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BACKGROUND: High-density lipoproteins (HDLs) have antiatherogenic properties related to their chemical structure. Adipose tissue (AT) influences HDL reverse cholesterol transport and plasma HDL cholesterol levels. However, whether AT dysfunction affects HDL subpopulations and their glycation in early type 2 diabetes (T2D) is still unknown. OBJECTIVE: To investigate the association of inflammation and AT dysfunction serum markers with the size and glycation of HDLs in normoglycemic, prediabetes, and T2D subjects. METHODS: We assessed HDL particle size and advanced glycation end-product (AGE) content in HDLs isolated from normoglycemic (n = 17), prediabetes (n = 17), and recently T2D-diagnosed (n = 18) subjects. Insulin, adiponectin, and plasminogen activator inhibitor 1 (PAI-1) were determined using the Bio-Rad Multiplex Platform, and free fatty acids (FFAs) and high sensitivity C-reactive protein (hs-CRP) were determined by standard procedures. The AT insulin resistance (ATIR) index and ATIR/adiponectin and adiponectin/leptin ratios were calculated. RESULTS: HDL was progressively smaller (nm) and enriched with AGE (mg-BSA-AGE/mg protein) according to the glucose categories: 8.49 and 7.5 in normoglycemic subjects, 8.44 and 12.4 in prediabetic subjects, and 8.32 and 14.3 in T2D subjects (P = 0.033 and P = 0.009 for size and AGE, respectively). In multivariable regression analysis, the ATIR/adiponectin ratio was inversely associated with HDL size (ß = -0.257, P = 0.046), and the ATIR ratio was directly associated with HDL glycation (ß = 0.387, P = 0.036). In contrast, adiponectin and the adiponectin/leptin ratio were not associated with alterations in HDL particles. Furthermore, HDL size was associated with resistin (ß = -0.348, P = 0.007) and PAI-1 (ß = -0.324, P = 0.004). HDL and AGE were related to insulin concentrations (ß = 0.458, P = 0.015). Analyses were adjusted for age, sex, body mass index, triglycerides, and HDL-cholesterol. CONCLUSION: HDL size was significantly associated with the ATIR/adiponectin ratio and inflammation, whereas glycation was more strongly related to the ATIR index. These findings have important implications for the management and prevention of cardiovascular disease in T2D patients.

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Introducción:El síncope vasovagal es la principal causa de pérdida transitoria de la conciencia, y es un motivo de consulta cada vez más frecuente en pediatría y medicina del adulto. La midodrina es un agonista de los recepto-res alfa, de acción periférica, empleada principalmente en el manejo de la hipotensión ortostática; sin embargo, también se ha evaluado en el síncope vasovagal, con resultados prometedores.Objetivo:Analizar la evidencia más reciente sobre la utilidad de la midodrina para el control y la prevención del síncope vasovagal.Materiales y métodos: Se realizó una búsqueda bibliográfica utilizando términos de búsqueda como Vasovagal Syncope y Midodrine, así como sinónimos, que se combinaron con operadores booleanos, en cinco bases de datos, hasta octubre del 2022. Se incluyeron estudios originales, revisiones sistemáticas y metanálisis, publicados tanto en inglés como en español.Resultados:Ensayos controlados aleatorizados y revisiones sistemáticas y metanálisis difieren ligeramente entre resultados, pero estos demuestran un efecto global protector. La evidencia más reciente y completa indica que utilizar este agente reduce significativamente la positividad al realizar la prueba de la mesa inclinada y que previene la aparición de episodios sincopales.Conclusiones:Aunque la evidencia actual sobre la eficacia de la midodrina respecto a la prevención y control del síncope vasovagal es limitada, se observa un efecto protector significativo, porque disminuye el riesgo de sufrir un episodio sincopal, aproximadamente hasta en un 50 %.Palabras clave: midodrina; síncope vasovagal; síncope; adrenérgicos; medicina basada en la evidencia

Introduction: Vasovagal syncope is the main cause of transient loss of consciousness, being an in-creasingly frequent reason for consultation in pediatrics and adult medicine. Midodrine, a periphe-rally acting alpha-receptor agonist, is mainly used in the management of orthostatic hypotension. However, it has also been evaluated in vasovagal syncope, with promising results. Objective: To analyze the most recent evidence on the usefulness of midodrine for the control and prevention of vasovagal syncope. Materials and Methods: A literature search was performed using search terms such as "Vasovagal Syncope" and "Midodrine," as well as synonyms, which were combined with Boolean operators, in 5 databases until October 2022. Original studies, systematic reviews and meta-analyses, published in both English and Spanish, were included. Results: Randomized controlled trials and systematic reviews and meta-analyses differ slightly between results, but these demonstrate an overall protective effect. The most recent and complete evidence shows that using this agent significantly reduces the probability of positivity when performing the tilt table test and prevents the occurrence of syncopal episodes. Conclusions: Although current evidence on the efficacy of midodrine with respect to the prevention and control of vasovagal syncope is limited, a significant protective effect is observed, reducing the risk of suffering syncopal episode by approximately up to 50%

Introdução: a síncope vasovagal é a principal causa de perda transitória de consciência e é um motivo cada vez mais comum de consulta em pediatria e medicina de adultos. A midodrina é um agonista do receptor alfa de ação periférica usado principalmente no tratamento da hipotensão ortostática; no entanto, ela também foi avaliada na síncope vasovagal, com resultados promissores. Objetivo: Revisar as evidências mais recentes sobre a utilidade da midodrina para o controle e a pre-venção da síncope vasovagal. Materiais e métodos: Foi realizada uma pesquisa na literatura usando termos de pesquisa como Va-sovagal, Syncope e Medodrine, bem como sinônimos, que foram combinados com operadores boo-leanos, em cinco bancos de dados, até outubro de 2022. Foram incluídos estudos originais, revisões sistemáticas e metanálises, publicados em inglês e espanhol. Resultados: Os ensaios clínicos randomizados, as revisões sistemáticas e as metanálises diferem ligei-ramente entre os resultados, mas demonstram um efeito protetor geral. As evidências mais recentes e abrangentes indicam que o uso desse agente reduz significativamente a positividade no teste de inclinação da mesa e evita a ocorrência de episódios de síncope. Conclusões: Embora as evidências atuais sobre a eficácia da midodrina em relação à prevenção e ao controle da síncope vasovagal sejam limitadas, observa-se um efeito protetor significativo, pois ela diminui o risco de sofrer um episódio sincopal em aproximadamente 50%

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In the Caribbean region of Colombia, Lutzomyia evansi is recognized as the vector for Leishmania infantum and Leishmania braziliensis. Identifying breeding sites and surveying abundance of immature phlebotomine sand flies in urban foci of leishmaniasis are useful tool to design new vector control strategies. The objective of this study was to describe the natural breeding sites of Lu. evansi in peridomiciliary vegetation in a peri-urban area of the Colombian Caribbean region. Between 2013 and 2015, 466 microhabitats were sampled, collecting 621 kg of soil samples. The explored microhabitats were bases and tree holes, fallen trees, animal caves, leaf litter, domestic animal shelters, and the inside of dwellings. The immature phlebotomines were recovered by direct search under the stereoscope and incubation of soil samples. In total, 103 microhabitats, associated with 17 arboreal species, were identified as natural breeding sites. Of 422 immature sandflies detected, 98.6% were found in soils at the base of the trees. Eight species of the genus Lutzomyia were identified, of which Lu. evansi (52.6%) was the most abundant, followed by Lu. rangeliana, Lu. cayennensis cayennensis, Lu. atroclavata, Lu. micropyga, Lu. trinidadensis, Lu. dubitans and Lu. gomezi. The arboreal species Cordia alba was the most used by phlebotomines for the development of their immature stages. From 63 natural breeding sites identified 268 immatures were recovered including 176 Lu. evansi. The accumulated precipitation showed correlation (R2 = 0.643, p = 0.013) with the abundance of developmental stages, which increased in September and October. The natural breeding sites of Lu. evansi exhibited a local pattern of occurrence dependent on rainfall. The physicochemical analysis of the soil samples showed that the natural sites for C. alba were categorized as fertile loam soils. This is the first systematic study that estimates the temporal variation of immature sand flies in peridomiciliary vegetation in a peri-urban focus of leishmaniasis in Colombia.

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Resumen Objetivo: Estimar la mortalidad atribuible al consumo de cigarrillo en el Caribe colombiano durante los años 2009-2013. Metodología: Estudio descriptivo retrospectivo. El número de defunciones se obtuvo del Departamento Administrativo Nacional de Estadísticas. La proporción y las muertes atribuibles al tabaco fueron estimadas a partir de la fracción etiológica poblacional, utilizando un método dependiente de prevalencia de consumo. Se calcularon los años potenciales de vida perdidos (descuento 3 %). La información se analizó en los programas Excel® y Epidat 4.1. Resultados: Se atribuyeron 964 muertes (método i), 1375 muertes (método ii) y 94 muertes (método iii). Los cánceres de tráquea, pulmón y bronquios fueron los que más contribuyeron a dicha mortalidad. Un total de 17 715 años potenciales de vida se perdieron (7745 en hombres, 9970 en mujeres). Conclusión: El consumo de tabaco en el Caribe colombiano contribuye significativamente a la mortalidad por cáncer y al aumento de años potenciales de vida perdidos.

Abstract Objective: To estimate the mortality attributable to cigarette consumption in the Colombian Caribbean during the years 2009-2013. Methodology: retrospective descriptive ecological study. The number of deaths was obtained from the National Administrative Department of Statistics. The proportion and deaths attributable to smoking were estimated from the population etiological fraction, using a method dependent on prevalence of consumption. Potential years of life lost (3% discount) were calculated. The information was analyzed in Excel and Epitat 4.1 programs. Results: There were 964 deaths (method i), 1375 deaths (method ii) and 94 deaths (method iii). Cancer of the trachea, lungs and bronchi was the neoplasia that most contributed to this mortality. A total of 17715 potential years of life were lost (7745 in men, 9970 in women). Conclusion: Tobacco use contributes significantly to cancer mortality and increases in potential years of life lost.

Resumo Objetivo: Estimar a mortalidade atribuível ao tabagismo no Caribe colombiano durante 2009-2013. Metodologia: Estudo descritivo retrospectivo. O número de mortes foi obtida a partir do Departamento Administrativo Nacional de Estatísticas. A proporção e raé mortes atribuíveis foram estimados a partir da fracção etiológico população usando uma prevalência dependente método de utilização. Anos potenciais de vida perdidos (3% de desconto) foram calculados. A informação foi analisada em 4.1 programas Excel e Epidat. Resultados: 964 mortes (método i), de 1375 mortes (Método ii) e 94 mortes (Método iii) é atribuída. Câncer da neoplasia traquéia, pulmão e brônquios foi o principal contribuinte para essa mortalidade. Um total de 17715 anos potenciais de vida perdidos (7745 homens, 9970 mulheres). Conclusão: O consumo de tabaco contribui significativamente para a mortalidade por câncer e aumento de anos potenciais de vida perdidos.

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Resumen ANTECEDENTES: El embarazo ectópico abdominal es una alteración poco frecuente, pero con alta tasa de morbilidad y mortalidad materno-fetal-neonatal. Para establecer el diagnóstico se requiere un alto grado de sospecha y casi siempre se efectúa durante el procedimiento quirúrgico. Es el único tipo de embarazo ectópico que puede llegar a término. CASO CLÍNICO: Paciente de 35 años, con antecedente obstétrico de dos cesáreas, que acudió al servicio médico por dolor abdominal de larga evolución, con varios meses de amenorrea, sin control prenatal. El dolor fue inicialmente adjudicado a una hernia umbilical, pero ante su persistencia se reexaminó a la paciente y se encontró una masa abdominal, por lo que se sospechó embrazo ectópico. El ultrasonido abdominal y la resonancia magnética confirmaron el embarazo de término, que finalizó mediante laparotomía. Se decidió dejar la placenta in situ, debido al riesgo de hemorragia por su remoción. Tanto el neonato como la madre fueron dados de alta en buenas condiciones después de dos semanas de estancia hospitalaria, con posterior seguimiento. CONCLUSIONES: Aunque el embarazo ectópico abdominal es una alteración poco frecuente, es importante saber qué debe hacerse de acuerdo con las semanas de gestación, debido al incremento reciente en su incidencia y a la alta tasa de complicaciones, con la finalidad de preservar el bienestar materno-fetal y la fertilidad femenina.

Abstract BACKGROUND: Abdominal pregnancy is a rare clinical entity with a high risk for both the mother and the product. It's diagnosis requires a high level of suspicion, being usually made during the surgical management of the case. It is the only type of ectopic pregnancy that can reach term. CLINICAL CASE: A 35 year-old patient, with two previous cesarean deliveries, who presents with chronic abdominal pain, without prenatal consultations and with several months of amenorrhea. The pain is initially atributted to an umbilical hernia, but due to it's persistence she is re-examined, finding an abdominal mass and raising suspicion of a possible ectopic pregnancy. She's sent to a hospital in western Mexico, where she undergoes abdominal examination with ultrasound and magnetic resonance, which shows a full term abdominal pregnancy, for which a laparotomy is performed. The placenta is left in situ, due to the high risk of hemorrhage associated with it's removal. Both the newborn and the mother are released from the hospital in good conditions after two weeks of stay, with subsequent follow-up. CONCLUSIONS: Despite it being a rare condition, it's important to be acquainted with the proper management according to the gestational age of the pregnancy due to the recent rise in it's incidence, as well as it's particularly high rate of complicactions, in order to preserve the wellbeing of both patients when possible, as well as maternal fertility.

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Abstract Introduction: Evidence has demonstrated clinical or prescriptive inertia along with an increased prescription of insulin, causing a delay in the change of prescription. Objective: To determine the prescription pattern and clinical inertia of insulin use in the treatment of patients with type 2 diabetes mellitus (DM2) enrolled in a diabetes program at a primary health care institution of Cartagena, Colombia. Materials and methods: Pharmacoepidemiology study that addresses drug utilization based on data collected through a review of medical records of 331 patients with DM2, aged 18 and older, who had at least 6 months of control. Results: 64.4% of patients were treated with long-acting insulin analogues and 18.4% used insulin; 52.7% of the patients in which insuline use was required did not have a prescription of this drug. Conclusions: There is clinical inertia related to insulin prescription. Strategies should be implemented to overcome prescriptive inertia for people with DM2 in order to achieve therapeutic goals earlier and effectively prevent the development and progression of chronic complications.

Resumen Introducción. Paralelo al aumento de la prescripción de la insulina se ha demostrado la inercia clínica o prescriptiva, de tal manera que la demora en cambiar la prescripción es prolongada. Objetivo. Determinar el patrón de prescripción y la inercia clínica en la utilización de insulina al momento de estar indicada en el tratamiento de los pacientes con diabetes mellitus tipo 2 (DM2) que acuden a un programa de diabetes en una institución de baja complejidad de Cartagena, Colombia. Materiales y métodos. Estudio de farmacoepidemiología dirigido al campo de los estudios de utilización de medicamentos que se basó en datos recogidos mediante la revisión de historias clínicas de 331 pacientes con DM2, mayores de 18 años y que tuvieran mínimo 6 meses de control. Resultados. El 18.4% de los pacientes utilizaron insulina. 64.4% fueron tratados con análogos de insulinas de acción prolongada. 52.7% de los pacientes con indicación de insulina no tenían prescrito el fármaco. Conclusiones. Existe inercia clínica para la prescripción de insulina. Se deben implementar estrategias que superen la inercia prescriptiva para que las personas con DM2 alcancen tempranamente las metas terapéuticas y prevengan de manera efectiva el desarrollo y la progresión de complicaciones crónicas.

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Resumen Objetivo: Describir la experiencia pedagógica para promover la salud mental, utilizando tecnologías multimedia en estudiantes de la salud de una universidad pública de Cartagena. Metodología: Se describieron los contenidos del módulo de Salud Mental, del curso Salud y Vida, desarrollado por estudiantes del área de la salud de una universidad pública de Cartagena. Es un curso que utilizo la metodología de ciclos de conferencias semanales y se apoyó en la realización de talleres, paneles, discusiones de grupo y la incorporación de una plataforma virtual donde se pudieron reforzar los contenidos e intercambiar experiencias personales y grupales, durante el desarrollo del curso, a través de foros y wikis. Estas experiencias tenían el fin de promover conductas saludables en la salud mental. Resultados: Dentro de los testimonios y entrevistas de los estudiantes se identificó que reconocen la importancia del cuidado de la salud mental como parte integral del ser humano y como un aspecto que puede potenciar la salud o perjudicar el avance de un individuo. Conclusiones: El fomento de la promoción de conductas saludables en salud mental es un factor importante desde la formación de los profesionales de la salud, para sensibilizarlos sobre este aspecto integral de la salud y crear la cultura de cuidar y ser agentes cuidadores de la salud mental.

Abstract Objective: To describe the pedagogical experience of promoting mental health, using multimedia technologies with health students of a public university in Cartagena. Methodology: The contents of the mental health module of Health and Life course, developed by health students of a public university in Cartagena are described. It is a course that uses a cyclic methodology of weekly lectures and relies on workshops, panels, group discussions and incorporates a virtual platform where students can reinforce the content and exchange personal and group experiences during the course development, through forums and wikis. These experiences are analyzed at the end of the course, in order to promote healthy behaviors in mental health. Results: During the testimonies and interviews, students recognized the importance of mental health care as an essential part of the human being and as an aspect that can enhance health or harm the progress of a person. Conclusions: Promoting healthy behaviors in mental health is an important factor in the training of health professionals, to raise their awareness on this integral aspect of health and create a culture of caring and being a mental health caring agents.

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Objetivo: Estimar el exceso de costos directos de atención atribuible a la neumonía asociada a ventilador mecánico en una unidad de cuidados intensivos de adultos en la ciudad de Cartagena durante los años 2009 al 2014. Material y Método: Se plantea un estudio de evaluación económica parcial centrado en el análisis de costos directos de atención contrastando los escenarios de neumonía asociada a ventilador mecánico versus los escenarios sin neumonía asociada a ventilador mecánico. La población de estudio la constituye 23 pacientes con neumonía asociada a ventilador mecánico. Del mismo modo, se tomaron 46 controles. La información correspondiente a los costos directos se obtuvo a través del departamento de costos de la institución hospitalaria. Se estimó la razón de costos que permite establecer el exceso de costo atribuible a la enfermedad nosocomial. Resultados: La estancia promedio en los casos fue de 47 días mientras que en los controles fue de 9 días. El costo promedio de un caso de neumonía asociada a ventilador mecánico fue de US$ 44.354 mientras que el de un control fue de US$ 5.037. Discusión: El exceso de costo promedio total así como el incurrido en antibióticos y en estancia resultan ser mucho más altos que los encontrados en otros estudios realizados. Conclusiones: Un caso de neumonía asociada a ventilador mecánico cuesta 10 veces más con respecto a los medicamentos y 8 veces más con relación a exámenes de laboratorio se insumos. La estancia resulta ser 6,6 veces más costosa que cuando no se presenta esta patología. El costo que se asume en antibióticos es 7,8 veces más alto. Los casos de neumonía asociada a ventilador mecánico cuestan en promedio 8,8 veces más que los controles.

Aims: To estimate the excess direct care costs attributable to ventilator-associated pneumonia in an intensive care unit adult in the city of Cartagena during the years 2009 to 2014. Material and method: A study of partial economic evaluation focused on the analysis of direct care costs contrasting the scenarios of mechanical ventilator associated pneumonia versus scenarios without mechanical ventilator associated pneumonia. The study population is 23 patients with ventilator associated pneumonia. Similarly, 46 control were taken. The information for direct costs was obtained through the cost department of the hospital institution. The ratio of costs for establishing the excess cost attributable to ventilator associated pneumonia was estimated. Results: The average stay in cases was 47 days, while in controls was 9 days. The average cost of a case of ventilator associated pneumonia was US$ 44354 While the control was US$ 5037. Discussion: Excess average total cost incurred as well as antibiotics and stay out to be much higher than those found in other studies. Conclusions: A case of ventilator associated pneumonia costs 10 times more with regard to medicaments and 8 times more in relation to testing laboratories and supplies. The stay is 6.6 times more expensive than in controls without mechanical ventilation. The cost which is assumed in antibiotics is 7.8 times higher. Cases of ventilator associated pneumonia cost on average 8.8 times more that controls.

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Over the years, incisional hernia repair has evolved. Currently, primary closure of the defect before placing the mesh is a critical step in incisional hernia repair and minimally invasive surgery incorporation has an important role due to great advantages. Despite its benefits, laparoscopic closure with suture intracorporeal knotting is physically demanding and technically complex. Robotic technology provides an optimal three-dimensional view, maneuverability of the instruments but no study has assessed the impact of the DaVinci system in the ergonomics which is the objective in this study. Fourteen surgeons were able to achieve surgical repair of a defect in an incisional hernia inanimate model. The task was performed with conventional laparoscopy and robotic assistance. The mental effort was registered and physical disturbances were measured with the Local Experienced Discomfort scale. The subjects expressed discomfort mainly in the dominant side (p = 0.006). In the comparative analysis between the two approaches, upper limb less disturbance (p = 0.04) and lower mental effort (p = 0.001) were reported with robotic approach. Robotic assistance decreases mental and physical effort during the primary closure of a defect in an incisional hernia inanimate model.

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Objetivo: Describir el estrés académico de estudiantes de enfermería de la ciudad de Cartagena, Colombia. Métodos: Estudio descriptivo transversal que incluyó 587 estudiantes matriculados en los tres programas de enfermería de la ciudad, seleccionados mediante un muestreo probabilístico. Para la recolección de la información, se utilizó una encuesta sociodemográfica, y para medir el estrés académico, el inventario SISCO. El análisis se hizo mediante estadística descriptiva con el programa SPSSS versión 22. Fueron tenidos en cuenta todos los aspectos éticos nacionales e internacionales para investigación en salud. Resultados: Del total de participantes, el 89,6% (526) son mujeres, con una edad promedio de 20,2 años (DE = 2,52); el 43,4% (255) pertenecía al estrato 2. Con relación al estrés, el 90,8% (533) manifestó haber tenido momentos de preocupación o nerviosismo durante el transcurso del semestre, el 42% (224) reportó un nivel medio de estrés, cuya fuente principal fue la sobrecarga académica derivada de la demanda de tareas de las asignaturas teóricas] y prácticas con un 48,2% (257). La estrategia de afrontamiento más usada para canalizar el estrés fueron las actividades religiosas (41,7%). Conclusión: Los estudiantes de los programas de enfermería de Cartagena tienen niveles heterogéneos de estrés y se sienten nerviosos y preocupados por la carga académica de los semestres, lo que puede repercutir de forma negativa en su salud física y mental; pero puede ser atenuado con la promoción de prácticas que faciliten el intercambio social y la relajación.

Objective: To describe the academic stress of nursing students in the city of Cartagena. Methods: Cross-sectional study that included 587 students enrolled in the three nursing programs in the city, selected through a multistage probability sampling. For data collection it was used a demographic survey and SISCO inventory for measuring academic stress. Tic information was analyzed in SPSSS software version 22, using descriptive statistical data. At research was take into account national and international ethical health. Results: Of the total participants, 89.6% (526) are women, with an average age of 20.2 years (SD=2,52) and 43.4% (255) belonged to the stratum 2. With regard to stress, 90.8% (533) reported having had moments of anxiety or nervousness during the course of the semester, 42% (224) reported an average level of stress, the main source of this, academic overload derived from the demand for tasks theoretical subjects and practices 48.2% (257). The most frequently used coping strategy to channel stress were religious activities (41.7%). Conclusion: Students of nursing programs Cartagena have heterogeneous stress levels and feel nervous and concerned about the academic burden semesters, which can have a negative impact on their physical and mental health, but can be mitigated with promoting practices that facilitate social interaction and relaxation.

Objetivo: Descrever o estresse acadêmico dos estudantes de enfermagem na cidade de Cartagena, Colômbia. Métodos: Estudo transversal que incluiu 587 alunos matriculados nos três programas de enfermagem na cidade, selecionados através de uma amostragem probabilística em múltiplos estágios. Para coleta de dados foi utilizado um questionário demográfico e inventário SISCO para medir estresse acadêmico. A informação foi analisada no software SPSSS versão 22, utilizando dados estatísticos descritivos. Eles foram levados em conta todas as pesquisas nacionais e internacionais de saúde ético. Resultados: Do total de participantes, 89,6% (526) são mulheres, com uma idade média de 20,2 anos e 43,4% (255) pertencia ao estrato 2. No que diz respeito ao estresse, 90,8% (533) relataram ter tido momentos de ansiedade ou nervosismo durante o curso do semestre, 42% (224) relataram um nível médio de estresse, a principal fonte deste, sobrecarga acadêmica derivado da demanda por tarefas disciplinas teóricas e pratica 48,2% (257). A estratégia de enfrentamento mais frequentemente utilizado para canalizar o estresse foram atividades religiosas (41,7%). Conclusão: Estudantes de programas de enfermagem Cartagena têm níveis de estresse heterogêneos e sentir-se nervoso e preocupado com os semestres carga acadêmica, que podem ter um impacto negativo na sua saúde física e mental, mas pode ser atenuado com promoção de práticas que facilitam a interação social e relaxamento.

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