Background and aim: Mental health services in Colombia have had a complex history shaped by 50 of years armed conflict, disproportionate clinical approach and social factors such as stigma. Nevertheless, recent global tendencies and interventions have suggested basing mental health services on communities and the recovery approach and considering the social determinants of mental health during planning. Colombia has involved these approaches in its legal and practical framework in recent years, but multiple internal and external factors have retarded an accurate implementation. This systematic review aims to contribute to mental health services understanding in Colombia, offering an implementation research approach. Methods: A comprehensive strategy search was developed to include peer-reviewed studies where mental health services were mentioned or described. The review was conducted in five databases (Medline (OVID), PubMed, Scopus, Scielo and BVS), three languages (English, Spanish & Portuguese) and was limited to the last ten years. Moreover, it followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and used the Consolidated Framework for Implementation Research (CFIR) to identify barriers and facilitators during the implementation of mental health services. Results: Twelve articles were selected. The principal reported barriers were lack of coordination, workloads, and funding. Implementation differences between public and private settings were significant and repeatedly reported. On the other hand, good planning strategies and the involvement of communities, stakeholders, users, and external champions facilitated implementation. Remarkable efforts to adopt community-based mental health services were described as well. Conclusions: Overall, this review offers significant insight into current mental health services, their implementation status, and principal barriers to effective implementation. It is suggested to continue applying community and recovery approaches in mental health services, but also to improve coordination between all actors (e.g., public and private organisations, non-governmental organisations (NGOs), and users and their families).

Abstract: Objective: To describe the prevalence pattern of anemia among Indigenous children in Latin America. Methods: PRISMA guidelines were followed. Records were identified from the databases PubMed, Google Scholar, and Lilacs by two independent researchers between May and June 2021. Studies were included if the following criteria were met: a) studied Indigenous people b) was about children (from 0 to 12 years old); c) reported a prevalence estimate of anemia; d) had been conducted in any of the countries of Latin America; e) was published either in English, Portuguese, or Spanish; f) is a peer-reviewed article; and g) was published at any date. Results: Out of 2,401 unique records retrieved, 42 articles met the inclusion criteria. A total of 39 different Indigenous communities were analyzed in the articles, and in 21 of them (54.0%) child anemia was a severe public health problem (prevalence ? 40%). Those communities were the Aymara (Bolivia); Aruak, Guaraní, Kamaiurá, Karapotó, Karibe, Kaxinanuá, Ma-cro-Jê, Suruí, Terena, Xavante (Brazil); Cabécar (Costa Rica), Achuar, Aguaruna, Awajún, Urarina, Yomybato (Peru); Piaroa and Yucpa (Venezuela); and Quechua (Peru and Bolivia). Children below two years had the highest prevalence of anemia (between 16.2% and 86.1%). Among Indigenous people, risk factors for anemia include nutrition, poor living conditions, access to health services, racism, and discrimination. Bolivia and Guatemala are scarcely studied, despite having the highest proportion of Indigenous communities in Latin America. Conclusions: Anemia constitutes a poorly documented public health problem among Indigenous children in 21 Indigenous communities in Bolivia, Brazil, Colombia, Costa Rica, Ecuador, Guatemala, Mexico, and Peru. In all Indigenous communities included in this study child anemia was an issue, especially in younger children. Resumen: Objetivo: Describir el patrón de prevalencia de anemia en niños indígenas de América Latina. Métodos: Se siguieron las directrices PRISMA. Los registros fueron identificados en las bases de datos PubMed, Google Scholar y Lilacs por dos investigadores independientes entre mayo y junio de 2021. Los estudios se incluyeron si cumplían los siguientes criterios: a) estudiaban a indígenas; b) eran sobre niños (de 0 a 12 años); c) reportaban una estimación de prevalencia de anemia; d) se habían realizado en cualquiera de los países de América Latina; e) se publicaron en inglés, portugués o español; f) eran artículos revisados por pares; y g) se publicaron en cualquier fecha. Resultados: De los 2.401 registros únicos recuperados, 42 artículos cumplían los criterios de inclusión. Un total de 39 comunidades indígenas diferentes fueron analizadas en los artículos, y en 21 de ellas (54,0%) la anemia infantil era un problema grave de salud pública (prevalencia ? 40%). Esas comunidades eran aymara (Bolivia); aruak, guaraní, kamaiurá, karapotó, karibe, kaxinanuá, macro- jê, suruí, terena, xavante (Brasil); cabécar (Costa Rica), achuar, aguaruna, awajún, urarina, yomybato (Perú); piaroa y yucpa (Venezuela); y quechua (Perú y Bolivia). Los niños menores de dos años presentaban la mayor prevalencia de anemia (entre el 16,2% y el 86,1%). Entre los indígenas, los factores de riesgo de la anemia son la nutrición, las malas condiciones de vida, el acceso a los servicios sanitarios, el racismo y la discriminación. Bolivia y Guatemala están escasamente estudiados, a pesar de tener la mayor proporción de comunidades indígenas de América Latina. Conclusiones: La anemia constituye un problema de salud pública poco documentado entre los niños indígenas de 21 comunidades indígenas de Bolivia, Brasil, Colombia, Costa Rica, Ecuador, Guatemala, México y Perú. En todas las comunidades indígenas incluidas en este estudio, la anemia infantil era un problema, especialmente en los niños más pequeños.

Abstract: Aim: To evaluate the reliability of the ExSel® self-questionnaire to detect an excess salt intake (≥12 g/24h) in patients consulting for hypertension and/or renal failure. Methods: Results of the ExSel® self-questionnaire were compared to 24 h sodium excretion using the Cohen’s kappa test and a Chi² test. Sensitivity, specificity, VPP and VPN were calculated. A ROC curve was realized to find an accurate cut-off.Results: Mean characteristics of the 101 patients with reliable results were: age of 67+12 years, Body Mass Index 28.4+5.6 kg/m², SBP/DBP 139+23/74+13 mmHg (98% were hypertensives. Mean salt intake was 7.5+3.1 g/24h and mean creatininuria was 13.9+20.1 mmol/24 h. An excess salt intake (≥12 g/24h) was observed in 8% of the patients. The Kappa test at 0.17 and the Chi² at 0.66 signify that the agreement was very low. Sensitivity was 37%, specificity 90%, PPV 20% and NPV 94%. The AUC under the ROC curve was too low (0.665) to determine a threshold adapted to the renal patients. Conclusions: The ExSel® auto-questionnaire is not adapted to outpatients, mainly hypertensives (98%) followed in a nephrology consultation to detect an excess salt consumption.

Abstract: This review aimed at evaluating the state of availability, accessibility and model of delivery of oral health services in prisons, globally. Five databases of peer-reviewed literature and potential sources of gray literature were systematically searched. Inclusion criteria encompassed oral health papers related to prisons globally, with exclusion of certain article types. Selection involved independent evaluations by two researchers, followed by quality assessment. Data on the availability of oral health interventions in prisons came from18 countries, while information on the model of delivery of the services is scarce. In addition, two sets of individual and organizational barriers toward oral health service uptake in prisons were revealed and discussed in the text. Lack of oral health services in prisons affects people living in prisons and jeopardizes their reintegration. Urgent and concrete international actions are required to ensure the availability, accessibility, and quality of oral health services among people living in prisons.

Resumen: Tras una cirugía de reemplazo articular, la presencia del material protésico, la intervención quirúrgica y los factores de riesgo del paciente predisponen la aparición de una infección protésica. En general las tasas de infección rondan el 1,5% en las prótesis de cadera y el 2,5% en las de rodilla. Los protocolos de tratamiento consisten en una combinación de medidas quirúrgicas junto con un tratamiento farmacológico sistémico de rifampicina y fluoroquinolonas en monoterapia o en combinación durante al menos 3-9 meses. El desarrollo de nanopartículas cargadas con antibióticos permite la administración selectiva en el lugar de la infección, reduciendo los efectos adversos sistémicos del antibiótico y logrando la liberación controlada del mismo. Por ello, el objetivo del presente trabajo fue el desarrollo de una formulación de nanopartículas poliméricas de ciprofloxacino por el método de doble emulsión (W/O/W) extracción-evaporación del solvente para su administración local en el tratamiento de infecciones protésicas. Para el desarrollo y optimización de las formulaciones se ha empleado el diseño experimental. Se ha realizado un diseño factorial completo (L12) de dos niveles para evaluar y determinar el grado de influencia de diversos parámetros del proceso de elaboración en las características de estos nanosistemas. Gracias a este diseño se determinó que la hidrofobicidad del polímero y la cantidad de ciprofloxacino fueron los únicos factores que mostraron una influencia estadísticamente significativa en el tamaño de partícula y carga de antibiótico de las nanopartículas, respectivamente. Por último, se ha estudiado el perfil de liberación del ciprofloxacino en las formulaciones seleccionadas. Con el fin de garantizar las condiciones sink, previamente se evaluó la solubilidad del fármaco en tampón fosfato a distintos valores de pH. Este estudio demostró que el ciprofloxacino presenta baja solubilidad a pH >6 y forma soluciones sobresaturadas metaestables a pH 6 y 5.5. La formulación elaborada con PLGA-502, 15mg de ciprofloxacino y NaCl en la fase externa acuosa, se seleccionó como la formulación más adecuada, mostrando un tamaño de partícula de 307 nm, un PDI de 0.28, una eficacia de encapsulación de 62.46% y una liberación controlada del ciprofloxacino durante al menos 7 días.

Abstract: At the present time, climate change and antimicrobial resistance are considered as the most critical threats, affecting human, animal, plant, and environmental health. Although these terms may initially appear different, they are interconnected and share similarities in their causes (human interventions and natural cycles), health, and societal consequences. Climate change is associated through direct and indirect pathways with an increase in infectious diseases. Nonetheless, the association between global warming and antimicrobial resistance requires a comprehensive summary of evidence exploring it. Methods: A literature review was conducted to identify and describe the association between climate change and the rapid emergence and spread of antimicrobial resistance. The search was conducted in the following databases: PubMed, Web of Science, Scopus, Embase, Epistemonikos, and Google Scholar. The search period was restricted to articles published from January 2010 to June 2021. Additionally, a snowballing approach was conducted to identify any additional papers. Data extraction included study location, weather factors, environmental elements, antibiotics, and bacteria analysed, as well as the results. Results: 29 articles were included (ten literature or systematic reviews, eight experimental, six ecological, four observational, and one quasi-experimental). In terms of location, all the studies were conducted in countries between 35° and 75° north latitude. The results suggested some evidence of the effects of climate change (alterations in temperature, precipitation, and humidity) on the emergence and rapid spread of antimicrobial resistance in different environments (water, soil, cryosphere, and air). Temperature was described as a main effect of climate change that had effects on antibiotic resistance (increasing bacteria growth, altering metabolism, inducing crossprotection, and facilitating horizontal gene transfer between bacteria). Additionally, results also described the association between altered rain patterns and humidity and antimicrobial resistance, through the runoff of antibiotic molecules or the transport of antibiotic resistance mechanisms to other areas. Conclusions: This literature review has underscored the association between climate change and antimicrobial resistance. According to the results shown in the selected studies, the alterations in weather factors resulting from climate change have varying effects on the emergence and spread of antibiotic resistance. However, further research is imperative to decipher the complex interactions between other environmental processes, pollutants, patterns of antibiotic consumption, wastewater, animal migration, and regions below the latitudes covered in this literature review.

Abstract: Background: Multidrug resistant TB cases have been on the rise, risking advances in TB prevalence and control. Early diagnosis and targeted initial treatment are paramount for effective management and control of spreading of MDR/XDR-TB cases Methods: 161 isolates from patients with L-J culture confirmed TB in Lima, Peru, were tested with MODS+ assay, the diagnostic test and Sensititre, the reference standard. Analysis of growth patterns of bacteria in both methods were used to determine susceptibility/resistance of each isolate to three first line and six second line anti-TB agents, using two different critical concentrations (CC) for each antibiotic. Results: Agreement between susceptibility profiles and operational characteristics of diagnostic test yielded high performance and strong agreement with rifampicin 1μg/ml (agreement percent 90%, Kappa value 0.80) and amikacin 1μg/ml (agreement percent 96%, Kappa value 0.81), moderate for isoniazid 0.4μg/ml (agreement percent 89.4%, Kappa value 0.78), moxifloxacin at both CC’s 0.5μg/ml and 0.25μg/ml (agreement percent 93 and kappa values 0.73 for both), levofloxacin 2μg/ml (agreement 93%, kappa 0.69) and amikacin 2μg/ml (agreement 96%, Kappa 0.81), minimal for levofloxacin at CC 1.5μg/ml (agreement 90%, kappa 0.57) kanamycin at both CC’s 10μg/ml and 5μg/ml (agreement 87%, kappa 0.52) and ethionamide 5μg/ml (agreement 89%, kappa 0.46), weak for PAS 10μg/ml (agreement percent 93.9, kappa value 0.29), and none for ethambutol (Kappa value 0.02 for CC 10μg/ml, 0.07 for CC 5μg/ml). Conclusions: MODS+ assay is a cost-effective option for the diagnosis of TB and MDR/XDRTB, specially, in low resource settings with high TB incidence. Further operational research using lower CC’s, results read on different days and placed in settings with high and low TB and MDR/XDRTB burden could offer better sensitivities and wider applicability of results.

Background: Data are rare about the incidence of severe Fontan-associated liver disease (FALD) and its association with mortality. We sought to: (1) estimate the probability of developing severe FALD in patients who undergo the Fontan procedure (Fontan patients), compared with severe liver complications in patients with a ventricular septal defect; (2) assess the severe FALD-mortality association; and (3) identify risk factors for developing severe FALD. Methods and Results: Using the Quebec Congenital Heart Disease database, a total of 512 Fontan patients and 10232 patients with a ventricular septal defect were identified. Kaplan-Meier curves demonstrated significantly higher cumulative risk of severe FALD in Fontan patients (11.95% and 52.24% at 10 and 35years, respectively), than the risk of severe liver complica- tions in patients with a ventricular septal defect (0.50% and 2.75%, respectively). At 5years, the cumulative risk of death was 12.60% in patients with severe FALD versus 3.70% in Fontan patients without FALD (log-rank P=0.0171). Cox proportional hazard models identified significant associations between the development of severe FALD and congestive heart failure and supraventricular tachycardia, with hazard ratios (HRs) of 2.36 (95% CI, 1.38–4.02) and 2.45 (95% CI, 1.37–4.39), respectively. More recent Fontan completion was related to reduced risks of severe FALD, with an HR of 0.95 (95% CI, 0.93–0.97) for each more recent year. Conclusions: This large-scale population-based study documents that severe FALD in Fontan patients was associated with a >3-fold increase in mortality. The risk of FALD is time-dependent and can reach >50% by 35years after the Fontan operation. Conditions promoting poor Fontan hemodynamics were associated with severe FALD development.

Insulin hormone is produced by pancreatic beta-cells and its biosynthesis, secretion, and intracellular degradation is tightly regulated. Newly formed SGs are preferentially released upon glucose stimulation while aged SGs are less competitive to be released and are more prompt to degradation mainly within lysosomes. The most assumed mechanism leading aged SGs to lysosome is autophagy, a degradation system for altered proteins and damaged organelles. The autophagic marker LC3 has facilitated the detection of autophagy through LC3-based biochemical and microscopic assays, as well as the possibility to experimentally manipulate the autophagy pathway. Here, we intended to establish a model for the further study of mechanism that target aged Ins-SNAPTMR-Star+ SGs to GFP-LC3+ autophagosomes in INS-1 cells by using three different approaches. Our results show that in INS-1 cells, modulation of autophagy with chemical agents can be detected by western blot. Likewise, TIRF Microscopy allowed for the detection of positive GFP-LC3+ aged Ins-SNAPTMR-Star+ objects in the cortical region of INS-1 cells. Additionally, we implemented SIM microscopy to gain more detail in the morphological aspect of autophagosomes vesicles. Despite some hints about the autophagosomal structures were uncovered through these approaches, further experiments should be performed to complement and confirm our findings. Thus, establishment of a suitable model for the study of autophagy, will allow us to further study the mechanisms behind the targeting process of aged SGs and to better understand how impairment of autophagy contributes to deterioration of pancreatic beta-cell function and subsequent onset of type 2 diabetes.

El síndrome de Treacher Collins o disostosis mandibulofacial, es un desorden congénito craneofacial poco frecuente y se caracteriza por tener malformaciones en cabeza y cuello. Presentan vía aérea difícil predicha, alta incidencia de síndrome de apnea obstructiva del sueño; así como; pueden debutar con edema faríngeo y laríngeo transoperatorio, ocasionando distrés respiratorio y muerte súbita. La planificación de la vía aérea en estos pacientes es muy importante para el abordaje de la vía aérea por el anestesiólogo. Objetivo general: Determinar la frecuencia y manejo de la vía aérea difícil en los pacientes con síndrome de Treacher Collins intervenidos en el Hospital Dr. Manuel Gea González entre 1998 al 2018. Material y métodos: Se llevó a cabo un estudio observacional descriptivo, transversal y retrolectivo. El tamaño de la muestra fue de 134 eventos anestésicos con una población de 25 pacientes con síndrome de Treacher Collins que fueron atendidos entre 1998 al 2018 en el Hospital General “Dr. Manuel Gea González”. Resultados: De un total de 41 pacientes con síndrome de Treacher Collins atendidos en el hospital, sólo 25 requirieron de alguna intervención con manejo anestésico. En esta población se contabilizó un total de 134 eventos anestésicos, principalmente cirugías reconstructivas craneofaciales. Dentro de las características de la población el 52% fueron hombres; la media del número de cirugías por paciente fue de 5.36. La media de edad en la que fueron intervenidos fue de 12.36 años. La frecuencia de vía aérea difícil fue de 93.3% (125/134). La laringoscopia directa fue la principal técnica definitiva de abordaje de la vía aérea 42.5%, seguido del fibroscopio 35.1%, mascarilla laríngea 4.5%, tubo laríngeo 0.7% y traqueostomía 0.7%. La escala de Cormack-Lehane se reportó en el 34.3% de los eventos anestésicos, predominando el grado 4 (19.4%). Se realizó intubación exitosa en el 87.3% de los casos y los principales eventos adversos fueron sangrado de la vía aérea, edema de glotis y laringoespasmo. Se cancelaron 5 cirugías relacionado al manejo de la vía aérea, ningún paciente falleció y el uso del fibroscopio se asoció a menores complicaciones. Conclusiones: En esta población de estudio donde se realizaron 134 eventos anestésicos, en 125 se presentó vía área difícil, lo que corresponde a un 93.3%, así mismo un 59.5% (80/134) fue intubación difícil. Sin embargo, en el 87.3%, se logró una intubación exitosa (117/134). En relación a eventos adversos el más frecuente fue el sangrado con un 20.1% (27/134). De los 47 pacientes intubados con fibroscopio en 25 se resolvió con el plan A y al primer intento. Con base a esta información, observamos que en estos pacientes hay una alta frecuencia de vía aérea difícil, por lo que se tiene que tener presente que la preparación anticipada es esencial para ser abordados, contemplando dispositivos avanzados de vía aérea y personal experto en el manejo de esta situación. A mayor número de laringoscopias y utilización de diferentes aditamentos, aumenta el riesgo de eventos adversos. El fibroscopio según nuestros hallazgos es una opción ideal como plan A en el aseguramiento de la vía aérea de estos pacientes. Nuestra serie de casos es la más grande actualmente en México y Latinoamérica y es un preámbulo para realización de guías de vía aérea difícil en los pacientes con Síndrome de Treacher Collins en el futuro.