en sus dos fases (inspiración y espiración) Identificar los ruidos respiratorios anormales “sibilancias” Describir las complicaciones secundarias a la presencia de “sibilancias”

Background: Cryptococcosis is a fungal infection with a worldwide distribution, mainly caused by Cryptococcus neoformans and Cryptococcus gattii. Aims: To molecularly characterize the mating-types, serotypes, genotypes and antifungal susceptibility profiles of a set of retrospectively isolated C. neoformans strains from Lima, Peru. Methods: A set of 32 Cryptococcus spp. strains from the Institute of Tropical Medicine of the National University of San Marcos, Lima, Peru, were included in this retrospective study. Twenty-four strains were isolated from patients, while the remaining 8 were isolated from the environment. Results: Using conventional PCR, 27 (84.4%) of the isolates were identified as C neoformans var. grubii mating-type alpha and serotype A. Using the AFLP fingerprinting, it was shown that 16 (50%) of the C. neoformans strains were genotype AFLP1, 13 (40.6%) were genotype AFLP1B, 2 (63%) were genotype AFLP2, and 1 (3.1%) was found to be a hybrid between both C. neoformans varieties (genotype AFLP3). The antifungal susceptibility profiles for amphotericin B, fluconazole and voriconazole showed that all the 32 C neoformans are sensitive to these antifungal compounds. Conclusions: In this study we observed that C neoformans var. grubii (AFLP1 and AFLP1B) and C neoformans var. neoformans (AFLP2) were the only cryptococcal varieties involved. All strains were found to be sensitive to the antifungals tested, results that are consistent with those found in the international literature. (C) 2013 Revista Iberoamericana de Micologia. Published by Elsevier Espana, S.L.U. All rights reserved.

This study evaluates the influenza vaccine effectiveness (VE) in preventing laboratory-confirmed cases in Navarre, Spain, in the 2011/12 season in which the peak was delayed until week 7 of 2012. We conducted a test-negative case–control study. Patients with influenza-like illness in hospitals and primary healthcare were swabbed for testing by reverse transcription-polymerase chain reaction. Influenza vaccination status and other covariates were obtained from healthcare databases. The vaccination status of confirmed cases and negative controls was compared after adjusting for potential confounders. VE was calculated as (1-odds ratio)x100. The 411 confirmed cases (93% influenza A(H3)) were compared with 346 controls. Most characterised viruses did not match the vaccine strains. The adjusted estimate of VE was 31% (95% confidence interval (CI): -21 to 60) for all patients, 44% (95% CI: -11 to 72) for those younger than 65 years and 19% (95% CI: -146 to 73) for those 65 or older. The VE was 61% (95% CI: 5 to 84) in the first 100 days after vaccination, 42% (95% CI: -39 to 75) between 100 and 119 days, and zero thereafter. This decline mainly affected people aged 65 or over. These results suggest a low preventive effect of the 2011/12 seasonal influenza vaccine, and a decline in VE with time since vaccination.

Objetivos: Optimizar y evaluar técnicas de ruptura de quistes de Giardia spp para obtener ADN, paso previo a pruebas moleculares. Diseño: Experimental. Institución: Instituto de Medicina Tropical Daniel A. Carrión, Facultad de Medicina, UNMSM. Material biológico: Muestras de heces con quistes de Giardia. Intervenciones: Las muestras de heces con abundantes quistes de Giardia fueron evaluadas con una técnica de obtención de quistes y tres de desenquistamiento. Técnica 1: sedimentación rápida; el sedimento fue lavado varias veces con agua destilada y centrifugado. Para el desenquistamiento, los quistes fueron incubados a: Técnica A: 37°C con bilis de cerdo. Técnica B: con HCl 0,1 N y luego hipoclorito de sodio al 20% a 37°C. Técnica C: Por duplicado, cinco ciclos de congelamiento (-20°C), calentamiento (80°C) y luego papaína a 60°C. Se contó en cámara Newbauer el número de quistes antes y después de cada prueba. Principales medidas de resultados: Mayor número de trofozoítos. Resultados: La técnica B rindió mayor número de trofozoítos que la A. La C no tuvo éxito. Conclusiones: Desenquistar con HCl 1N e hipoclorito de sodio al 20% a 37°C fue buen método para obtener trofozoítos de Giardia.

Dada la importancia de conocer, bajo las con­diciones de la caficultura colombiana, el in­cremento poblacional de la broca del café respecto al desarrollo del fruto, para llevar a cabo programas de manejo en épocas críticas del cultivo, se propuso buscar la relación entre el incremento poblacional y el nivel de infestación de la broca con el estado de desa­rrollo del fruto del cafeto. Además se estu­dió la distribución de la broca en la rama y en el árbol y el impacto del hongo Beauveria bassiana sobre la broca en condiciones de campo, durante el desarrollo del fruto. En el cultivo se seleccionaron al azar 80 árboles, de los cuales 40 se utilizaron para las eva­luaciones de infestación por la broca y la in­fección natural por B. bassiana, y los 40 res­tantes para evaluar el número de estados bio­lógicos de la broca, la mortalidad causada por el hongo sobre los adultos y el peso seco del fruto. Se llevaron a cabo 12 evaluaciones quincenales entre los 105 y los 265 días del desarrollo del fruto. Los primeros huevos se encontraron a los 119 días después de la flo­ración, las primeras larvas a los 133 y las primeras pupas a los 147 días. La duración de la primera generación, de huevo a pupa, fue de 28 días. El número promedio de estados biológicos por fruto "brocado" aumentó durante el período de desarrollo del fruto. El mayor in­: cremento en la infestación se presentó entre los 133 y los 220 días después de la floración. La distribución de la infestación en las ramas fue mayor en los primeros cinco nudos Contados del tallo hacia afuera. Se presentó una relación lineal simple entre el peso seco del fru­to y la infestación media por árbol entre los 105 y los 220 días después de la floración. La infección y la mortalidad por el hongo fueron mayores en frutos verdes que en frutos maduros y sobremaduros.

We investigate the variation of the oscillation frequency of the Mg$^{2+}$ and O$^{2-}$ ions in the magnesium oxide lattice due to the interactions of the surface with water monolayers by means of Low Energy Electron Diffraction. Our key result is a new technique to determine the adsorbate vibrations produced by the water monolayers on the surface lattice as a consequence of their change in the surface Debye temperature and its chemical shift. The latter was systematically investigated for different annealing times and for a constant external thermal perturbation in the range of 110-300 K in order to accomplish adsorption or desorption of water monolayers in the surface lattice., Comment: 8 pages, 5 figures

Glycoproteins of peripheral blood mononuclear cells (PBMC) in patients with liver cirrhosis (LC) have not yet been studied. In the present study, we investigated high mannose-type glycoproteins of PBMC from patients with LC. We showed that [2- 3 H]mannose uptake by PBMC and binding of glycoproteins from PBMC to concanavalin A (Con A)-Sepharose were significantly lower in patients with LC than in healthy subjects. These results indicate that high mannose-type glycoproteins of PBMC are decreased in patients with LC. High mannose-type glycoproteins play an important role in the formation of functional high-affinity interleukin-2 (IL-2) receptors. Thus, the decrease of high mannose-type glycoproteins may be one of the factors affecting the function of T or natural killer (NK) cells, which require IL-2 receptors to exert various immunological functions, in patients with LC.

Background Over the past three decades, there has been a remarkable improvement in the outcome of children diagnosed with systemic lupus erythematosus (SLE). In general, paediatric-onset SLE has been associated with higher mortality rates and more disease damage than adults with SLE. The objective was to determinate the impact of clinical, laboratory, and electroencephalographic findings on survival amongst patients with paediatric-onset SLE. Methods Charts of Mexican patients with paediatric-onset SLE diagnosed between 1970 and 2001 were analysed retrospectively; univariate and multivariate analyses were used for analysing associations between clinical and laboratory features and death; Kaplan�Meier tests were used to estimate survival curves. Results 159 patients were included, 105 were female, with a median age of 12.7 years at diagnosis and a median duration of symptoms prior to diagnosis of 8.4 months. Univariate analysis showed that haematuria, leukocyturia, proteinuria, presence of urine cast

To investigate the frequency of malnutrition and associated factors in patients over 65 years of age in a hospital.We conducted an observational, crosssectional and descriptive study. Department of Nutritional Support, Hospital Medica Sur, Mexico, we evaluated patients over 65 years of age within the first 24 hours of admission.We evaluated 769 patients, 49% of whom were women and 51% were men, with an average age of 75.3 ± 7.7 years. Among the patients evaluated, 53.6% exhibited an altered nutritional state. In addition, 9% were diagnosed as obese and 15% as overweight. Their risk of malnutrition was determined to be 22.5%, and at the time of admission, 7% were malnourished.The prevalence of malnutrition in hospitalized patients over 65 years of age was high. Thus, the early diagnosis of patients who are at risk for malnutrition or who are malnourished is essential and allows for prompt treatment.

Mexico has the highest rates of childhood obesity of any country in the world. As an environmental risk factor, family perception and behavior concerning child obesity is thought to have an important influence on the prevention and treatment of obesity.the aim of this study was to evaluate maternal perceptions of children's weight and to determine whether these perceptions are associated with the actual weight of the children.A descriptive study was conducted that assessed 273 children and included interviews with their mothers. Maternal perceptions of the children's weight status were compared with the measured weights, statures and body mass indices (BMI).The mean BMIs of the children and mothers were 18.1 ± 3.6 and 27.7 ± 4.7 kg/m², respectively. The perceptions of mothers of children's weight are not associated with actual BMI category of children (p0.0001). We found 74 children who were overweight and obese (27%); 62.2% of the mothers of these children considered them to be overweight and obese and 37.8% of these mothers felt that their sons were of normal weight when in fact they were overweight (p = 0.038).We found no association between actual BMI category of children and their mother's perceptions of their weight. In addition, found that third of mothers with obese or overweight children reported that their children had a normal nutritional status.

OBJECTIVE To study the association between adherence to the Mediterranean dietary pattern (MDP) and risk of developing type 2 diabetes, across European countries. RESEARCH DESIGN AND METHODS We established a case-cohort study including 11,994 incident type 2 diabetic case subjects and a stratified subcohort of 15,798 participants selected from a total cohort of 340,234 participants with 3.99 million person-years of follow-up, from eight European cohorts participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. The relative Mediterranean diet score (rMED) (score range 0–18) was used to assess adherence to MDP on the basis of reported consumption of nine dietary components characteristic of the Mediterranean diet. Cox proportional hazards regression, modified for the case-cohort design, was used to estimate the association between rMED and risk of type 2 diabetes, adjusting for confounders. RESULTS The multiple adjusted hazard ratios of type 2 diabetes among individuals with medium (rMED 7–10 points) and high adherence to MDP (rMED 11–18 points) were 0.93 (95% CI 0.86–1.01) and 0.88 (0.79–0.97), respectively, compared with individuals with low adherence to MDP (0–6 points) (P for trend 0.013). The association between rMED and type 2 diabetes was attenuated in people

The technological advance allowed the improvement of existent Geodetic Reference Systems (GRS) in their definition (system) as well in their realization (frame). Usually, the coordinate transformation among the different GRS is done in an analytical way by formulae based on transformation parameters which are not able to model local deformations present in the classical networks. The objective of this work is to evaluate an Artificial Neural Network (ANN) as a basis of a transformation method. For this study coordinates in the system PSAD56 (Provisional South American Datum 1956) in Ecuador were chosen and the cartesian geodetic coordinates in the system SIRGAS95 (Geocentric Reference System for Americas 1995) were determined. Firstly, a set of point coordinates was transformed by a seven parameter transformation derived from the similarity mapping among known coordinates of homologous points in both systems. Secondly, an Artificial Neural Network with Radial Basis Functions (ANN-RBF) was trained to predict coordinates from one system to the other. The results found that the ANN-RBF gave better results for the transformation. These better results would indicate that an ANN-RBF is superior to model the existent deformations in classical networks like PSAD56 when transferred to a new geocentric system like the SIRGAS95.

Fundamentación: La fiebre es la causa más común de consulta en Pediatría y está habitualmente relacionada con enfermedades infecciosas. Objetivo: Describir el comportamiento del síndrome febril prolongado. Método: Se realizó un estudio descriptivo en 27 pacientes ingresados con síndrome febril prolongado en la sala Antonio Maceo del Hospital Pediátrico Provincial Docente Dr. Eduardo Agramonte Piña de Camagüey, desde septiembre de 2002 a enero de 2007. Resultados: Los principales signos y síntomas acompañantes fueron astenia, anorexia, palidez cutáneo-mucosa y adenopatías. Las causas encontradas con más frecuencia fueron infecciosas y las colagenosis. Entre los exámenes complementarios con resultado patológico se encontraron el hemograma con diferencial y la lámina de periferia. Más de la mitad de los pacientes fueron tratados con antimicrobianos. Conclusiones: En un número notable de pacientes no se precisaron las causas de este síndrome.

The Los Azufres caldera (Michoacan, Mexico) is located in the Trans-Mexican Volcanic Belt (MVB). The pre-caldera volcanic basement consists of a 3-km-thick pile of andesitic flows, intruded and/or overlain by rhyolitic and dacitic domes and flows. The geochemistry of the volcanic layers has been investigated in three deep wells (A9, A25 and A48) down to 3.0 km. Such deep wells have given the opportunity to investigate the geochemical changes related to the hydrothermal metamorphism as well as the stratigraphy of the thick volcanic pile. Systematic analysis of major elements in cores and cuttings shows that the partial to total hydrothermal metamorphism of the series from the greenschist to the amphibolite facies produces significant geochemical changes on the whole-rock geochemistry. Gains in CO 2 , H 2 O and depletions in alkalis are especially observed and may be related with the crystallization of carbonates and phyllosilicates. However, the depth-concentration profiles have shown that most other elements (such as Al, Fe, Ca, Mg, P and Ti) display moderate changes due to hydrothermal alteration in comparison with their initial variations of magmatic origin. Rythmic compositional changes are observed all along the volcanic pile, with progressive changes in rock composition from basalts to dacites within four megasequences of a few hundred meters thickness. Elements rather immobile under hydrothermal conditions, such as Ti, have been especially useful for the reconstruction of magmatic sequence stratigraphy. Variations of element concentrations seem mostly due to magmatic differentiation of parental basalts which produces compositions from basaltic andesites to dacites. However, the four magmatic suites distinguished display calc-alkaline features coherent with other suites of the MVB volcanoes.

In this paper, we conduct a series of computer simulations on the genetic modification of disease vectors. In our model, a population of mosquitoes is modeled as DNA sequences. A gene drive mechanism based on simulated transposable elements is inserted into DNA sequences to confer immunity to individuals. Different scenarios on the spread and prevalence of modified genes are simulated using the evolutionary game theory. Preliminary results suggest that the proposed model could be useful for identifying a set of population-level conditions that a disease control strategy based on genetic modification of vectors should satisfy to be effective.

Several previous studies reported that the Venezuelan Warao Indians presented unusual genetic characteristics.The present study checked previous reports of a high frequency of hereditary persistence of fetal hemoglobin (HPFH) and examined other hematological traits.Standard hematology, electrophoresis on cellulose acetate, fetal hemoglobin alkali denaturation, gamma-globin chain, DNA amplification and sequencing, and denaturing gradient gel electrophoresis determinations were performed in 269 individuals living in two localities of the Orinoco River Delta.Two beta(s) genes, in apparently non-related individuals, were found. HPFH, detected in this same population of Warao Indians 25 years ago, was present in heterozygous form in five individuals from a large kindred, with hemoglobin F levels ranging from 3.7% to 8%, and with a pancellular distribution. The HPFH mutation was of the deletional type. beta-globin gene haplotypes were determined by direct counting (through family studies) in 150 chromosomes; 26% of the 150 examined cluster presented haplotype 2, 22% haplotype 6, and 13% a new, Warao haplotype. Haplotype 3, of probable African origin, was also found with a frequency of 5%.The presence of the HPFH mutation was confirmed, and the new beta-globin gene haplotype together with the presence of other rare variants indicates that the Warao are very distinctive in relation to other Native Americans. Evidence was also found of a slight admixture from Africa-derived subjects (Layrisse et al. 1988).

The population older than 60 years in Mexico is growing changing the classic pyramidal demographic structure. This fact is increasing the risk of malnutrition in the elderly, specially under nutrition which is a common problem among elderly people living at home and during hospitalizations, condition that is closely related to the increasing of morbidity, mortality and costs.Describe the prevalence of malnourished elderly who needs hospital admission.Cross-sectional observational study.Third-level reference hospital.Ninety seven consecutive subjects older than 60 years admitted to hospitalization.During the first three days of admission all subjects were evaluated to determine their nutritional status using Mini Nutritional Assessment and Subjective Global Assessment; albumin, total lymphocytes, level of income and school grade were also included.Just 48% of patients have finished primary school and 66% had middle economic incomes. According to Mini Nutritional Assessment 69% of patients had risk associated to malnutrition (18% at high risk and 50% at moderate risk). The short form of the Mini Nutritional Assessment described 73% of patients at risk related to malnutrition in correlation with the complete Mini Nutritional Assessment. 46% and 20% of patients were classified at moderate malnutrition and severe malnutrition respectively using the Subjective Global Assessment. Kappa between Mini Nutritional Assessment and Subjective Global Assessment was of 42%. The Nutritional Risk Index mean value was of 85.9 +/- 11, with 80% of patients at risk associated with malnutrition when moderate and severe risk was included. Kappa between Nutritional Risk Index and Mini Nutritional Assessment was 11%. 70% of patients had serum albumin values under 3 g/dl. According to Chang's method 52% had caloric undernutrition, 29% protein undernutrition and 18% mixed undernutrition.Malnutrition is a common problem in elderly population at hospital admissions according to different methods used. Mini Nutritional Assessment and Subjective Global Assessment are useful low cost and replicable nutritional evaluation tools in elderly population. Mini Nutritional Assessment could have a better value to predict morbidity and mortality in institutionalized and community elderly subjects.

Hepatorenal syndrome (HRS) is a common complication of advanced cirrhosis characterized not only by renal failure but also by marked alterations in systemic haemodynamics and activity of endogenous vasoactive systems. Renal failure is due to a severe vasoconstriction of the renal circulation. The pathogenesis of HRS is not completely understood but it is probably the result of extreme underfilling of the arterial circulation secondary to arterial vasodilation located in the splanchnic circulation. As well as the renal circulation, all other extrasplanchnic vascular beds appear to be vasoconstricted. The diagnosis of HRS is currently based on the exclusion of nonfunctional causes of renal failure; prognosis of patients with HRS is very poor. Liver transplantation is the best option in selected patients, but it is not always applicable as survival expectancy is short. Vasoconstrictor drugs with preferential effect on the splanchnic circulation (vasopressin analogues with a predominant V1 receptor effect, such as terlipressin--Glypressin) are very effective in improving renal function, with reversal of HRS being achieved in approximately two-thirds of patients. There is no agreement as to the terlipressin treatment regimen that is associated with a greater efficacy and lower incidence of side-effects. It appears that the administration of albumin together with terlipressin improves the therapeutic response rate. The impact of treatment on the natural course of HRS remains to be assessed in prospective investigations, but it seems that the reversal of HRS is associated with improved survival. Finally, treatment of patients with HRS with terlipressin before transplantation seems to improve post-transplantation outcome.