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BACKGROUND: Haemodialysis is the most frequently prescribed Renal Replacement Therapy modality worldwide. However, patients undergoing this therapy have an unpredictable evolution related to vascular access. OBJECTIVE: To determine the factors associated with the mortality and hospitalization rate in haemodialysis patients at a third-level care Centre in the Dominican Republic. METHODS: This was an observational and prospective study involving a cohort of 192 haemodialysis patients. The patient selection was non-probabilistic for convenience, and a direct source questionnaire was applied. RESULTS: Of the 192 patients in the cohort, 103 (53.6%) were hospitalized and evaluated. The most frequent cause of hospitalization was catheter-related bloodstream infections (53.4%). Almost one-third (28.2%) of the hospitalized patients died, mostly due to infections (12.6%). Of those who died 29 patients (90%) had a Central venous catheter (CVC) with a non-tunnelled catheter (NTCVC) (65.5%); having an NTC CVC makes a patient 85.5 times more likely to be hospitalized than patients with arteriovenous fistulas. CONCLUSION: Vascular access plays a predominant role in the hospitalization and mortality rates in haemodialysis. Patients with an arteriovenous fistula obtained significantly better outcomes than those with central venous catheters.

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BACKGROUND: Due to the health emergency of COVID-19, telemedicine has become more relevant. Remote monitoring conspicuous as a valuable tool for the clinical follow-up of kidney patients, in this case, who are treated with automated peritoneal dialysis. This study aims to describe the use of remote monitoring as a surveillance method in a cohort of patients on automated peritoneal dialysis prevent complications and COVID-19 contagion. METHODS: Study of a cohort of patients who initially participated in a randomized block clinical trial in which the use of Automated Peritoneal Dialysis with Remote Monitoring (APD-RM) was compared with conventional treatment. A descriptive analysis was performed of the rates of infection by COVID-19, the time of incidence until this, mortality, and rates of transfer to hemodialysis. In addition, survival was measured by survival curves. RESULTS: Of the 509 patients, 19 were positive for COVID-19 (incidence rate of 7.0 episodes/100 patient-year), and only six patients recovered from the infection; the death rate was 2.6 % compared to all-cause death of 9.8 %. The most affected group of patients were those over 50 years old, with 71.4 % mortality, in contrast to younger patients infected, with a mortality of 60 %. During the follow-up period, 21 patients were transferred to HD: six due to peritonitis, five due to UF failure, seven due to catheter dysfunction, one due to uremic syndrome, one due to COVID-19, and one by surgical intervention. CONCLUSION: APD-RM patients have a significant advantage over other dialysis therapies because the use of telemedicine not only provides continuity in the patient's clinical treatment but also favors the prevention of COVID-19 infection, the management and prevention of complications inherent to therapy and the preservation of the life of Peritoneal Dialysis patients.

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Intracranial germ cell tumors are uncommon brain tumors; germinoma is the most common tumor in children and young adults, and the most common regions affected are pineal gland and suprasellar region. Germinomas of the suprasellar region are accompanied by endocrine alterations, with adipsia being a rare presentation. Here, we present the case of a patient with an extensive intracranial germinoma whose initial presentation was adipsia, without any other endocrinological alteration, with development of severe hypernatremia and unusual manifestations derived from it, such as deep vein thrombosis, myopathy with rhabdomyolysis, and neurological axonal damage.

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AIM: The aim of the study was to understand the experiences of patients on automated peritoneal dialysis (APD) during the period of confinement due to the COVID-19 pandemic. DESIGN: Qualitative exploratory study, phenomenological through semi-structured telephone interview. METHOD: A priori sampling was carried out with patients on APD with remote monitoring and telephone follow-up, in 13 hospitals in Mexico. RESULTS: Twenty-nine informants, mean age 45.41 ± 16.93; 15 women and 14 men. The analysis revealed four categories of analysis: home isolation, clinical follow-up, socioeconomic challenges and infodemic. The experiences of these patients led them to somatize emotions, presenting symptoms such as anxiety, sadness, loneliness, sleep, eating and digestive disorders, situation that sets the tone for future research on telemedicine care models, coping styles, emotional support strategies and socioeconomic impact on patients with chronic home treatments during the pandemic.

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El propósito de este artículo es tratar sobre la discusión metódica como cualidad fundante para la construcción de espacios sociales para que la interculturalidad tenga despliegue. La propuesta metódica gira en torno a la necesidad de enfatizar dos dinamizadores para la interculturalidad, el acento sobre la dimensión política y la dinamización de los encuadres metodológicos -diatopía, interseccionalidad y ecológico-. Esta propuesta, con perspectiva pedagógica, que se dinamiza por medio de la ECMI -Educación para la Ciudadanía Mundial Intercultural que se funda en el entrecruce epistemológico entre la subjetividad y los movimientos sociales, requieren de nuevas opciones comprensivas. Se concluye sobre la apuesta que ofrece para la educación los encuadres metodológicos para la formación ciudadana, que ha de contar con la interculturalidad como giro para desplegar la relación local-global.

The purpose of this article is to deal with the methodical discussion as a fundamental quality for the construction of social spaces for interculturality to unfold. The methodical proposal revolves around the need to emphasize two dynamizers for interculturality, the accent on the political dimension and the dynamization of methodological frames -diatopy, intersectionality and ecology-. This proposal, with a pedagogical perspective, which is dynamized by means of the ECMI - Education for Intercultural World Citizenship, based on the epistemological interweaving between subjectivity and social movements, requires new comprehensive options. It is concluded on the bet that offers for education the methodological frameworks for citizenship training, which has to count on interculturality as a twist to deploy the local-global relationship.

O objetivo deste artigo é abordar a discussão metódica como qualidade fundamental para a construção de espaços sociais para o desenvolvimento da interculturalidade. A proposta metodológica gira em torno da necessidade de enfatizar dois dinamizadores da interculturalidade, a ênfase na dimensão política e a dinamização dos quadros metodológicos - diatopia, interseccionalidade e ecologia. Esta proposta, com uma perspetiva pedagógica, dinamizada através da ECMI - Educação para a Cidadania Intercultural Mundial, que se baseia no entrelaçamento epistemológico da subjetividade e dos movimentos sociais, exige novas opções compreensivas. Conclui-se com o desafio colocado à educação pelos quadros metodológicos da educação para a cidadania, que devem assumir a interculturalidade como uma reviravolta para a implantação da relação local-global.

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Coronavirus disease 2019 (COVID-19) has been declared a pandemic. Peritoneal dialysis (PD), being a home therapy, allows for physical distancing measures and movement restrictions. In order to prevent COVID-19 contagioun among the Dominican Republic National Health System PD program patients, a follow-up virtual protocol for this group was developed. The aim of this study is to outline the protocol established by the PD program's healthcare team using telemedicine in order to avoid COVID-19 transmission and to report initial results and outcomes of this initiative. This is an observational prospective longitudinal study with 946 patients being treated in seven centers distributed throughout the country between April 1 and June 30. The protocol was implemented focusing on the patient follow-up; risk mitigation data were registered and collected from electronic records. During the follow-up period, 95 catheters were implanted, 64 patients initiated PD, and the remaining were in training. A total of 9532 consultations were given by the different team specialists, with 8720 (91%) virtual and 812 (9%) face-to-face consultations. The transfer rate to hemodialysis was 0.29%, whereas the peritonitis rate was 0.11 episode per patient/year. Eighteen adults tested positive for COVID-19. The implementation of the protocol and telemedicine utilization have ensured follow-up and monitoring, preserved therapy, controlled complications, and PD lives protected.

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INTRODUCTION: For the majority of renal replacement therapy history, the main treatment option for patients with end-stage renal disease (ESRD) in Mexico has been peritoneal dialysis. However, the use of hemodialysis is overwhelmingly increasing, driving public health care institutions to subrogate this service. Even when the actual hiring model for subrogation is accurate, there is a lack of quality control points in the hemodialysis prescription, poor adherence to clinical practice guidelines, and a few or no record of outcomes in hemodialysis patients of these subrogated services. The objective of this work is to fill this information gap to allow for uniform and safe hemodialysis for patients of Mexico. MATERIAL AND METHODS: An observational and cross-sectional study was performed, including all patients receiving chronic hemodialysis treatment in subrogated units of Mexican Social Security Institute (IMSS) in the northern region of Mexico City. Clinical and biochemical data as well as hemodialysis dose by Kt/V and urea reduction rate were collected and evaluated. To determine distribution, mean or median and SD or interquartile range were used; for nominal variables, the difference in proportions was estimated using the χ2 test; proportions were analyzed for biochemical values using the statistical package SPSS version 25. RESULTS: In our study, >60% (485) of the patients were anemic with an average hemoglobin of 9.39 mg/dL (SD ± 1.83); serum calcium was found below 8.4 mg/dL in 51.3% (383) of patients, and only in 45.8% (342) was at an optimal level of this parameter. Only 33.5% of patients have arteriovenous fistula for dialysis access. The hemodialysis dose was optimal in >75% of patients. CONCLUSIONS: It is necessary to enhance and monitor treatment of comorbidities in patients with ESRD in subrogated hemodialysis units in México. We observed adequate prescription of hemodialysis in a majority of patients, achieving quality control points for removal of nitrogen products. Yet, there is a lack of quality control of comorbidities; therefore, we should aim to optimize treatment for mineral-bone disorder, anemia, and nutritional status.

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Intestinal pathogenic microorganisms are introduced into the water by means of faecal contamination, thus creating a threat to public health and to the environment. Detecting these contaminants has been difficult due to such an analysis being costly and time-intensive; as an alternative, microbiological indicators have been used for this purpose, although they cannot differentiate between human or animal sources of contamination because these indicators are part of the digestive tracts of both. To identify the sources of faecal pollution, the use of chemical, microbiological and molecular markers has been proposed. Currently available markers present some geographical specificity. The aim of this study was to select microbial and molecular markers that could be used to differentiate the sources of faecal pollution in the Bogotá River and to use them as tools for the evaluation and identification of the origin of discharges and for quality control of the water. In addition to existing microbial source markers, a phage host strain (PZ8) that differentiates porcine contamination was isolated from porcine intestinal content. The strain was identified biochemically and genotypically as Bacteroides. The use of this strain as a microbial source tracking indicator was evaluated in bovine and porcine slaughterhouse wastewaters, raw municipal wastewaters and the Bogotá River. The results obtained indicate that the selected microbial and molecular markers enable the determination of the source of faecal contamination in the Bogotá River by using different algorithms to develop prediction models.

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Etiology of acute undifferentiated febrile syndrome (AUFS) is often unknown, leading to inaccurate diagnosis and treatment. Villeta town has been identified as an endemic area for spotted fever group (SFG) rickettsioses but little is known about possible amplifier hosts and other Rickettsia species different from Rickettsia rickettsii. Besides, few studies have approached other AUFS etiologies in the region. We investigated the role of dengue, leptospirosis, rickettsioses, human anaplasmosis, and Q fever as possible causes of AUFS in patients from Villeta. Sera specimens and ticks from animals as well as ticks from vegetation were studied for the presence of different Rickettsia spp. Among 104 sera from patients with AUFS, 16.4%, 24.0%, and 2.9% patients seroconverted to dengue, Leptospira, and SFG Rickettsia, respectively, with a case of probable coinfection or cross-reaction with Anaplasma phagocytophilum. None of the samples were reactive for Coxiella burnetii. Sera samples from 74 horses, 118 dogs, and 62 bovines were collected and showed 33.8%, 14.4%, and 50.0% of seroprevalence for SFG Rickettsia, respectively. A total of 1,287 ixodid ticks were collected from animals/vegetation and processed in pools for polymerase chain reaction. Among them, 1.7% was positive for Rickettsia genes, and Rickettsia amblyommii, R. rickettsii, and Rickettsia spp. were found. These results confirm the circulation of dengue, different SFG Rickettsia species and the relevance of other etiologies like leptospirosis and human anaplasmosis. Further studies must identify different epidemiological variables to establish proper surveillance and control programs.

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Understanding the pedestrian choices is essential for the design of safe road systems. This study develops methods for self-reported assessment of pedestrian behavior. A self-report instrument was developed to investigate the Theory of Planned Behavior (TPB) constructs in relation to pedestrians' road crossing using a convenient sample. Internal consistency and factor analysis were conducted to test the reliability and construct validity of the instrument. Self-reported intention to execute risky behavior was compared with observed behaviors. The developed questionnaire showed high internal consistency for most of the TPB constructs (Chronbach's alpha>0.7). Factor analyses confirmed that questions grouped in constructs, as hypothesized. Pedestrians' intention to execute risky behavior was related to pedestrians' perceived physical capability and to the simultaneous crossing of other pedestrians. However, this intention correlated moderately with observed risky behavior (Rs = 0.35). The potential to understand the mechanisms of pedestrian choices using the developed instrument are considered exploratory, yet promising.

El poder entender las decisiones que toma un peatón es esencial para el diseño de sistemas viales seguros. Este estudio desarrolla métodos para la medición del comportamiento del peatón por medio de auto-reportes. Se desarrolló un instrumento de auto-reporte para investigar los constructos de la Teoría del Comportamiento Planeado (TPB, por sus siglas en inglés) en relación al cruce de las vías por parte de los peatones, usando una muestra conveniente. Se condujeron análisis de consistencia interna y de factores para probar la confiabilidad y validez de constructos del instrumento. La intención auto-reportada de ejecutar comportamientos riesgosos fue comparada con los comportamientos observados. El desarrollo del cuestionario mostró una alta consistencia interna para la mayoría de los constructos del TPB (alfa de Cronbach > 0.7). El análisis de factores confirmó que las preguntas se agrupaban en constructos, tal y como se hipotetizó; la intención de los peatones de ejecutar comportamientos riesgosos estuvo relacionada con la posibilidad física percibida por los peatones y con el cruce simultáneo de otros peatones. Sin embargo, esta intención se correlacionó solo moderadamente con el comportamiento riesgoso observado (Rs = 0.35). En conclusión, el potencial para entender los mecanismos de las elecciones de los peatones, usando el instrumento desarrollado, se considera aún exploratorio, pero sin embargo prometedor.

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