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Anomalous origin of the circumflex artery from the pulmonary artery (ACxAPA) is a rare but clinically significant condition in which the circumflex artery arises from either the main pulmonary artery or one of its main branches. Untreated patients with ACxAPA may develop severe heart failure or sudden cardiac death. Diagnosis is established with either catheter or CT angiography. We present a case of an adult male with no prior known cardiac history who was found to have ACxAPA after presenting to our institution in acute decompensated heart failure.

Periosteal reaction may result from multiple causes including infection, trauma, medications, and neoplasms. One important etiology that must be considered in the differential diagnosis of symmetric periosteal reaction, especially in immunocompromised patients, is voriconazole use. We present a case of a 65-year-old man who underwent liver transplantation complicated by acute hypoxic respiratory failure and Aspergillus infection. Long term voriconazole therapy was initiated with resultant development of thoracic periosteal reaction which improved following discontinuation of the medication. Given the preferential upper body distribution of periosteal reaction induced by voriconazole, chest radiologists might be the first ones to recognize this adverse effect.

Objective: To describe the clinical and radiographic findings in a large cohort of patients with positive cultures for Nocardia emphasizing the differences between invasive disease and colonization. Patients and Methods: We conducted a single-center, retrospective cohort study of 133 patients with a positive Nocardia isolate between August 1, 1998, and November 30, 2018, and a computed tomography (CT) of the chest within 30 days before or after the bacteria isolation date. Results: Patients with colonization were older (71 vs 65 years; P=.004), frequently with chronic obstructive pulmonary disease (56.8% vs 16.9%; P

A test of independence is commonly used to determine differences (or associations) between samples in a nominal level measurement. Fisher’s exact test and Chi-square test are two of the most widely applied tests of independence used in the data analyses in different areas such as information technologies, biostatistics, psychology and health sciences. In some cases, contingency tables with null entries (also called random zeros) arise, particularly if the number of samples is small, and the variables analyzed are multilevel. This situation becomes a problem because if one or more entries in a contingency table are zero or have small values, then the tests of independence produce unreliable results. In this paper, we propose a method to address that issue. The method merges one or more levels of the variables analyzed to create contingency tables with only one degree of freedom, avoiding applying a test of independence on contingency tables with random zeros. The source code (Python) of the method is publicly available for use. The results obtained using our method give a complete panorama of the associations between the variables of a data set. To show the effectiveness of our approach to find dependencies between variables, we use four data sets publicly available on the Internet.

This work presents the development of a classification method that can contribute to precise and increased awareness of the situational context of vehicles, for it to be used in autonomous driving applications. This work aims to obtain a method for machine-learning-based driving environment classification that does not involve computer vision but instead makes use of dynamics variables from Inertial-Measurement-Unit (IMU) sensors and instantaneous energy consumption measurements. This article includes details about the data acquisition, the electric vehicle used for the experiments, and the pre-processing methods employed. This explores the viability of a method for classifying a vehicle’s driving environment. The results of such a system can potentially be used to provide precise information for path planning, energy optimization, or safety purposes. Information about the driving context could be also used to decide if the conditions are safe for autonomous driving or if human intervention is recommended or required. In this work, the feature selection process and statistical data pre-processing methods are evaluated. The pre-processed data are used to compare 13 different classification algorithms and then the best three are selected for further testing and data dimensionality reduction. Two approaches for feature selection based on feature importance and final classification scores are tested, achieving a classification mean accuracy of 93 percent with a real testing dataset that included three driving scenarios and eight different drivers. The obtained results and high classification accuracy represent a first approach for the further development of such classification systems and the potential for direct implementation into autonomous driving technology.

Introduction: Dengue, mainly transmitted by Aedes aegypti, is a very important viral disease in terms of public health. Colombia is an endemoepidemic country for dengue and, in cities like Medellín, there are neighborhoods with high and low incidence. The disease dynamics in the neighborhoods might be determined by differences in the knowledge, practices and entomological aspects of the vector among the communities. Objective: To identify the knowledge and practices of residents of neighborhoods with high and low incidence of dengue, and to explore the entomological aspects related to the presence of the vector. Materials and methods: We conducted a cross-sectional study comparing two neighborhoods with high incidence and two with low incidence during the triennium of 2013-2015. A random sample of 100 houses per neighborhood was selected in order to evaluate the knowledge, practices and entomological aspects related to dengue. In addition, descriptive, bivariate and multivariate analyses (logistic regression) were performed. Results: In neighborhoods with high incidence, participants had not attended school or had only a primary school level of education (OR=1.69; 95% CI: 1.09-2.63). Additionally, they did not have health coverage or belonged to the subsidized regime (OR=2.16; 95% CI: 1.41-3.32). In contrast, they had a greater knowledge of the vector (OR=1.53; 95% CI: 1.00-2.35). In terms of practices, there was a greater chance of finding houses where water was stored (OR=1.69; 95% CI: 1.11-2.57) and regarding the entomological aspects, more houses with adult mosquitoes were found (OR=2.13 95% CI: 1.29-3.50). Conclusions: We found important differences among the neighborhoods regarding knowledge, practices, and the presence of adult stages of the vector, which helps to explain the epidemiology of dengue in these sites.

Coronary artery disease is a major cause of death and disability among women, worldwide, particularly during the postmenopausal state, with the caveat that their presenting symptoms are atypical compared to men. Also, there is conflicting data regarding the ideal method to determine their risk, particularly for primary prevention. During this review, we sought to determine the utility of the coronary calcium score for assessing such risk in asymptomatic women, by reviewing the most representative current data and analyzing additional studies to help improve the understanding of mechanisms of coronary artery calcification and determine better strategies of prevention and treatment in women with a positive CCS. Resumen: La enfermedad arterial coronaria es una causa importante de mortalidad y discapacidad en mujeres en el mundo, especialmente durante la postmenopausia, con la salvedad de que presentan síntomas atípicos comparados con los hombres. Además, existen datos contradictorios en cuanto al método para determinar su riesgo, en particular para la prevención primaria. En esta revisión se busca determinar la utilidad del puntaje de calcio coronario para determinar tal riesgo en mujeres asintomáticas, al revisar los datos actuales más representativos y analizar estudios adicionales para ayudar a mejorar la comprensión de los mecanismos de la calcificación de las arterias coronarias, y definir mejores estrategias de prevención y tratamiento en mujeres con un puntaje de calcio coronario positivo. Keywords: Coronary, Vascular, Tomography, Imaging, Coronary disease, Palabras clave: Coronario, Vascular, Tomografía, Imagenología, Enfermedad coronaria

By paying attention to what Peruvian and Bolivian students in schools say about how they are seen and treated by their native-born peers, this article aims to analyze the ways in which symbolic boundaries are produced, eventually giving way to social boundaries between natives and migrants. The methodology is based on in-depth interviews with students, parents, and educators of rural and urban schools in the region of Arica y Parinacota, the northernmost region of Chile, by the borders with Peru and Bolivia. We conclude that the production of symbolic boundaries among students emerges as discourses about nationality, skin color, ethnicity, and history. Peruvian and Bolivian migrant students describe being teased by their native-born peers because of their country of origin, for being darker-skinned, for being Aymara, and for having lost the War of the Pacific (and, in the case of Bolivians, for having lost access to the coastline). Some migrant students perceive these discourses as discrimination and consider them harmful; however, many others accept them as normal school stuff -- as long as there is no physical violence. Moreover, teachers and parents do not see these interactions as problematic. The article concludes that the normalization of stigmatizing and discriminatory dynamics against migrant students complicates their inclusion in Chilean schools.

La intención de este artículo es evidenciar la importancia de los grupos focales de discusión como estrategia metodológica para la recolección de información en el trabajo con adolescentes institucionalizados con experiencia de vida en calle y, al mismo tiempo, mostrar su valor en el abordaje de la salud sexual con esta población, en tanto que permite una interacción flexible y reflexiva entre investigadores y participantes, así como de los participantes entre sí. El valor de esta estrategia metodológica es sustentado en este artículo mediante testimonios y resultados obtenidos durante su implementación en el estudio llevado a cabo con adolescentes institucionalizados entre 2013 y 2014 en Medellín. Se espera con este reducir las creencias de profesionales con respecto a las limitaciones de la estrategia para abordar temáticas relacionadas con la salud sexual de este grupo poblacional. Los resultados se articulan en cuatro categorías: conocimientos y percepciones sobre vih e its, salud sexual y reproductiva (ssr), el lenguaje en la ssr, y acceso y uso de las tecnologías de la información y la comunicación (tic). De esta manera, se deja de manifiesto el aporte y potencial de la estrategia para el abordaje del tema y para el acercamiento e interacción con adolescentes con experiencia de vida en calle.

The aim of this study was to assess the seroprevalence of human toxocariasis in three Andean communities from the Northeast of Lima, Peru. A total of 303 subjects including children and adults were studied and blood samples were collected to detect anti-Toxocara antibodies by ELISA-IgG test and by hematological examination; stool samples were collected also for parasitological examination. The overall seroprevalence of toxocariasis observed in the total population was 20.46%, with a significant high proportion in children from one to 10 years old (p = 0.034). Among the subjects with positive serology, 32.26% of them had respiratory disturbances, 22.58% hepatomegaly, 17.74% ocular signs or symptoms, 14.51% abdominal pain, 9.68% neurological involvement, and 4.84% cutaneous signs, but none of these clinical features were associated to a positive serology by multivariate analysis. Furthermore, 79.03% of seropositive subjects also harbored at least one intestinal parasite, which was associated to a positive serology (p < 0.05). The presence of pets within the houses, a previous history of pica or geophagia and the use of public places were also present in this population, but only the latter was associated to the serology (p < 0.05). In conclusion, clinical, serological, and epidemiological evidences for larval Toxocara infection were found in the studied population.O propósito do presente trabalho foi estimar a soroprevalência da toxocaríase humana em três comunidades andinas do Nordeste de Lima, Peru. Foi estudado um total de 303 pessoas, entre crianças e adultos. Foram coletadas amostras de sangue para a detecção de anticorpos anti-Toxocara e para a análise hematológica, além de amostras fecais para o exame parasitológico. A soroprevalência geral da população foi de 20,46% com proporção significativamente maior de positividade em crianças de um a 10 anos (p = 0,034). Das pessoas com sorologia positiva, 32,26% apresentavam sintomas respiratórios, 22,58% moléstias hepáticas, 17,74% manifestações oculares, 14,51% dor abdominal, e 4,84% sinais cutâneos. Além disso, 79,03% das pessoas com sorologia positiva tinham pelo menos algum parasito intestinal com associação significativa (p < 0.05). A presença de cachorros dentro das casas, história de pica ou geofagia e o uso dos lugares públicos também estiveram presentes nesta população, mas o ultimo deles só esteve associado com a sorologia positiva (p < 0.05). Conclui-se que existem evidências clínicas, sorológicas e epidemiológicas de infecção por larvas de Toxocara na população estudada.

Introducción. La leishmaniasis cutánea americana es endémica en Colombia, donde cada año son notificados aproximadamente 6000 casos nuevos. En la actualidad las medidas de prevención y control están limitadas al diagnóstico y tratamiento de los casos. Objetivo. Evaluar la eficacia de una intervención múltiple para prevenir la transmisión de Leishmania en el foco endémico de Tumaco, costa Pacífica de Colombia. Materiales y métodos. Se realizó un ensayo de grupos aleatorizados. Veinte veredas fueron pareadas según prevalencia deLeishmania, habitantes y participación comunitaria y luego asignadas aleatoriamente a intervención o control. La intervención incluyó toldillos impregnados con deltametrina, repelente (N, N-dietil-m-toluamida 20% y Permetrina 0,5%), modificación de lugares de reposo para los vectores y educación. Al cabo de un año se comparó la incidencia de infección y enfermedad producida porLeishmania en los dos grupos, se monitorearon la adherencia a la intervención y la aparición de efectos adversos. Los resultados finales fueron ajustados por el efecto de correlación intra-grupo. Resultados. Se presentaron 10 casos de leishmaniasis cutánea americana en el grupo que recibió la intervención y 23 en el grupo control, OR=0,42, IC95% 0,14-1,26. La intervención tuvo un mayor efecto en los niños menores de 10 años, en aquellos que residían en la periferia de la vereda y en veredas con una prevalencia de infección en niños pequeños mayor del 1%. Se reportaron eventos adversos leves asociados con el uso de los toldillos impregnados y el repelente en 2% de los participantes. Conclusión. Los casos nuevos de Leishmaniasis cutánea americana se redujeron en un 58% en el grupo que recibió la intervención. Sin embargo, el número pequeño de casos hace que la estimación de la medida de efecto sea imprecisa y no nos permite afirmar que la intervención tiene un efecto protector. Poblaciones específicas podrían ser el blanco de futuras intervenciones más simples y costo-efectivas.

Se esboza en este trabajo el método del reemplazo molecular, que se ha convertido últimamente en una estrategia muy útil para la determinación de la estructura de macromoléculas biológicas, cuando se posee la estructura de una molécula homóloga a la estructura problema.

Se realizó un estudio descriptivo de 150 pacientes a los que se les diagnosticó una afección ginecológica, mediante examen físico exhaustivo y ultrasonido ginecológico, biopsia o laparoscopia, y sin previo conocimiento de dicho diagnóstico por parte del estomatólogo, fueron remitidos a la consulta de Medicina Tradicional del Departamento de Estomatología del Hospital Clínico-Quirúrgico Docente “Manuel Fajardo Rivero” de Santa Clara, Villa Clara. El rango de edad de las pacientes se hallaba entre 15 y 60 años; se les realizó un examen bucal para investigar campo de interferencia en aquellos dientes que por el microsistema dental guardan relación con el aparato ginecológico, y de esa forma relacionarlos con el diagnóstico del ginecólogo. Para detectar estos campos o focos, utilizamos como diagnóstico los rayos X periapicales y oclusales, la sonda periodontal y el pulpovitalómetro; se compararon los diagnósticos ginecológicos con los resultados del examen bucal buscando la relación del microsistema dental, y se halló que el 100 % de las pacientes con afecciones ginecológicas presentaron focos de interferencias en el microsistema dental; el grupo etáreo de 45 a 54 años fue el más afectado. Las afecciones ginecológicas más observadas fueron la cervicitis crónica y el mioma uterino; los focos de interferencia dental que más se presentaron fueron las gingivitis en un 62 %, las espigas con un 59,3 % y los tratamientos pulporradiculares sin terminar, en un 54 %.

A study was conducted during 1996-1997 in 20 villages of Tumaco, Colombia, to evaluate the effectiveness of personal protective measures against cutaneous leishmaniasis (CL). The intervention was effective, but the high costs of the preventive measures and the lack of a more holistic approach hampered the intervention's sustainability. This paper analyzes the results using an ecosystem approach to human health. Using this approach, we found that CL has been present in the study area for a long time and affects farmers and those living closest to the forest. The forest constitutes the habitat for insect vectors (sandflies) and parasite reservoirs (wild mammals). Four spatial scales were identified in this ecosystem: residential, village, regional, and global. From the ecosystem perspective, three interventions are proposed to prevent CL in the 20 villages: improve housing construction, organize village housing in clusters, and make diagnosis and treatment of CL more accessible. The design and implementation of these interventions require active involvement by people with the disease (village inhabitants) and decision-makers (local authorities).Durante 1996-1997 se realizó un estudio en 20 veredas de Tumaco, Colombia, para evaluar la efectividad de medidas de protección para leishmaniasis cutánea (LC). La intervención fué efectiva, sin embargo, los altos costos de las medidas de protección y la falta de una propuesta más holistica no permitieron sostener la intervención. Los resultados de este estudio son analizados en este artículo usando una propuesta de ecosistemas para la salud humana. Usando esta propuesta, vemos que LC ha estado presente en la zona de estudio por mucho tiempo y que afecta a agricultores y a aquellos que vivien cerca del bosque. El bosque constituye el hábitat para los insectos vectores (sandflies) y los reservorios del parásito (mamiferos salvajes). Cuatro escalas espaciales fueron identificadas en este ecosistema: residencia, vereda, región y global. Desde la perspectiva de la propuesta de ecosistemas, se proponen tres intervenciones para prevenir LC en estas 20 veredas: mejorar la construcción de las residencias, organizar las residencias en conglomerados, y hacer más accesibles el diagnostico y el tratamiento de LC. Estas intervenciones requerirán la participación activa de aquellos que sufren la enfermedad (habitantes de las veredas) y de aquellos que pueden tomar decisiones al respecto (autoridades locales).

A study was conducted during 1996-1997 in 20 villages of Tumaco, Colombia, to evaluate the effectiveness of personal protective measures against cutaneous leishmaniasis (CL). The intervention was effective, but the high costs of the preventive measures and the lack of a more holistic approach hampered the intervention's sustainability. This paper analyzes the results using an ecosystem approach to human health. Using this approach, we found that CL has been present in the study area for a long time and affects farmers and those living closest to the forest. The forest constitutes the habitat for insect vectors (sandflies) and parasite reservoirs (wild mammals). Four spatial scales were identified in this ecosystem: residential, village, regional, and global. From the ecosystem perspective, three interventions are proposed to prevent CL in the 20 villages: improve housing construction, organize village housing in clusters, and make diagnosis and treatment of CL more accessible. The design and implementation of these interventions require active involvement by people with the disease (village inhabitants) and decision-makers (local authorities).