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STUDY OBJECTIVE: To determine whether a postoperative 5-day treatment schedule with vaginal metronidazole added to conventional antibiotic prophylaxis with 2 g cefazolin modifies the risk of pelvic cellulitis (PC) and pelvic abscess (PA) after total laparoscopic hysterectomy (TLH). DESIGN: A randomized, controlled, triple-blind, multicenter clinical trial. SETTING: Two centers dedicated to minimally invasive gynecologic surgery in Colombia. PATIENTS: A total of 574 patients were taken to TLH because of benign diseases. INTERVENTION: Patients taken to TLH were divided into 2 groups (treatment group, cefazolin 2 g intravenous single dose before surgery + metronidazole vaginal ovules for 5 days postoperatively, control group: cefazolin 2 g intravenous single dose + placebo vaginal ovules for 5 days postoperatively). MEASUREMENTS AND MAIN RESULTS: The absolute frequency (AF) of PC and PA and their relationship with the presence of bacterial vaginosis (BV) were measured. There was no difference in AF of PC (AF, 2/285 [0.7%] vs 5/284 [1.7%] in the treatment and placebo groups, respectively; risk ratio, 1.75; 95% confidence interval, 0.54-5.65; p = .261), nor for PA (AF, 0/285 [0%] vs 2/289 [0.7%]; p = .159, in the treatment and placebo groups, respectively). The incidence of BV was higher in the metronidazole group than the placebo group (42.5% vs 33.4%, p = .026). CONCLUSION: The use of vaginal metronidazole ovules during the first 5 days in postoperative TLH added to conventional cefazolin prophylaxis does not prevent the development of PC or PA, regardless of the patient's diagnosis of BV.
Assuntos
Laparoscopia , Parametrite , Vaginose Bacteriana , Humanos , Feminino , Metronidazol/uso terapêutico , Abscesso/etiologia , Abscesso/prevenção & controle , Cefazolina/uso terapêutico , Parametrite/tratamento farmacológico , Histerectomia/efeitos adversos , Vaginose Bacteriana/diagnóstico , Vaginose Bacteriana/tratamento farmacológico , Laparoscopia/efeitos adversos , Método Duplo-Cego , Antibacterianos/uso terapêuticoRESUMO
Introducción. La tiña de la cabeza es una micosis que se presenta en el tejido queratinizado, afecta al cuero cabelludo y puede causar alopecia, prurito y descamación. Este tipo de micosis es más frecuente en niños de edad escolar, por lo que puede desencadenar un problema de salud pública. En Colombia, los principales agentes etiológicos reportados son los dermatofitos zoofílicos. Objetivo. En el presente estudio se buscó caracterizar un brote de tinea capitis en 32 niños de un colegio de la zona rural del departamento del Cauca. Materiales y métodos. Se llevó a cabo una investigación epidemiológica de campo en la que se aplicó una encuesta estructurada para caracterizar aspectos sociodemográficos y factores predisponentes para su ocurrencia. Se recolectaron muestras de escamas de cuero cabelludo y cabellos afectados para estudios micológicos. Finalmente, por medio de la Secretaría Departamental del Cauca y del hospital local, se manejó el brote de tinea capitis y se hicieron recomendaciones a los niños, los padres de familia y la población en general para prevenir estas micosis. Este estudio contó con el consentimiento informado verbal por parte de los padres de familia y los niños. Resultados. El agente etiológico aislado en el 63 % de las muestras recolectadas fue Trichophyton tonsurans y el principal factor predisponente para esta micosis fue compartir máquinas rasuradoras (87,5 %). El agente etiológico de este brote de tinea capitis no inflamatoria fue un dermatofito antropofílico. Conclusión. Idealmente, se deben practicar los estudios micológicos con el fin de establecer el agente etiológico y, así, plantear las terapéuticas y recomendaciones según las guías de manejo. Además, se debe realizar un trabajo multidisciplinario para el control del brote y la educación de la población respecto a esta micosis.
Introduction. Tinea capitis is a mycosis of keratinized tissue, which affects the scalp and may cause alopecia, pruritus, and desquamation. This type of mycosis is more frequent in school-age children, and it may represent a public health problem; the main etiological agents reported for Colombia are zoophilic dermatophytes. Objective. To characterize an outbreak of Tinea capitis in 32 children from a rural school in the department of Cauca. Materials and methods. We conducted an epidemiological field study using a structured survey to characterize sociodemographic aspects and predisposing factors for this mycosis. We collected samples of affected scalp scales and hair for mycological studies. The children and the general population received recommendations, about these mycoses' prevention, from Cauca's health authorities and the local hospital. The parents verbally approved the informed consent. Results. The etiological agent isolated in 63% of the collected samples was Trichophyton tonsurans, an anthropophilic dermatophyte, and the main predisposing factor was sharing razors (87.5%). Conclusions. Ideally, mycological studies define the etiological agent to propose therapeutics and recommendations in agreement with management guidelines. Implementation of multidisciplinary measures to control the outbreak and educate the population is required.
Assuntos
Tinha do Couro Cabeludo , Micologia , Saúde PúblicaRESUMO
Chagas and leishmaniasis are two neglected diseases considered as public health problems worldwide, for which there is no effective, low-cost, and low-toxicity treatment for the host. Naphthoquinones are ligands with redox properties involved in oxidative biological processes with a wide variety of activities, including antiparasitic. In this work, in silico methods of quantitative structure-activity relationship (QSAR), molecular docking, and calculation of ADME (absorption, distribution, metabolism, and excretion) properties were used to evaluate naphthoquinone derivatives with unknown antiprotozoal activity. QSAR models were developed for predicting antiparasitic activity against Trypanosoma cruzi, Leishmania amazonensis, and Leishmania infatum, as well as the QSAR model for toxicity activity. Most of the evaluated ligands presented high antiparasitic activity. According to the docking results, the family of triazole derivatives presented the best affinity with the different macromolecular targets. The ADME results showed that most of the evaluated compounds present adequate conditions to be administered orally. Naphthoquinone derivatives show good biological activity results, depending on the substituents attached to the quinone ring, and perhaps the potential to be converted into drugs or starting molecules.
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Resumen En este estudio se buscó analizar los procesos de evaluación en el campo de la psicología forense en Colombia, teniendo como producto argumentativo un marco teórico acerca de la definición de la Psicología Forense (funciones y rol), sus problemas éticos, su aplicación en los diferentes campos del derecho, y sus contraflujos más recurrentes como el tipo de instrumentos y entrevistas que utiliza el psicólogo. De acuerdo con lo anterior y teniendo en cuenta los criterios de selección de los peritos para las pruebas, se diseñó una entrevista estructurada aplicada a una muestra de psicólogos del campo forense a nivel nacional realizando un análisis de corte cuantitativo sobre la experiencia del psicólogo forense, su participación en los diferentes clases de perito, las técnicas y criterios que usa como soporte en cualquier proceso, y por último, algunas conclusiones acerca del posicionamiento en que se encuentra el psicólogo forense en Colombia.
Abstract In this study, we sought to analyze the evaluation processes in the field of forensic psychology in Colombia, having as argumentative product a theoretical framework about the definition of forensic psychology (functions and role), its ethical problems, its application in different fields of law, and its most recurrent counter-flows as the type of instruments and interviews used by the psychologist. In accordance with the foregoing and taking into account the selection criteria of the experts for the tests, a structured interview was designed applied to a sample of forensic field psychologists at a national level performing a quantitative analysis on the experience of the forensic psychologist, their participation in the different types of expert works, the techniques and criteria used as support in any process, and finally, some conclusions about the position in which the forensic psychologist is in Colombia.