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Abstract Background Infection prevention and control (IPC) programs are essential to prevent and control the spread of multidrug-resistant organisms in healthcare facilities (HCFs). The current implementation of these programs in Latin America remains largely unknown. Methods We conducted a mixed-methods evaluation of IPC program implementation in HCFs from Guatemala, Panama, Ecuador, and Argentina, March-July 2022. We used the World Health Organization (WHO) IPC Assessment Framework (IPCAF) survey, a previously validated structured questionnaire with an associated scoring system that evaluates the eight core components of IPC (IPC program; IPC guidelines; IPC education and training; healthcare-associated infection [HAI] surveillance; multimodal strategies; monitoring and audit of IPC practices and feedback; workload, staffing, and bed occupancy; and the built environment and materials and equipment for IPC). Each section generates a score 0–100. According to the final score, the HCF IPC program implementation is categorized into four levels: inadequate (0–200), basic (201–400), intermediate (401–600), or advanced (601–800). Additionally, we conducted semi-structured interviews among IPC personnel and microbiologists using the Systems Engineering Initiative for Patient Safety model to evaluate barriers and facilitators for IPC program implementation. We performed directed content analysis of interview transcripts to identify themes that focused on barriers and facilitators of IPC program implementation which are summarized descriptively. Results Thirty-seven HCFs (15 for-profit and 22 non-profit) completed the IPCAF survey. The overall median score was 614 (IQR 569, 693) which corresponded to an “advanced” level of IPC implementation (32% [7/22] non-profit vs. 93% [14/15] for-profit HCFs in this category). The lowest scores were in workload, staffing and bed occupancy followed by IPC training and multimodal strategies. Forty individuals from 16 HCFs were interviewed. They perceived inadequate staffing and technical resources, limited leadership support, and cultural determinants as major barriers to effective IPC guideline implementation, while external accreditation and technical support from public health authorities were perceived as facilitators. Conclusions Efforts to strengthen IPC activities in Latin American HCFs should focus on improving support from hospital leadership and public health authorities to ensure better resource allocation, promoting safety culture, and improving training in quality improvement.

Abstract Background The burden of antimicrobial resistance (AMR) in Latin America is high. Little is known about healthcare workers’ (HCWs) knowledge, attitudes, and perceptions of antimicrobial stewardship (AS), AMR, and antibiotic use (AU) in the region. Methods HCWs from 42 hospitals from 5 Latin American countries were invited to take an electronic, voluntary, anonymous survey regarding knowledge, attitudes, and perceptions of AS, AMR, and AU between March–April 2023. Findings Overall, 996 HCWs completed the survey (52% physicians, 32% nurses, 11% pharmacists, 3% microbiologists, and 2% “other”). More than 90% of respondents indicated optimizing AU was a priority at their healthcare facility (HCF), 69% stated the importance of AS was communicated at their HCF, and 23% were unfamiliar with the term “antibiotic stewardship”. Most (> 95%) respondents acknowledged that appropriate AU can reduce AMR; however, few thought AU (

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Investigación que estudia los mecanismos de los mercados de las drogas, particularmente de la cocaína, en sus fases de distribución, cambio y consumo, en sociedades con alto nivel de bienestar, particularmente en España. Además de apoyarse en documentos oficiales y en las encuestas sobre consumo de drogas que el gobierno español aplica sobre los jóvenes entre 14 y 18 años, (ESTUDES) y entre las familias (EDADES) para adultos de entre 19 y 64 años, recurre a otras fuentes como el Observatorio europeo y el Observatorio español sobre drogas, el Departamento de Estado de los Estados Unidos, el Informe anual sobre drogas de la ONU y otros estudios de diversos autores y fuentes (FMI, BM, OEA, GAFI, etc.), en torno a la economía subterránea y sumergida en España y el Mundo.

“Desde que el Estado emergió como uno de los entes identitarios de la sociedad,los dueños del dinero y poseedores del capital han encontrado en la elusión de sus compromisos legales y financieros con la sociedad uno de los mecanismos de acumulación y reproducción de sus fondos económicos. Recientemente, se han identificado numerosas actividades económicas que lindan en la corrupción y que aunque constituyen un gran componente del Producto Económico de los países y del Producto Económico Mundial, no aparecen registrados en sus cuentas. Empero, los esfuerzos multilaterales orientados a limitar los campos de acción de dichas actividades se focalizan de manera específica en unas pocas, permitiendo, aún, escenarios en los que se enjuagan sumas considerables de dinero, en un entorno transnacional, libre de barreras y controles societales.” Es, por tanto, interés de este ejercicio académico, Identificar aquellos límites que impiden aproximar el conocimiento de las fuentes y volúmenes de las riquezas que movilizan estas economías, subterráneas y sumergidas. ABSTRACT: Since the State has emerged as one of the bodies identity of the society, the owners of the money and capital holders have found themselves in circumvention of its legal and financial commitments with the society and the state, one of the mechanisms of accumulation and reproduction its economic wealth. Recently, we have identified numerous economic activities bordering on corruption and that though they are a big component of the Product Economic countries and the Grow World Economic, not appearing in their accounts. But the multilateral efforts aimed at limiting the fields of action of such activities are focused in a specific way in a few, allowing even scenarios where rinse-off significant amounts of money in a transnational environment, free from barriers and societal controls. It is the interest of this academic exercise Identify those limits that prevent approximate knowledge of the sources and amounts of wealth that mobilize these economies, and submerged underground. Therefore, the interest of this academic exercise, identify those limits that prevent approximate knowledge of the sources and amounts of wealth that mobilize these economies, and submerged underground.

Se observara como, en cada una de las etapas y modos de producción característicos, las ciudades se convierten en espacios o escenarios fundamentales de los procesos productivos, correspondientes a saberes y conocimientos determinados, se revisa la discusión sobre las Ciudades en la Globalización y se analiza la relación entre desarrollo tecnológico de ciudades y países, en relación con el PIB, para concluir que, los cambios introducidos por las TICs, aun no revelan la importancia económica de países y ciudades. ABSTRACT Be observed as, in each of the stages and modes of production characteristic, cities become key venues or spaces of production processes, for certain knowledge and skills, revises the discussion of the Cities in Globalization and discusses the relationship between technological development of cities and countries, in relation to GDP, to conclude that the changes brought about by ICTs, not even reveal the economic importance of countries and cities.

En tanto que las fronteras territoriales interestatales son cada vez menos importantes en las dinámicas económicas, políticas y culturales, que estimula la mundialización del capital, con sus diversas formas de globalización, los países de América latina no logran avanzar en los procesos de integración económica a nivel intraregional ni mundial, debido a que el sistema de relaciones externas definidas por los estados de esos países, aún están supeditadas a la definición de sus linderos territoriales, desde México hasta la Patagonia, en un ambiente de tensión y enfrentamientos permanentes, que desestabiliza todos los procesos y proyectos de actuación comunitaria, frente a los grandes desafíos del desenvolvimiento económico y tecnológico mundial.

Esta versión que publica la Revista Apuntes del CENES, hace parte de un texto más extenso en el que se incluye además, el análisis de las reformas a la Educación Superior en América Latina y en los Estados Unidos de América. Este avance, por tanto, versa, primero, sobre el análisis de las principales características del Nuevo Orden Económico Mundial que moldean y condicionan el desenvolvimiento de la Universidad a nivel mundial, y en particular en cada una de las regiones política y económicamente reconocidas. En segundo lugar, se realiza un análisis de las principales tendencias y lineamientos que estructuran la reforma al Sistema de Educación Superior en Europa, del que se muestran sus peculiaridades,contradicciones y vacíos y se confronta con el experimento Tuning o proyecto de un número representativo de universidades europeas orientado a crear su propio y autónomo espacio de educación superior. En este aspecto se asume de manera ligera lo que hasta ahora ha avanzado la adecuación del sistema universitario español a los lineamientos del Espacio Europeo de Enseñanza Superior – EEES, adoptado en la Conferencia de Bolonia.

El artículo presenta una semblanza del entorno político reciente que compromete una dimensión de las estrategias de la lucha contra las drogas, un mapa del mercado de narcóticos, especialmente centrado en el de cocaina, los fundamentos de la estrategia de lucha contra el narcotráfico y los elementos de su crísis, la dimensión del Negocio de la cocaína, considerando una cuantificación de la magnitud del mismo y la concentración de las grandes rentas en los centros financieros de las países consumidores, una visión alternativa al control del mercado de sustancias psicoactivas, destacándose el programa, del fracaso e implicaciones de la opción militar al control de la economía de la cocaína, aspecto cuyo análisis se fundamenta en las cifras que arroja la permanencia de las áreas cultivadas,el precio minorista en las calles de ciudades estadounidenses, el aumento de los consumidores, y las implicaciones sociales y políticas que ha generado para los países andinos, entre otros aspectos.

Consiste el trabajo en realizar una evaluación preliminar sobre el plan "bases para un Estado comunitario" elaborado por el DNP para el gobierno del presidente Álvaro Uribe Vélez. La perspectiva de análisis enfatiza en dilucidar el sentido comunitario del Estado a partir de la estrategia transversal "la seguridad democrática" en su énfasis militar. Con estadísticas de entidades como el DANE, DNP o Banco de la República se aproxima la inconsistencia de la políticaeconómica y social al preferir el manejo especulativo de variables monetarias que favorece la concentración especulativa de la riqueza a través de los TES, mientras crece la deuda pública y se agrava la calidad de vida de los colombianos con índices preocupantes de pobreza y miseria.

Background: Ongoing efforts within the Alzheimer's disease (AD) field have focused on improving the intra- and inter-laboratory variability for cerebrospinal fluid (CSF) biomarkers. Fully automated assays offer the possibility to eliminate sample manipulation steps and are expected to contribute to this improvement. Recently, fully automated chemiluminescence enzyme immunoassays for the quantification of all four AD biomarkers in CSF became available. The aims of this study were to (i) evaluate the analytical performance of the Lumipulse G β-Amyloid 1-42 (restandardized to Certified Reference Materials), β-Amyloid 1-40, total Tau, and pTau 181 assays on the fully automated LUMIPULSE G600II; (ii) compare CSF biomarker results of the Lumipulse G assays with the established manual ELISA assays (INNOTEST®) from the same company (Fujirebio); and (iii) establish cut-off values and the clinical performance of the Lumipulse G assays for AD diagnosis., Methods: Intra- and inter-assay variation was assessed in CSF samples with low, medium, and high concentrations of each parameter. Method comparison and clinical evaluation were performed on 40 neurological controls (NC) and 80 patients with a diagnosis of probable AD supported by a follow-up ≥ 3 years and/or positive amyloid PET imaging. A small validation cohort of 10 NC and 20 AD patients was also included to validate the cut-off values obtained on the training cohort., Results: The maximal observed intra-assay and inter-assay coefficients of variation (CVs) were 3.25% and 5.50%, respectively. Method comparisons revealed correlation coefficients ranging from 0.89 (for Aβ40) to 0.98 (for t-Tau), with those for Aβ42 (0.93) and p-Tau (0.94) in-between. ROC curve analysis showed area under the curve values consistently above 0.85 for individual biomarkers other than Aβ40, and with the Aβ42/40, Aβ42/t-Tau, and Aβ42/p-Tau ratios outperforming Aβ42. Validation of the cut-off values in the independent cohort showed a sensitivity ranging from 75 to 95% and a specificity of 100%. The overall percentage of agreement between Lumipulse and INNOTEST was very high (> 87.5%)., Conclusions: The Lumipulse G assays show a very good analytical performance that makes them well-suited for CSF clinical routine measurements. The good clinical concordance between the Lumipulse G and INNOTEST assays facilitates the implementation of the new method in routine practice.

Objective: To determine the cutoffs that optimized the agreement between 18 F-Florbetapir positron emission tomography (PET) and Aβ1-42, Aβ1-40, tTau, pTau and their ratios measured in cerebrospinal fluid (CSF) on the LUMIPULSE G600II instrument, we quantified the levels of these four biomarkers in 94 CSF samples from participants of the Sant Pau Initiative on Neurodegeneration (SPIN cohort) using the Lumipulse G System with available 18 F-Florbetapir imaging., Methods: Participants had mild cognitive impairment (n = 35), AD dementia (n = 12), other dementias or neurodegenerative diseases (n = 41), or were cognitively normal controls (n = 6). Levels of Aβ1-42 were standardized to certified reference material. Amyloid scans were assessed visually and through automated quantification. We determined the cutoffs of CSF biomarkers that optimized their agreement with 18 F-Florbetapir PET and evaluated concordance between markers of the amyloid category., Results: Aβ1-42, tTau and pTau (but not Aβ1-40) and the ratios with Aβ1-42 had good diagnostic agreement with 18 F-Florbetapir PET. As a marker of amyloid pathology, the Aβ1-42/Aβ1-40 ratio had higher agreement and better correlation with amyloid PET than Aβ1-42 alone., Interpretation: CSF biomarkers measured with the Lumipulse G System show good agreement with amyloid imaging in a clinical setting with heterogeneous presentations of neurological disorders. Combination of Aβ1-42 with Aβ1-40 increases the agreement between markers of amyloid pathology., (© 2019 The Authors. Annals of Clinical and Translational Neurology published by Wiley Periodicals, Inc on behalf of American Neurological Association.)

At the end of the 18th Century, the history of immunology began in Mexico, with Francisco Xavier Balmis, who initiated the process of vaccination against smallpox. By doing this, he established the bases for research and clinical practice in this field of medicine. Among the pioneers of immunology in Mexico stand out Eduardo Licega, Maximiliano Ruiz Castañeda and Mario Salazar Mallén. This last one founded the first allergy laboratory located in the Hospital General de Mexico, becoming the first one of its nature in the entire nation as well as being recognized by Universidad Nacional Autónoma de México (UNAM) as the first course of allergy. The Unique Plan of Medical Specializations (PUEM it's the acronym in Spanish) is a curricular plan organized in a functional conceptual construction, destined to conduct medical educational actions and designed by Faculty of Medicine UNAM, health institutes and the Mexican counsels of specialists; having as the main purpose that medical residents acquire knowledge, ability, skills, and ethical values to practice medicine with quality and efficiency. The specialty of Allergy and Clinic Immunology is part of PUEM since 1994 for adult patients and since 1998 in pediatrics. At the present it's being held in 8 different institutions of health conformed by six courses for adult patients and two for pediatric ones. The UNAM evaluates the quality of the specialty courses through diverse processes, all coordinated by the Postgraduate Department from the Faculty of Medicine, through the coordination of academic subcommittees who's also helped by the members of the Academic Subcommittees of Allergy and Clinic Immunology with the objective of guaranteeing quality in the formation of human resources.

Central pontine myelinolysis (CPM) is an uncommon neurological syndrome that is usually related to the rapid restoration of a previous hyponatraemia. Although the most frequent location of CPM injury is the pons, it is now designated osmotic demyelination syndrome (ODS) because, as well as in the brainstem, these injuries can be observed in other parts of the central nervous system (CNS)-for example, the thalamus, subthalamic nucleus, external geniculate body, putamen, globus pallidum, internal capsule, white matter of cerebellum and the deep layers of the brain cortex. However, an exhaustive search of the literature (MEDLINE 1967-2007) has revealed no case report of peripheral nervous system (PNS) demyelination secondary to severe hyponatraemia.