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Failure of treatment of cutaneous leishmaniasis with antimonial drugs and miltefosine is frequent. Use of oral combination therapy represents an attractive strategy to increase efficacy of treatment and reduce the risk of drug resistance. We evaluated the potency of posaconazole, itraconazole, voriconazole, and fluconazole and the potential synergy of those demonstrating the highest potency, in combination with miltefosine (HePC), against infection with Leishmania (Viannia) panamensis. Synergistic activity was determined by isobolograms and calculation of the fractional inhibitory concentration index (FICI), based on parasite quantification using an ex vivo model of human peripheral blood mononuclear cells (PBMCs) infected with a luciferase-transfected, antimony and miltefosine sensitive line of L. panamensis. The drug combination and concentrations that displayed synergy were then evaluated for antileishmanial effect in 10 clinical strains of L. panamensis by reverse transcription-quantitative (qRT-PCR) of Leishmania 7SLRNA. High potency was substantiated for posaconazole and itraconazole against sensitive as well as HePC- and antimony-resistant lines of L. panamensis, whereas fluconazole and voriconazole displayed low potency. HePC combined with posaconazole (Poz) demonstrated evidence of synergy at free drug concentrations achieved in plasma during treatment (2 μM HePC plus 4 μM Poz). FICI, based on 70% and 90% reduction of infection, was 0.5 for the sensitive line. The combination of 2 μM HePC plus 4 μM Poz effected a significantly greater reduction of infection by clinical strains of L. panamensis than individual drugs. Orally administrable miltefosine/posaconazole combinations demonstrated synergistic antileishmanial capacity ex vivo against L. panamensis, supporting their potential as a novel therapeutic strategy to improve efficacy and effectiveness of treatment.

La cartografía social constituye un enfoque teórico-metodológico para analizar y comprender los procesos de participación social y educativa. En este enfoque la realidad es construida culturalmente por las personas a través de sus experiencias interpersonales que influyen en la percepción de su comunidad y representación sobre las relaciones de coexistencia. Este artículo, a través de un enfoque de estudio cualitativo, estudia la importancia de la cartografía social para la construcción de ciudadanía y analiza las prácticas educativas desarrolladas por un grupo de jóvenes estudiantes en la licenciatura de Ciencia Política en la Universidad Autónoma Metropolitana, Campus Iztapalapa en octubre de 2019. Los hallazgos indican que existen diversas expresiones educativas y culturales sobre la percepción del territorio, la política, las narrativas y las prácticas sociales que influyen en la construcción de ciudadanía activa y que son claves para impulsar la cultura democrática.

The immune mechanisms that contribute to the efficacy of treatment of cutaneous leishmaniasis (CL) are not fully understood. The aim of this study was to define immune correlates of the outcome of treatment of CL caused by Leishmania (Viannia) species during standard of care treatment with pentavalent antimonials. We conducted a comparative expression profiling of immune response genes in peripheral blood mononuclear cells (PBMCs) and lesion biopsy specimens obtained from CL patients before and at the end of treatment (EoT) with meglumine antimoniate. The ex vivo response of PBMCs to L. (V.) panamensis partially reflected that of lesion microenvironments. Significant downregulation of gene expression profiles consistent with local innate immune responses (monocyte and neutrophil activation and chemoattractant molecules) was observed at EoT in biopsy specimens of patients who cured (n = 8), compared to those from patients with treatment failure (n = 8). Among differentially expressed genes, pretreatment expression of CCL2 was significantly predictive of the therapeutic response (receiver operating characteristic [ROC] curve, area under the curve [AUC] = 0.82, P = 0.02). Polymorphisms in regulatory regions of the CCL2 promoter were analyzed in a pilot cohort of DNA samples from CL patients (cures, n = 20, and treatment failure, n = 20), showing putative association of polymorphisms rs13900(C/T) and rs2857656(G/C) with treatment outcome. Our data indicate that dampening gene expression profiles of monocyte and neutrophil activation characterize clinical cure after treatment of CL, supporting participation of parasite-sustained inflammation or deregulated innate immune responses in treatment failure.

espanolEn este trabajo se caracterizo un grupo de victimas del Resguardo Indigena Canamomo y Lomaprieta del municipio de Riosucio (ubicado en el departamento de Caldas-Colombia) con el fin de brindarles herramientas que los apoyen en el diseno de intervenciones e informes ante la Jurisdiccion Especial para la Paz (JEP) o la Comision para el Esclarecimiento de la Verdad, la Convivencia y la No Repeticion (CEV), instituciones creadas en el Acuerdo de Paz alcanzado con las FARC (Presidencia de la Republica de Colombia - Oficina del Alto Comisionado para la Paz, 2016), esto segun sus intereses y necesidades como victimas del conflicto con identidad etnica diferenciada. Apoyar a las victimas del conflicto exige responder a las preguntas: ?Quienes son las victimas?; ?Cual ha sido el hecho victimizante?; ?Cual fue el lugar de los hechos y cuando ocurrio?La metodologia empleada combino diferentes herramientas de investigacion social tales como la encuesta, las entrevistas semiestructuradas y los grupos focales, entre otras.En este sentido, se observaron protocolos de etica de la investigacion social tendientes a aplicar debidamente las herramientas de investigacion con el animo de generar el menor impacto posible en las comunidades y personas consultadas. A este respecto el trabajo de Taborda Ocampo (2011) fue ilustrativo. Las conclusiones a las que arribo el estudio muestran el tipo de expectativas que tienen las victimas con identidad etnica (indigena) con las que se trabajo, en materia de Verdad, Justicia, Reparacion y No Repeticion, asi como las dificultades que enfrentan a pesar de los principios que guian el Acuerdo de Paz “Centralidad de las Victimas y Paz Territorial” para acceder al Sistema Integral de Verdad, Justicia, Reparacion y No Repeticion, tema creado en el Acuerdo y del cual forman parte las dos instituciones mencionadas antes. EnglishIn this work was characterized a group of victims of the Canamomo and Lomaprieta Indigenous authority of the municipality of Riosucio (located in the department of Caldas - Colombia) in order to provide some tools that support them in the design of interventions and reports to the Special Jurisdiction for the Peace (JEP - Jurisdiccion Especial para la Paz -in Spanish- ) or the Commission for the Clarification of Truth, Coexistence and Non-Repetition (CEV), as institutions created in the Peace Agreement reached with the FARC, according to their interests and needs as victims of the conflict with differentiated ethnic identity. Supporting the victims of the conflict requires answering the questions: Who are the victims? What was the victimizing fact? What was the place and when it happened?The methodology used combined different social research tools, such as the survey, semi-structured interviews and focus groups, among others. The conclusions reached by the study show the kind of expectations that the victims with ethnic identity (indigenous) have with which they worked, in terms of Truth, Justice, Reparation and Non-Repetition, as well as the difficulties they face despite of the principles that guide the Peace Agreement: Centrality of Victims and Territorial Peace, to access the Integral System of Truth, Justice, Reparation and Non-Repetition, created in the Agreement and of which the two institutions mentioned above.

Resumen El presente artículo da cuenta de una revisión bibliográfica sobre comunidades de práctica cultivadas en el contexto educativo. Su propósito es servir de base documental, para la visualización de un panorama preliminar, en el posterior desarrollo de una investigación sobre los efectos que tiene la configuración de una comunidad de práctica en la enseñanza de las matemáticas, cuando es conformada por docentes de educación básica primaria de una misma institución educativa. Por lo que se presentan los principales hallazgos de investigaciones relacionadas con tres niveles de la educación colombiana, a saber: la universidad y la educación básica secundaria y media, donde se evidencian una mayor cantidad de investigaciones al compararse con la educación básica primaria. Una de las principales conclusiones, es que las comunidades de práctica desempeñan un papel fundamental, cuando se utilizan para mejorar los procesos educativos permitiendo fortalecer los mecanismos de mejoramiento de las prácticas pedagógicas. Abstract This article reports a literature review on communities of practice developed in the educational context. Its purpose is to serve as a documentary basis for the visualization of a preliminary panorama in the subsequent development of a research on the effects of the configuration of a community of practice in the teaching of mathematics, when it is formed by elementary school teachers from the same educational institution. Therefore, the main findings of research related to three levels of Colombian education are presented, namely: university and basic secondary and middle school education, where a greater amount of research is evidenced when compared to basic elementary education. One of the main conclusions is that communities of practice play a fundamental role when they are used to improve educational processes, allowing the strengthening of mechanisms for the improvement of pedagogical practices. Resumo Este artigo relata uma revisão bibliográfica sobre comunidades de prática cultivadas no contexto educacional. Tem por finalidade servir de base documental, para a visualização de um panorama preliminar, no posterior desenvolvimento de uma investigação sobre os efeitos que a configuração de uma comunidade de prática tem no ensino da matemática, quando este é constituído por professores de educação, escola primária da mesma instituição de ensino. Portanto, são apresentados os principais resultados das pesquisas relacionadas aos três níveis da educação colombiana, a saber: a universidade e a educação básica secundária e média, onde se evidencia uma maior quantidade de pesquisas quando comparada à educação primária básica. Uma das principais conclusões é que as comunidades de prática desempenham um papel fundamental, quando são utilizadas para a melhoria dos processos educativos, permitindo fortalecer os mecanismos de melhoria das práticas pedagógicas.

The mechanisms of Leishmania resistance to antimonials have been primarily determined in experimentally derived Leishmania strains. However, their participation in the susceptibility phenotype in field isolates has not been conclusively established. Being an intracellular parasite, the activity of antileishmanials is dependent on internalization of drugs into host cells and effective delivery to the intracellular compartments inhabited by the parasite. In this study we quantified and comparatively analyzed the gene expression of nine molecules involved in mechanisms of xenobiotic detoxification and Leishmania resistance to antimonial drugs in resistant and susceptible laboratory derived and clinical L.(Viannia) panamensis strains (n=19). In addition, we explored the impact of Leishmania susceptibility to antimonials on the expression of macrophage gene products having putative functions in transport, accumulation and metabolism of antimonials. As previously shown for other Leishmania species, a trend of increased abcc3 and lower aqp-1 expression was observed in the laboratory derived Sb-resistant L.(V.) panamensis line. However, this was not found in clinical strains, in which the expression of abca2 was significantly higher in resistant strains as both, promastigotes and intracellular amastigotes. The effect of drug susceptibility on host cell gene expression was evaluated on primary human macrophages from patients with cutaneous leishmaniasis (n=17) infected ex-vivo with the matched L.(V.) panamensis strains isolated at diagnosis, and in THP-1 cells infected with clinical strains (n=6) and laboratory adapted L.(V.) panamensis lines. Four molecules, abcb1 (p-gp), abcb6, aqp-9 and mt2a were differentially modulated by drug resistant and susceptible parasites, and among these, a consistent and significantly increased expression of the xenobiotic scavenging molecule mt2a was observed in macrophages infected with Sb-susceptible L. (V.) panamensis. Our results substantiate that different mechanisms of drug resistance operate in laboratory adapted and clinical Leishmania strains, and provide evidence that parasite-mediated modulation of host cell gene expression of molecules involved in drug transport and metabolism could contribute to the mechanisms of drug resistance and susceptibility in Leishmania.

Infection by Leishmania ( Viannia ) panamensis , the predominant etiologic agent for cutaneous leishmaniasis in Colombia, is characterized by a chronic mixed inflammatory response. Current treatment options are plagued by toxicity, lengthy treatment regimens, and growing evidence of drug resistance. Immunotherapy, modulating the immune system to mount a protective response, may provide an alternate therapeutic approach. We investigated the ability of the Toll-like receptor 9 (TLR9) ligand CpG to modulate established disease in the L . ( V .) panamensis mouse model. Treatment of established infection with a high dose (50 μg) of CpG ameliorated disease and lowered parasite burden. Interestingly, immediately after treatment there was a significant increase in transforming growth factor β (TGF-β) and concomitantly an increase in T regulatory cell (Treg) function. Although a general reduction in cell-mediated immune cytokine and chemokine (gamma interferon [IFN-γ], interleukin 10 [IL-10], IL-13, IL-6, granulocyte-macrophage colony-stimulating factor [GM-CSF], IL-4, and MIP-1α) responses of the treated mice was observed, certain chemokines (RANTES, monocyte chemoattractant protein 1[MCP-1], and IP-10) were increased. Further, in peripheral blood mononuclear cells (PBMCs) from patients with cutaneous leishmaniasis, CpG treatment similarly exhibited a dose-response effect on the production of IFN-γ, IL-17, IL-10, and IL-13, with reductions observed at higher doses. To further understand the underlying mechanisms and cell populations driving the CpG mediated response, we examined the ex vivo dose effects mediated by the TLR9 + cell populations (dendritic cells, macrophages, and B cells) found to accumulate labeled CpG in vivo . Notably, B cells altered the production of IL-17, IL-13, and IFN-γ, supporting a role for B cells functioning as antigen-presenting cells (APCs) and/or regulatory cells during infection. Interestingly, B cells have been previously demonstrated as a primary type of APC in patients infected with L . ( V .) panamensis and thus may be useful targets of immunotherapy. Collectively, our results show that CpG-induced immune regulation leads to a dampening of the host immune response and healing in the mouse model, and it may provide an alternate approach to treatment of cutaneous leishmaniasis caused by L . ( V .) panamensis .

Treatment failure and parasite drug susceptibility in dermal leishmaniasis caused by Leishmania ( Viannia ) species are poorly understood. Prospective evaluation of drug susceptibility of strains isolated from individual patients before drug exposure and at clinical failure allows intrinsic and acquired differences in susceptibility to be discerned and analyzed. To determine whether intrinsic susceptibility or loss of susceptibility to miltefosine contributed to treatment failure, we evaluated the miltefosine susceptibility of intracellular amastigotes and promastigotes of six Leishmania ( Viannia ) braziliensis and six Leishmania ( Viannia ) panamensis strains isolated sequentially, at diagnosis and treatment failure, from two children and four adults ≥55 years old with concurrent conditions. Four patients presented only cutaneous lesions, one had mucosal disease, and one had disseminated mucocutaneous disease. Expression of the Leishmania drug transporter genes abca2 , abca3 , abcc2 , abcc3 , abcg4 , abcg6 , and LbMT was evaluated by quantitative reverse transcription-PCR (qRT-PCR). Intracellular amastigotes (median 50% effective concentration [EC 50 ], 10.7 μmol/liter) were more susceptible to miltefosine than promastigotes (median EC 50 , 55.3 μmol/liter) ( P < 0.0001). Loss of susceptibility at failure, demonstrated by a miltefosine EC 50 of >32 μmol/liter (the upper limit of intracellular amastigote assay), occurred in L. panamensis infection in a child and in L. braziliensis infection in an adult and was accompanied by decreased expression of the miltefosine transporter LbMT (LbMT/β-tubulin, 0.42- to 0.26-fold [ P = 0.039] and 0.70- to 0.57-fold [ P = 0.009], respectively). LbMT gene polymorphisms were not associated with susceptibility phenotype. Leishmania ABCA3 transporter expression was inversely correlated with miltefosine susceptibility ( r = −0.605; P = 0.037). Loss of susceptibility is one of multiple factors involved in failure of miltefosine treatment in dermal leishmaniasis.

A partir de los resultados del Estado del Arte de la investigación en el campo de Educación y Democracia de la Maestría en Educación de la Universidad Católica de Manizales 2003-2012, se dio lugar al presente estudio de corte documental, donde se analiza la metáfora desde una perspectiva de la educación y la democracia, y estas, a su vez, desde una perspectiva metafórica. Se revisaron 277 obras**, de las cuales, 33 fueron seleccionadas, debido a que su análisis permitió reconocer las metáforas, en tanto invención para resolver problemas mediante la creatividad y el pensamiento divergente, en el campo de la educación y la democracia. Se espera facilitar el desarrollo de otras indagaciones, otros estudios, otros cuestionamientos, que hagan y se hagan partícipes de la metáfora.

Cutaneous and mucosal leishmaniasis is widely distributed in Central and South America. Leishmania of the Viannia subgenus are the most frequent species infecting humans. L. (V.) braziliensis, L. (V.) panamensis are also responsible for metastatic mucosal leishmaniasis. Conventional or real time PCR is a more sensitive diagnostic test than microscopy, but the cost and requirement for infrastructure and trained personnel makes it impractical in most endemic regions. Primary health systems need a sensitive and specific point of care (POC) diagnostic tool. We developed a novel POC molecular diagnostic test for cutaneous leishmaniasis caused by Leishmania (Viannia) spp. Parasite DNA was amplified using isothermal Recombinase Polymerase Amplification (RPA) with primers and probes that targeted the kinetoplast DNA. The amplification product was detected by naked eye with a lateral flow (LF) immunochromatographic strip. The RPA-LF had an analytical sensitivity equivalent to 0.1 parasites per reaction. The test amplified the principal L. Viannia species from multiple countries: L. (V.) braziliensis (n = 33), L. (V.) guyanensis (n = 17), L. (V.) panamensis (n = 9). The less common L. (V.) lainsoni, L. (V.) shawi, and L. (V.) naiffi were also amplified. No amplification was observed in parasites of the L. (Leishmania) subgenus. In a small number of clinical samples (n = 13) we found 100% agreement between PCR and RPA-LF. The high analytical sensitivity and clinical validation indicate the test could improve the efficiency of diagnosis, especially in chronic lesions with submicroscopic parasite burdens. Field implementation of the RPA-LF test could contribute to management and control of cutaneous and mucosal leishmaniasis., Author Summary Cutaneous leishmaniasis is a parasitic disease transmitted by the bite of sandflies that produces skin ulcers. The severe, disfiguring form of the disease is characterized by parasite dissemination to the mucosa of the nose and palate. Current diagnosis is based on microscopy which has low sensitivity in chronic cases. Molecular methods (PCR) that detect parasite DNA are highly sensitive but costs and personnel training make it impossible to implement it in resource-limited areas. We developed a novel molecular method (RPA-LF) that could be applied in the field because it does not require sophisticated equipment. It is also very sensitive and specific to detect the principal Leishmania species that produce cutaneous leishmaniasis in Latin America. Future field implementation of RPA-LF could have a positive impact on disease management and control.

Resistance to antimonial drugs has been documented in Leishmania isolates transmitted in South America, Europe, and Asia. The frequency and distribution of resistance to these and other antileishmanial drugs are unknown. Technical constraints have limited the assessment of drug susceptibility of clinical strains of Leishmania . Susceptibility of experimentally selected lines and 130 clinical strains of Leishmania panamensis , L. braziliensis , and L. guyanensis to meglumine antimoniate and miltefosine was determined on the basis of parasite burden and percentage of infected U-937 human macrophages. Reductions of infection at single predefined concentrations of meglumine antimoniate and miltefosine and 50% effective doses (ED 50 s) were measured and correlated. The effects of 34°C and 37°C incubation temperatures and different parasite-to-host cell ratios on drug susceptibility were evaluated at 5, 10, and 20 parasites/cell. Reduction of the intracellular burden of Leishmania amastigotes in U-937 cells exposed to the predefined concentrations of meglumine antimoniate or miltefosine discriminated sensitive and experimentally derived resistant Leishmania populations and was significantly correlated with ED 50 values of clinical strains (for meglumine antimoniate, ρ = −0.926 and P < 0.001; for miltefosine, ρ = −0.906 and P < 0.001). Incubation at 37°C significantly inhibited parasite growth compared to that at 34°C in the absence of antileishmanial drugs and resulted in a significantly lower ED 50 in the presence of drugs. Susceptibility assessment was not altered by the parasite-to-cell ratio over the range evaluated. In conclusion, measurement of the reduction of parasite burden at a single predetermined drug concentration under standardized conditions provides an efficient and reliable strategy for susceptibility evaluation and monitoring of clinical strains of Leishmania .

La generación creciente de importantes volúmenes de datos, como resultado de la actividad de la empresa, ha obligado de forma generalizada al uso de recursos informáticos que permitan su tratamiento y disponibilidad, creando una cultura de confianza y uso adecuado de la información. Lo que no es tan frecuente encontrar es empresas que hagan uso del conocimiento que se puede generar de esos datos a partir de uso de herramientas de minería de datos. Las reglas de asociación se basan en métodos y técnicas de la minería de datos que permiten estimar o predecir comportamientos sobre datos recolectados como resultado del quehacer operativo de la empresa, con las que se espera conocer, a partir de la aplicación de modelos formales, el comportamiento de compra de los clientes de un supermercado de mediana superficie y proponer, a partir de este conocimiento, estrategias y acciones a seguir para de un lado fortalecer los hallazgos favorables encontrados, y de otro, mejorar las posibles falencias identificadas.

Background Therapeutic response in infectious disease involves host as well as microbial determinants. Because the immune and inflammatory response to Leishmania (Viannia) species defines the outcome of infection and efficacy of treatment, immunomodulation is considered a promising therapeutic strategy. However, since Leishmania infection and antileishmanial drugs can themselves modulate drug transport, metabolism and/or immune responses, immunotherapeutic approaches require integrated assessment of host and parasite responses. Methodology To achieve an integrated assessment of current and innovative therapeutic strategies, we determined host and parasite responses to miltefosine and meglumine antimoniate alone and in combination with pentoxifylline or CpG 2006 in peripheral blood mononuclear cells (PBMCs) of cutaneous leishmaniasis patients. Parasite survival and secretion of TNF-α, IFN-γ, IL-10 and IL-13 were evaluated concomitantly in PBMCs infected with Luc-L. (V.) panamensis exposed to meglumine antimoniate (4, 8, 16, 32 and 64 μg SbV/mL) or miltefosine (2, 4, 8, 16 and 32 μM HePC). Concentrations of 4 μM of miltefosine and 8 μg SbV/mL were selected for evaluation in combination with immunomodulators based on the high but partial reduction of parasite burden by these antileishmanial concentrations without affecting cytokine secretion of infected PBMCs. Intracellular parasite survival was determined by luminometry and cytokine secretion measured by ELISA and multiplex assays. Principal Findings Anti- and pro-inflammatory cytokines characteristic of L. (V.) panamensis infection were evaluable concomitantly with viability of Leishmania within monocyte-derived macrophages present in PBMC cultures. Both antileishmanial drugs reduced the parasite load of macrophages; miltefosine also suppressed IL-10 and IL-13 secretion in a dose dependent manner. Pentoxifylline did not affect parasite survival or alter antileishmanial effects of miltefosine or meglumine antimoniate. However, pentoxifylline diminished secretion of TNF-α, IFN-γ and IL-13, cytokines associated with the outcome of infection by species of the Viannia subgenus. Exposure to CpG diminished the leishmanicidal effect of meglumine antimoniate, but not miltefosine, and significantly reduced secretion of IL -10, alone and in combination with either antileishmanial drug. IL-13 increased in response to CpG plus miltefosine. Conclusions and Significance Human PBMCs allow integrated ex vivo assessment of antileishmanial treatments, providing information on host and parasite determinants of therapeutic response that may be used to tailor therapeutic strategies to optimize clinical resolution., Author Summary Host determinants of the response to infection have increasingly been recognized as therapeutically relevant targets. Despite the pathogenesis of dermal leishmaniasis being mediated by the immune and inflammatory response, in vitro anti-leishmanial drug screening has been based on antimicrobial effect without consideration of effects on the host response. The results of this study show that peripheral blood mononuclear cells from patients allow an integrated evaluation of both antimicrobial efficacy and host response to drugs, immunomodulatory agents, and their combinations. This integrated approach to defining treatment strategies based on host and parasite responses opens the way for the optimization and tailoring of treatment to different clinical circumstances.

Background Pentavalent antimonials have been the first line treatment for dermal leishmaniasis in Colombia for over 30 years. Miltefosine is administered as second line treatment since 2005. The susceptibility of circulating populations of Leishmania to these drugs is unknown despite clinical evidence supporting the emergence of resistance. Methodology/Principal Findings In vitro susceptibility was determined for intracellular amastigotes of 245 clinical strains of the most prevalent Leishmania Viannia species in Colombia to miltefosine (HePC) and/or meglumine antimoniate (SbV); 163, (80%) were evaluated for both drugs. Additionally, susceptibility to SbV was examined in two cohorts of 85 L. V. panamensis strains isolated between 1980–1989 and 2000–2009 in the municipality of Tumaco. Susceptibility to each drug differed among strains of the same species and between species. Whereas 68% of L. V. braziliensis strains presented in vitro resistance to HePC, 69% were sensitive to SbV. Resistance to HePC and SbV occurred respectively, in 20% y 21% of L. panamensis strains. Only 3% of L. V. guyanensis were resistant to HePC, and none to SbV. Drug susceptibility differed between geographic regions and time periods. Subpopulations having disparate susceptibility to SbV were discerned among L. V. panamensis strains isolated during 1980–1990 in Tumaco where resistant strains belonged to zymodeme 2.3, and sensitive strains to zymodeme 2.2. Conclusions/Significance Large scale evaluation of clinical strains of Leishmania Viannia species demonstrated species, population, geographic, and epidemiologic differences in susceptibility to meglumine antimoniate and miltefosine, and provided baseline information for monitoring susceptibility to these drugs. Sensitive and resistant clinical strains within each species, and zymodeme as a proxy marker of antimony susceptibility for L. V. panamensis, will be useful in deciphering factors involved in susceptibility and the distribution of sensitive and resistant populations., Author Summary Treatment of dermal leishmaniasis is unsuccessful in an important proportion of cases and evidence of loss of susceptibility to antimonial drugs and miltefosine has been demonstrated in some cases of treatment failure with these medications. Despite the variability in the clinical outcome of treatment, little is known about the susceptibility of the different species and diverse populations of these species circulating in areas of high transmission. Based on 402 strains isolated from patients, the susceptibility of the Leishmania species most frequently causing dermal leishmaniasis in Colombia was determined to first and second line medications commonly used in Latin America. The results showed that susceptibility to each drug varied among the species and populations of each species, geographically between regions east and west of the Andes mountain range, during different time periods over 30 years, and within different epidemiological circumstances. The findings provide a comprehensive picture of drug susceptibility of dermal leishmaniasis in Colombia and baseline information for monitoring the emergence of drug resistance.

El presente artículo de revisión se constituye en un recorrido que identifica los momentos claves en el desarrollo de las diferentes concepciones de la educación y su influencia en épocas y contextos histórico-sociales, que respondieron a ciertas necesidades de formación académica. Para lograr lo anterior, se aplicó una metodología de revisión documental incluyendo fuentes primarias y secundarias, páginas web, revistas de circulación nacional, legislación y normatividad sobre educación y otros textos académicos, lo que permitió comprender los desarrollos que han tenido los tipos de educación que se alejan de la educación formal.