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Hasta la fecha se han identificado más de 500 fitocannabinnoides derivados de la planta de Cannabis sativa, entre los cuales los más importantes son el ∆9-tetra-hidrocannabinol (THC) y el cannabidiol (CBD). Ambas moléculas interactúan con el sistema endocannabinoide y generan un efecto terapéutico en diferentes desórdenes neurológicos, dentro de los cuales se incluye la espasticidad. El mecanismo de acción postulado considera que el THC modula la hiperexcitabilidad de la neurona motora inferior, lo que provoca una disminución en el tono muscular, mientras que el CBD genera un efecto antiinflamatorio que contribuye a reducir el dolor. El uso terapéutico de estas moléculas en sujetos con espasticidad refractaria causada por diferentes etiologías ha permitido la mejoría de síntomas como los calambres, el dolor y el insomnio, lo que a su vez ha llevado a disminuir la dosis de fármacos antiespásticos y analgésicos. Esta revisión narrativa pretende ilustrar brevemente a la comunidad hispanohablante la fisiología del sistema endocannabinoide, la farmacología de los cannabinoides y su forma de uso, y sintetiza la información más relevante de los estudios que sugieren que estas moléculas son una potencial terapia en espasticidad refractaria.

Background: Irritability, as a trans dimensional symptom, is present in several mental disorders. This study investigated the psychometric properties of the Spanish version of the Brief Irritability Test (BITe). Subjects and Methods: The recruitment has been performed through an online survey launched through common social media (Facebook, Twitter) and messaging apps (WhatsApp, Telegram) from 1st to 31st May 2022. Subjects included were individuals ≥18 years old of age of both sexes. 1920 individuals were rated for the validation analysis. The BITe has been translated into Spanish and validated through confirmatory factor analysis. Participants have been also scored with the Aggression Questionnaire (AQ). Results: Kaiser-Meyer-Olkin (KMO) test was adequate (KMO=0.880) and sphericity tested significantly (p

Resumen Objetivo: Implementar una Guía de Práctica Clínica (GPC) para la detección temprana y diagnóstico del episodio depresivo y trastorno depresivo recurrente en adultos en los servicios de consulta prioritaria, consulta externa y hospitalización del Hospital Universitario Cari ESE Neurociencias de la ciudad de Barranquilla. Materiales y métodos: Se desarrolló el Plan de implementación de una GPC de manejo de episodio depresivo y trastorno depresivo recurrente, de acuerdo con la metodología del manual de implementación de guías de práctica clínica basadas en evidencia del Ministerio de Salud. El instrumento de recolección de datos utilizado fue el cuestionario. Se indagó acerca de la preparación académica, el tiempo laborado en el ESE Cari mental y la experiencia profesional específica; así como del manejo que tienen en su vida profesional y preferencias las GPC - depresión. Resultados: La GPC elegida por consenso fue la Guía de Práctica Clínica (GPC) para la detección temprana y diagnóstico del episodio depresivo y trastorno depresivo recurrente en adultos, atención integral de los adultos con diagnóstico de episodio depresivo o trastorno depresivo recurrente. Conclusiones: La demanda de servicios de salud siempre parece ser superior a la cantidad de recursos disponibles para satisfacerla. La anterior afirmación es válida en todas las sociedades, aun en los países clasificados como de altos ingresos. Es por ello que la adopción de GPC en el contexto clínico-administrativo de la ESE Cari mental -incluyendo los demás entes territoriales- es una decisión que redunda en la racionalización del recurso humano y administrativo, el cual siempre será escaso. Abstract Objective: Implement a Clinical Practice Guideline (CPG) for early detection and diagnosis of depressive episode and recurrent depressive disorder in adults, services for priority consultation, outpatient and inpatient University Hospital Cari ESE Neurosciences city Barranquilla. Materials and methods: Implementation Plan GPC management depressive episode and recurrent depressive disorder, according to the methodology manual implementation of clinical practice guidelines based on evidence from the Ministry of Health was developed. The data collection instrument used was the questionnaire. He asked about academic preparation, the time worked in the mental Cari and specific professional experience; as well as management they have in their professional life and preferences CPG - depression. Results: The GPC was chosen by consensus Clinical Practice Guideline (CPG) for early detection and diagnosis of depressive episode and recurrent depressive disorder in adults, comprehensive care of adults diagnosed with depressive episode or recurrent depressive disorder. Conclusions: The demand for health services always seems to be greater than the amount of resources available to meet. The above statement is valid in all societies, even in countries classified as high income. It is therefore that the adoption of GPC in the clinical context-Administrative of Cari Mental Hospital -including other local authorities- is a decision that results in the rationalization of human and administrative resource, which will always be scarce.

The safety and efficacy of a formulation high in cannabidiol (CBD) and low in ∆An open-label, prospective cohort, single-center in adult patients with DRFE, were receiving stable doses of antiepileptic drugs (AEDs). A cannabis based-magistral formulation (CBMF) (100 mg/ml CBD and THC1.9 mg/ml) was administrated 0.1 ml sublingually every 12 hours, up-titrated weekly. The primary outcome was to establish a reduction in seizures frequency50% at 12 weeks. Adverse-drug reactions monitoring was done. p-value0.05 was statistically significant.Between August 2020 and July 2022, 44 (38.6%) patients completed3 months of follow-up. The median daily dose of CBD was 200 mg, that of THC was 4 mg, and that of CBD per kilogram of weight was 3.7 mg. The median number of seizures per month before CBD treatment was 11, and after CBD treatment was 2.5 (p0.001). A reduction in seizures50% at 12 week was achieved in 79.5% of the patients. The median percentage change in seizure frequency per month was 84.1% at 12 weeks. Five patients reported any adverse-drug reactions.The CBMF is a highly effective and safety therapy to treat adult patients with DRFE. The reduction in seizures frequency is maintained over time.

Objetivo: Este trabajo tiene como objetivo proporcionar un procedimiento válido para caracterizar y clasificar perfiles de salud mental positiva de sujetos en confinamiento prolongado por COVID-19. Método: Metodológicamente se adoptaron los factores actitud prosocial, autocontrol, satisfacción personal, autonomía, resolución de problemas y autoactualización y relaciones interpersonales en 285 individuos en edades entre 18 y 75 años; se revisó la literatura relacionada con la salud mental positiva, la aplicación de las Redes Neuronales Artificiales y el Análisis de Clúster.

Although low back pain (LBP) is a high-impact health condition, its burden has not been examined from the syndemic perspective. To compare and assess clinical, socioeconomic, and geographic factors associated with LBP prevalence in low-income and upper-middle-income countries using syndemic and syndemogenesis frameworks based on network and cluster analyses. Analyses were performed by adopting network and cluster design, whereby interrelations among the individual and social variables and their combinations were established. The required data was sourced from the databases pertaining to the six Latin-American countries. Database searches yielded a sample of 55,724 individuals (mean age 43.38 years, SD = 17.93), 24.12% of whom were indigenous, and 60.61% were women. The diagnosed with LBP comprised 6.59% of the total population. Network analysis showed higher relationship individuals’ variables such as comorbidities, unhealthy habits, low educational level, living in rural areas, and indigenous status were found to be significantly associated with LBP. Cluster analysis showed significant association between LBP prevalence and social variables (e.g. Gender inequality Index, Human Development Index, Income Inequality). LBP is a highly prevalent condition in Latin-American populations with a high impact on the quality of life of young adults. It is particularly debilitating for women, indigenous individuals, and those with low educational level, and is further exacerbated by the presence of comorbidities, especially those in the mental health domain. Thus, the study findings demonstrate that syndemic and syndemogenesis have the potential to widen the health inequities stemming from LBP in vulnerable populations.

Protozoa, nematodes, and platyhelminths are of clinical interest due to their role on the modulation of the immune responses. To determine the frequency of infection by intestinal parasites as well as the status of single or mixed infection (coinfection) and its relation with inflammation and intestinal permeability markers in patients with rheumatoid arthritis (RA), a cross-sectional study was conducted in 18 women diagnosed with RA. A fecal sample of each participant was analyzed for parasitic identification. The DAS28-erythrocyte sedimentation rate score, as well as the serum levels of TNF-α, IL-10, IL-17A, and the intestinal fatty-acid binding protein 2 (IFABP2), was determined through the ELISA technique. The T CD4+ and CD8+ lymphocytes' proportions were determined by flow cytometry. In this study, 50% (n = 9) of the total sample tested were positive to the presence of intestinal protozoa (27% by single infection and 22.2% by coinfection). Blastocystis sp. and Endolimax nana were the most frequently identified protozoa. The serum levels of IFABP2 were increased in patients with infection by protozoa, mainly in those individuals with coinfection and a larger abundance of Blastocystis sp. We found that coinfection by protozoa was related to higher levels of TNF-α and higher frequency of T CD4+ lymphocytes, mainly in patients under antirheumatic treatment. Infection by intestinal protozoa is associated with increased intestinal permeability in patients with RA; thus, infection, coinfection, and abundance of intestinal protozoa should be clinically screened because they could be an associated factor to the clinical variability of the disease.

Systemic sclerosis (SSc) is characterized by chronic inflammation and fibrosis, two processes associated with transforming growth factor β (TGF-β) functions. In the present study, we investigated the expression of TGF-β isoforms in serum and the skin distribution of TGF-β and two receptors (TGF-βR1 and TGF-βR2) and their relationship with some clinical, inflammatory, autoimmune (autoantibodies), and vascular (platelets) biomarkers in SSc patients. A total of 56 SSc patients and 120 control subjects (CS) were included. The serum levels of TGF-β isoforms were quantified by immunoassay with magnetic microspheres, and the skin biopsies were processed by immunohistochemistry. The soluble levels of the three active TGF-β isoforms were lower in SSc patients than in CS (p 0.0001). However, sTGF-β1 and sTGF-β3 levels were positively correlated with C-reactive protein levels in SSc patients. Additionally, sTGF-β2 and sTGF-β3 levels were positively correlated with the number of platelets in SSc patients. In skin biopsies, TGF-β1, TGF-βR1, and TGF-βR2 expression levels were higher in SSc patients than CS. In conclusion, this is the first study showing a joint decrease of the 3 active TGF-β isoforms in SSc patients. However, TGF-β1, TGF-βR1, and TGF-βR2 are possibly increased in clinically involved skin. Therefore, it is likely that a distinct role is played by TGF-β at the local (skin lesions) and systemic levels in SSc patients.

Intestinal dysbiosis is related to the physiopathology and clinical manifestation of rheumatoid arthritis (RA) and the response to pharmacologic treatment. The objectives of this study were (1) to analyze the effect of conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs) on the abundance of gut microbiota’s bacteria; (2) to evaluate the relationship between the differences in microbial abundance with the serum levels of intestinal fatty-acid binding protein 2 (IFABP2), cytokines, and the response phenotype to csDMARDs therapy in RA. A cross-sectional study was conducted on 23 women diagnosed with RA. The abundance of bacteria in gut microbiota was determined with qPCR. The ELISA technique determined serum levels of IFABP2, TNF-α, IL-10, and IL-17A. We found that the accumulated dose of methotrexate or prednisone is negatively associated with the abundance of Lactobacillus but positively associated with the abundance of Bacteroides fragilis. The Lactobacillus/Porphyromonas gingivalis ratio was associated with the Disease Activity Score-28 for RA with Erythrocyte Sedimentation Rate (DAS28-ESR) (r = 0.778, p = 0.030) and with the levels of IL-17A (r = 0.785, p = 0.027) in the group treated with csDMARD. Moreover, a relation between the serum levels of IFABP2 and TNF-α (r = 0.593, p = 0.035) was observed in the group treated with csDMARD. The serum levels of IFABP2 were higher in patients with secondary non-response to csDMARDs therapy. In conclusion, our results suggest that the ratios of gut microbiota’s bacteria and intestinal permeability seems to establish the preamble for therapeutic secondary non-response in RA.

RESUMO O objetivo do artigo foi analisar a implantação do Programa Seguro-Emprego (PSE) em relação à saúde dos trabalhadores nas montadoras de autoveículos do ABC. A metodologia incluiu pesquisa documental em acordos coletivos de trabalho, legislação, documentos de entidades sindicais e empresariais. Em 2015, o PSE foi lançado pelo governo como resposta à crise econômica, permitindo redução de até 30% da jornada de trabalho e de salário. Apesar dos questionamentos de grupos sindicais e da resistência operária nas montadoras, a maioria do sindicalismo apoiou a implantação do Programa. Os resultados da pesquisa apontaram o PSE como parte de um novo ciclo de expansão e transformações produtivas na indústria automobilística, ampliando e aprofundando a intensificação do trabalho como forma de geração do desgaste operário. O PSE participa da estratégia empresarial para manter o emprego mais produtivo, selecionando os operários que se manterão no emprego e excluindo trabalhadores considerados de ‘baixo desempenho’ e os ‘compatíveis’ (com redução da capacidade laboral). A inclusão do Programa na reforma trabalhista torna-o alternativa permanente para utilização pelas empresas. Portanto, trata-se de tema relevante para as pesquisas e ações em saúde coletiva e saúde do trabalhador. ABSTRACT The aim of this article was to analyze the implementation of the Employment-Insurance Program (PSE) in relation to the workers’ health in the ABC automotive industry. The methodology included documentary research in collective labor agreements, legislation, union and corporate documents. In 2015, the PSE was launched by the government as a response to the economic crisis, allowing up to 30% reduction in working hours and wages. Despite questions from trade union groups and workers’ resistance at the automakers, most unionism supported the implementation of the Program. The survey results pointed to the PSE as part of a new cycle of expansion and productive transformations in the automobile industry, expanding and deepening the intensification of work as a way of generating worker wear. PSE participates in the business strategy to maintain more productive employment by selecting workers who will remain in employment and excluding ‘low performers’ and ‘compatible’ workers (with reduced work capacity). The inclusion of the Program in labor reform makes it a permanent alternative for use by companies. Therefore, it is a relevant theme for research and actions in collective health and worker’s health.

To review the importance of physical examination in the diagnostic process of musculoskeletal conditions vis-a-vis the development of sensitive and powerful technologies such as MRI and high-resolution ultrasound. Because the physical examination of the musculoskeletal system is an exercise of applied clinical anatomy, the authors tested, in one-to-one practical examinations, the basal knowledge of musculoskeletal anatomy of rheumatology trainees, rheumatologists, and other professionals of musculoskeletal medicine. The results of the authors' surveys were disappointing, with a correct response rate of 50 to 60% depending on the locales. To correct this deficit, the authors gave many active-learning, case-centered seminars throughout the Americas and some overseas that may have fostered an interest in the study of clinical anatomy. There was an increased interaction between anatomy departments and clinicians, and that daily use of clinical anatomy would make anatomy relevant, improve clinical skills, and probably reduce the overall costs of the health care system.Key Points• Knowledge of musculoskeletal anatomy is the basic diagnostic tool in the regional pain syndromes• Knowledge of musculoskeletal anatomy helps understand the musculoskeletal involvement in the regional and systemic rheumatic disorders• An active-learning methodology was used since 2006 to review the anatomy that is relevant for rheumatology trainees and practitioners of musculoskeletal medicine• A skilled, anatomy-based physical examination and a well-thought diagnostic hypothesis could reduce the use of expensive technologies that, being too sensitive, may lead the unaware clinician astray.

Systemic sclerosis (SSc) is a rare autoimmune disease with high mortality, characterized by chronic inflammation and fibrosis, which are processes associated with higher serum tumor necrosis factor-α (sTNF-α) levels. TNFA -308G>A and -238G>A polymorphisms have been associated with higher sTNF-α levels. In this study, we genotyped the TNFA -308G>A and -238G>A polymorphisms in 53 SSc patients and 115 unrelated control subjects (CS) from southern Mexico. The TNFA mRNA expression and sTNF-α levels were also quantified by qPCR and enzyme-linked immunosorbent assays, respectively. TNFA -308GA genotype was associated with disease susceptibility according to a codominant genetic model (OR = 3.2, 95% CI 1.05–9.75, p = 0.03), and with higher anti-fibrillarin antibodies (p = 0.01), and higher skin thickening (p = 0.006). TNFA -238GA was not associated with SSc risk. TNFA mRNA expression and sTNF-α levels were similar between SSc patients and CS and were not statistically associated with the TNFA polymorphisms; however, a correlation (rho = 0.362, p = 0.009) between sTNF-α levels with anti-RNA polymerase III antibodies was observed in the SSc patients. In conclusion, the -308G>A polymorphism is a genetic marker of SSc susceptibility in population from southern Mexico, and it is associated with skin thickening and anti-fibrillarin antibodies. In addition, sTNF-α levels correlate positively with the anti-RNA pol III antibodies levels.

Moyamoya disease is a cerebral arteriopathy with an incidence of 0.086 per 100,000 inhabitants, being more common in women and Asian population. It has a broad spectrum of clinical manifestations including movement disorders, which can occur more frequently at clinical debut. The following is an unusual case of late-onset chorea after cerebral revascularization, in medical literature only 3 cases like this have been described to our knowledge. A 4-year-old girl was admitted in 2015 for focal seizures, with an unremarkable physical examination. She had no relevant data in her past pre-/perinatal history and the neurological development was normal. Brain magnetic resonance imaging (MRI) was negative to lesions. The patient was treated with carbamazepine and levetiracetam, with satisfactory seizure control. Three years later, she had acute alternating hemiparesis, and cerebral arteriography showed decreased caliber of the left middle cerebral artery and multiple small vessels of perimesencephalic and basal ganglia location. Moyamoya disease was diagnosed at that moment. Thereafter, an encephaloduroarteriosynangiosis (EDAS) was carried out obtaining a full recovery of the motor symptoms.

Older patients experience a decline in their physiologic reserves as well as chronic low-grade inflammation named "inflammaging." Both of these contribute significantly to aging-related factors that alter the acute, subacute, and chronic response of these patients to critical illness, such as sepsis. Unfortunately, this altered response to stressors can lead to chronic critical illness followed by dismal outcomes and death. The primary goal of this review is to briefly highlight age-specific changes in physiologic systems majorly affected in critical illness, especially because it pertains to sepsis and trauma, which can lead to chronic critical illness and describe implications in clinical management.

Introducción y objetivo: En la actualidad, la rehabilitación de dientes tratados endodónticamente representa una gran demanda para el ejercicio profesional del rehabilitador oral. Por esta razón, surge la necesidad de identificar y manejar los procesos básicos y los determinantes biológicos que influencian un buen proceso de adhesión dentinal. El objetivo de este estudio fue caracterizar la capa híbrida en dentina intraradicular pretratada con hipoclorito de sodio (NaClO) al 5,25% usando dos agentes cementantes con sistemas adhesivos de auto y grabado convencional. Materiales y métodos: Se seleccionaron 40 dientes premolares unirradiculares que fueron distribuidos aleatoriamente en 4 grupos. Grupo A (dentina pretratada con NaClO al 5,25% y cementado con cemento Relyx® Ultimate (3M), grupo B(control del grupo A, sin pretratamiento de dentina); grupo C (dentina pretratadacon NaClO al 5,25% y cementado con cemento para Core®) y grupo D: Control del grupo C, sin pretratamiento de dentina. Los dientes fueron seccionados transversalmente y se analizó la presencia de capa híbrida enlos tercios cervical y medio radicular a través de microscopia electrónica de barrido. Resultados: Se encontraron diferencias estadísticamente significativas en el grosor de la capa híbrida de dientes pretratados con NaClOal 5,25% y cementados con paraCore® en comparación a los cementados con Relyx® ultimate valor p = 0,023 para la prueba de Anova.

Este articulo presenta la metodologia e implementacion del modelo Six Sigma en los diferentes tipos de organizaciones. Six Sigma es una herramienta con la finalidad de medir y mejorar la calidad. Se define como una metodologia basada en datos para conseguir la calidad mas cercana a la perfeccion. Esto se consigue examinando los procesos productivos de manera exhaustiva. Seis Sigma es diseno, comunicacion, formacion, produccion, administracion, etc. Para la implantacion de esta metodologia se requieren principalmente dos cosas: tiempo y compromiso. Tambien requiere de una inversion economica que en poco tiempo se convertira en un ahorro en costes para la empresa y en una mejora para los procesos internos de la organizacion.

Rheumatoid arthritis (RA) is a common autoimmune disease with a complex genetic background. The peptidyl arginine deiminase type IV (PADI4) gene has been associated with RA susceptibility in several populations. We addressed the relationship between three exonic PADI4 gene single nucleotide polymorphisms (SNPs) PADI4_89 (rs11203366), PADI4_90 (rs11203367) and PADI4_92 (rs874881) and related haplotypes with RA in a population from Southern México. This study included 200 RA patients and 200 control subjects. The SNPs were evaluated using the polymerase chain reaction-restriction fragment-length polymorphism (PCR-RFLP) technique, and antibodies to cyclic citrullinated peptides (anti-CCP) were measured by enzyme-linked immunosorbent assay (ELISA). In this population, the minor alleles of PADI4_89∗G, PADI4_90∗T and PADI4_92∗G gene polymorphisms were associated with RA susceptibility (OR=1.34, p=0.04; OR=1.35, p=0.03; OR=1.34, p=0.04; respectively). The GTG haplotype was also significantly associated with RA (OR=2.27 95%CI=1.18-4.41; p=0.008), but did not show association with levels of anti-CCP antibodies and clinical parameters. In conclusion, our replication study in a Southern Mexican population suggests that PADI4 individual polymorphisms and the related susceptibility haplotype (GTG) are also genetic risk markers for RA.

Paraoxonase 1 (PON1) promotes antioxidant and antiatherogenic activity related to the hydrolysis of oxidized lipids of low-density lipoproteins. In rheumatoid arthritis (RA) patients, it has been reported that low PON1 activity is related to an impaired lipid profile, increasing cardiovascular risk (CVR). The goal of this study was to analyze the effect of common PON1 polymorphisms and haplotypes on enzymatic activity, PON1 serum levels (PON1s), and lipid parameters related to atherogenic profile in RA patients.A cross-sectional study was carried out on 250 Mexican patients with RA. The lipid profile was determined by colorimetric tests. The PON1 activity (CMPAase) was measured by spectrophotometry. The levels of PON1s were determined by ELISA, and the polymorphisms in the PON-1 gene (-108CT, L55M, and Q192R) were genotyped by the PCR-RFLP method. The haplotypes were estimated and statistical analysis was performed.The median of the CMPAase activity and PON1 levels was 13.91 U/mL and 24.75 ng/mL, respectively. The CMPAase activity was significantly lower in carriers of -108TT and 192QQ genotypes (β = - 4.09, P = 0.001 and β = - 3.73, P = 0.002, respectively); moreover, the PON1 levels were lower in 192Q allele carriers (P 0.01). The TLQ haplotype was associated with CMPAase activity 13.91 U/mL (OR = 2.29, P 0.001), as well as with levels of PON1s 24.75 ng/mL (OR = 1.65, P = 0.017). In this study, the CMPAase activity ( 13.91 U/mL) showed a positive association with lower levels of high-density lipoprotein cholesterol (HDL-c; 40/50 mg/dL), and with a triglycerides/HDL-c ratio 3%, and a total cholesterol/HDL-c ratio 4.5/5%, all representatives of an atherogenic risk lipid profile.PON1 polymorphisms modulate the CMPAase activity and PON1 levels in Mexican patients with RA. The CMPAase activity 13.91 U/mL is associated with an atherogenic lipid profile, independently of inflammation markers and treatment with anti-rheumatic drugs. Key Points •The haplotype TLQ is a marker for low PONase activity in rheumatoid arthritis. •The haplotype TLQ is a marker for low PON1 serum levels in rheumatoid arthritis. •The enzymatic PON1 activity represents the best marker for an atherogenic lipid profile in rheumatoid arthritis, in comparison with PON1 levels. •The haplotype TLQ is a marker of low PON1 activity, levels of PON1s, and atherogenic lipid profile, independent of treatment therapy in rheumatoid arthritis.

Extracorporeal membrane oxygenation (ECMO) is a vital rescue technique in patients with cardio-respiratory failure, which as an invasive procedure is not exempt from complications such as embolism, ischemia, coagulopathy, bleeding, hemolysis and infections, some of which can affect the central nervous system up to 50% of cases [1,2].

Las vías clínicas son instrumentos desarrollados para planificar y coordinar la secuencia de procedimientos clínicos y administrativos necesarios para conseguir la máxima calidad asistencial. Su rápida difusión en EE. UU. explica que más del 60% de los hospitales usen vías clínicas para sus procesos más frecuentes. Esto contrasta con su escasa implementación en Colombia y los países de la Región de las Américas. Las Vías Clínicas se ajustan con el cambio que representa el enfoque en procesos, orientado a optimizar una mejor atención al paciente.

Background Awareness in the community is an important factor across a wide range of diseases and the communication media have an important role in its promotion. However, misinformation and misguide may take place heightening the expectations of people affected by chronic conditions such as multiple sclerosis (MS). This study explores media coverage of MS in a low prevalence country. Methods We identified the most important written media at national and local levels and performed a search in their digital archives and social media with the words "Multiple Sclerosis". The articles found were categorized as relevant, and non-relevant. We describe the total number, number of relevant and non-relevant articles published every year, since the earliest found until 2018. We identified the topics covered by the relevant articles and described their distribution and performed a quality evaluation of their content. Results We reviewed the archives of 20 sources. A total of 976 articles where MS was mentioned were reviewed (relevant: 143 [14.6%]; non-relevant: 833 [85.4%]). We observed a steady increase in the annual publication rate, from the first in 1991 up to 107 in 2018. The most frequent covered topic was disease modifying therapies and MS itself, and the least documented topic was rehabilitation. Most of the relevant articles had low quality scores. Conclusion The media coverage of different topics MS has risen steadily since its first appearance in the early nineties. This should be encouraged, but caution should be held so misinformation is not propagated. We call for the public to discuss misleading information with their healthcare providers.

Prolactin (PRL) is a sex hormone with immunomodulatory properties, and it is associated with the clinical activity of rheumatoid arthritis (RA). The -1149G>T polymorphism at the prolactin (PRL) gene has been associated with autoimmune diseases, but its functional effect is unclear. To analyze the association of the PRL -1149G>T polymorphism with disease susceptibility, mRNA, and protein expression of PRL in RA patients from Southern Mexico. We included 300 RA patients and 300 control subjects (CS). Genotypes were identified by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique, the PRL mRNA expression was determined by real-time PCR, and PRL serum levels were measured by enzyme-linked immunosorbent assay. Applying genetic models of inheritance (dominant, recessive, and additive), we found an association between the T allele and decreased RA susceptibility (OR = 0.55, 95% CI 0.35–0.87, p = 0.009; OR = 0.09, 95% CI 0.012–0.76, p = 0.011; OR = 0.49, 95% CI 0.32–0.76, p = 0.001, respectively). RA patients had higher mRNA expression and soluble levels of PRL than CS (p

Introduction. Systemic Sclerosis (SSc) is an autoimmune, inflammatory, and multisystemic disease characterized by the presence of autoantibodies and fibrosis. The pathogenesis involves the interaction between immune system cells such as macrophages, NK cells, T cells, and B cells. Killer-cell Immunoglobulin-like Receptors (KIR) are expressed in NK cells and some T cell subsets that recognize HLA class I molecules as ligands and are involved in regulating the activation and inhibition of these cells. The KIR family consists of 14 genes and two pseudogenes; according to the gene content, the genotype could be AA and Bx. The aim of this study was to evaluate the association between KIR/HLA genes and genotypes with SSc and the clinical characteristics. Methods. We included 50 SSc patients and 90 Control Subjects (CS). Genotyping of KIR, HLA-C, -Bw4, and -A∗03/∗11 was made by SSP-PCR. Results. In SSc patients, a higher frequency of KIR2DL2 (p=0.0007, p′=0.011), KIR2DS4del (p=0.001, p′=0.021), and HLA-C2 (p=0.02, p′=0.09) was found. This is the first study to evaluate the frequency of HLA-A∗03/∗11 in SSc patients, of which a low frequency was found in both groups. Compound genotypes KIR2DL2+/HLA-C1+ or KIR2DL2+/HLA-C2+ have a higher frequency in SSc patients. The Bx genotype was the most frequent and was associated with risk to SSc (p=0.007, OR=3.1, 95% CI=1.4–7.9, p′=0.014). The genotypes with a higher iKIR number than aKIR (iKIR>aKIR) were found in all individuals; genotypes with 7-8 iKIR genes were increased in SSc patients. We do not find an association between the KIR genes with the clinical characteristics. Conclusion. The results suggest that KIR2DL2 and 2DS4del could have a risk role in the development of SSc, but not with clinical manifestations.

Background /Aim: The hypertriglyceridaemic waist (HTGW) phenotype has been described and suggested in general population as a cardiovascular risk marker. The aim of the present study was to evaluate the HTGW phenotype as a marker related to HUC and MetS in rheumatoid arthritis (RA). Materials and methods This was a cross-sectional study was designed in 250 RA Mexicans patients. The HTGW phenotype was defined as elevated waist circumference and elevated triglyceride concentration. Logistic regression analysis was used to evaluate the association between the HTGW phenotype, HUC and MetS in its traditional NCEP/ATPIII versions and modified (HTGWm and MetSm). Results The prevalence of HTGW and HTGWm it was 20.4% and 32%, respectively. All patients with HTGW presented MetS ( P 0.001), and in a multivariate model, the HTGW phenotype was the marker most closely related to HUC in comparison to components of MetS. Conclusion The HTGW may represent a marker for screening of cardiometabolic risk in RA patients, so in clinical practice can be implemented as a low-cost marker in the evaluation of the patient regardless of clinical characteristics of disease.

Systemic sclerosis (SSc) is a complex autoimmune disease, characterized by microvascular lesions, autoimmunity, and fibrosis. It is suggested that MIF participates in the amplification of the proinflammatory process in SSc; moreover, the promoter polymorphisms − 794 CATT5–8 (rs5844572) and − 173G>C (rs755622) in the MIF gene have been associated with an increase in MIF serum levels in several autoimmune diseases. The aim of this study was to analyze the relationship of the − 794 CATT5–8 and − 173G>C MIF polymorphisms with mRNA expression, MIF serum levels, and the Th1/Th2/Th17 cytokine profile in SSc. A case-control study was carried out that included 50 patients with SSc and 100 control subjects (CS). Both polymorphisms were genotyped by PCR and PCR-RFLP. MIF levels were measured by ELISA kit. The cytokine profile and the MIF mRNA expression were quantified by BioPlex MagPix system and real-time PCR, respectively. An association between the − 794 CATT7 and − 173*C MIF alleles and the 7C haplotype with SSc susceptibility was found (p

OBJECTIVE: Implement a Clinical Practice Guideline for the early detection, diagnosis and treatment of the acute phase of intoxication of patients with alcohol abuse or dependence in the priority consultation services and outpatient consultation of the E.S.E Cari Neurosciences Hospital of the city of Barranquilla.INTRODUCTION: Alcoholism is the first drug addiction in many countries of the world. It affects all ages, both sexes and in almost all social groups. Alcohol is estimated to cause nearly 4% of deaths worldwide and is one of the top 20 causes of disability-adjusted life years (DALYs), either due to associated neurological and / or psychiatric conditions (38%), accidental injury (28%) or intentional injury (12%). In Colombia, alcohol consumption is widely accepted and promoted. The life prevalence of psychoactive substance use disorders is 10.6%, and alcohol abuse is the most prevalent disorder.MATERIALS & METHODS: An implementation plan for a management CPG for the early detection, diagnosis and treatment of an acute phase of intoxication of patients with alcohol abuse or dependence will be developed, according to the manual methodology of implementation of guidelines Clinical practice based on evidence from the Colombian Ministry of Health.CONCLUSIONS: The CPGs contain recommendations with the best clinical evidence available. Therefore, it is necessary that they be adopted by users, for which it is necessary to follow the dissemination, dissemination and implementation plan, address the intrinsic and extrinsic obstacles and facilitators of the CPGs and monitor the indicators described to measure the process of implementing CPGs in clinical practice.

Introduccion: La obesidad es un factor de riesgo de desarrollo y progresion de enfermedad renal cronica (ERC). En Latinoamerica existen pocos estudios donde se relacionen los estadios de ERC y grados de obesidad. Objetivo: El objetivo de estudio es evaluar la asociacion de obesidad con la enfermedad renal cronica de pacientes atendidos en la consulta externa del departamento de Nefrologia en la Clinica de la Costa en Barranquilla, Colombia. Materiales y metodos: Se realizo un estudio observacional descriptivo tipo serie de casos. La muestra estuvo compuesta por 300 pacientes acopiados en NefroRed©. Se realizaron medidas de tendencia central y un χ² para establecer la asociacion entre los grados de obesidad con los estadios de la ERC. Los analisis estadisticos se realizaron en R-CRAN. Al realizar la prueba, se encontro una asociacion entre los grados de obesidad y los diferentes estadios de la ERC [χ²: 48,62; p-valor < 0,01]. Conclusion: No se encontro evidencia estadistica de asociacion entre el Perimetro Abdominal y los estadios de ERC [χ²: 8,82; p-valor ≥ 0,05]. Existe asociacion entre los grados de obesidad y los diferentes estadios de la ERC. No se encontro la relacion entre perimetro abdominal y los estadios de ERC.

Background Pregnancy in women with autoimmune rheumatic diseases is associated with several maternal and foetal complications. The development of clinical practice guidelines with the best available scientific evidence may help standardize the care of these patients. Objectives To provide recommendations regarding prenatal care, treatment, and a more effective monitoring of pregnancy in women with lupus erythematosus (SLE), rheumatoid arthritis (RA) and antiphospholipid antibody syndrome (APS). Methodology Nominal panels were formed for consensus, systematic search of information, development of clinical questions, processing and grading of recommendations, internal validation by peers, and external validation of the final document. The quality criteria of the AGREE II instrument were followed. Results The various panels answered the 37 questions related to maternal and foetal care in SLE, RA, and APS, as well as to the use of antirheumatic drugs during pregnancy and lactation. The recommendations were discussed and integrated into a final manuscript. Finally, the corresponding algorithms were developed. We present the recommendations for pregnant women with SLE in this first part. Conclusions We believe that the Mexican clinical practice guidelines for the management of pregnancy in women with SLE integrate the best available evidence for the treatment and follow-up of patients with these conditions.

Objective: To evaluate the degree of knowledge of general dentists in the public network of the district of Barranquilla on dentoalveolar trauma. Materials and methods: Observational study, descriptive cross-sectional, based on interviews with 33 general dentists of the public network from Barranquilla, regarding dentoalveolar trauma. The survey was previously validated by an expert team of dental surgeons and endodontists. Results: It was observed a 12.12% (n=4) of the population studied had a low level of knowledge, 18.18% (n=6) an acceptable level, while only 9.09% (n=3) had a good level of knowledge. The most frequent category was “regular” with a 60.6% (n=20). Conclusion: In this project, it was observed that most general dentists who participated were categorized with a “not to standard” level of knowledge (60.6%) and acceptable (18.18%) according to the right answer scale of the applied questionnaire. A “low” level of knowledge was present on 12.12%, while only a 9.09% had a good level of knowledge.

OBJECTIVE: To determine the relationship between leptin levels and metabolic parameters in children and adolescents. METHODS: Descriptive cross-sectional study. Laboratory biochemical values ​​and anthropometric parameters were determined. Univariate analysis was performed with measurements of frequencies and percentages and bivariate analysis through statistical significance tests (p

OBJECTIVE: To identify the relationship between anxiety and depression with the severity of fibromyalgia and quality of life in patients aged 18 to 65 years, clinic of rheumatology of Barranquilla. METHODS: Observational, descriptive, comparative cross-sectional study. Patients with fibromyalgia who attend the external consultation of rheumatology will be surveyed. The questionnaires to be applied are the Fibromyalgia Impact Questionnaire Revised (Spanish version), Health Questionnaire SF-36, Patient Health Questionnaire and a Scale of 7 questions for generalized anxiety disorder. The data collected in this descriptive study will be analyzed by means of frequency and association measures. The analysis of association between sociodemographic factors and clinical characteristics will be carried out with bivariate analysis and the comparison of qualitative or categorical variables will be done through the analysis of variance, to compare variables of ordinal type and variables of type ratio. RESULTS: 34.2% of the patients did not present anxiety whereas 83.6% of the patients had some degree of depression. 50% of the patients had moderate, severe and extreme degrees of depression. An association was found between severity of fibromyalgia with anxiety, depression and quality of life (p

[Abstract] This study aimed to generate a minimum list of structural and functional anatomical items about the pelvis/hip, knee, ankle/foot, gait, and lower limb innervation, which are most relevant to the practice of rheumatology. To determine their perceived relevance to clinical practice, seven members of the Mexican Clinical Anatomy Task Force compiled an initial list of 470 anatomical items. Ten local and international experts according to a 0-10 Likert scale ranked these items. Of the original list, 101 (21.48%) items were considered relevant (global rate >40). These included 36/137 (26.27%) pelvis and hip items, 25/82 (30.48%) knee items, 22/168 (13.98%) ankle/foot items, 11/68 (16.17%) neurologic items, and 7/15 (46.66%) gait-related items. We propose that these 101 anatomical items of the lower extremity, when added to the 115 anatomic items of the upper extremity and spine we previously reported, may represent an approximation to the minimal anatomical knowledge central to the competent practice of rheumatology. The meager representation of ankle and foot items may reflect a lesser emphasis in these anatomical regions during rheumatologic training. Attention to these and related items during rheumatologic training and beyond may sharpen the rheumatologist's ability in the differential diagnosis of regional pain syndromes as well as strengthen an endangered art: the rheumatologic physical examination.

a b s t r a c t Objective: To survey the efficacy of a practical workshop on clinical musculoskeletal anatomy held in five American countries. Methods: A self-assessment competence questionnaire sent to participants 1-3 months after the work- shop. Results were compared to the results of a practical, instructor-assessed, pre-workshop test. Results: The response rate of participants was 76.4%. The overall, self-assessed competence score for anatomical items that had been included in the pre-test was 76.9 (scale 0-100) as compared to an over- all score of 48.1 in the practical, pre-workshop test (p < 0.001). For items that were addressed in the workshop, but not included in the pre-test, self-assessed competence was rated at 62.9. Differences in anatomical knowledge between individuals from different countries and professional groups noted in the practical pre-test were no longer present in the post-test self-assessment. Conclusions: From this preliminary data and supporting evidence from the literature we believe that our anatomy workshop provides an effective didactic tool for increasing competence in musculoskeletal anatomy.

Resumo Este ensaio desenvolve uma reflexão acerca da relação entre experiência operária e ciência na luta pela saúde e a emancipação social como contribuição para o campo da Saúde Coletiva/Saúde do Trabalhador. Partimos desta questão - pode haver compatibilidade entre produção capitalista e saúde? - para assinalar, na primeira seção, a resposta majoritária oferecida pelo movimento sindical brasileiro na atualidade. Na segunda e terceira seções analisamos algumas obras referidas à experiência histórica do enfrentamento do capital pelos trabalhadores, especialmente na Itália nos anos 1960-1970, para pensar, respectivamente, nas respostas à questão proposta e na relação entre teoria e prática. Depois, discutimos as contribuições e os limites do Modelo Operário Italiano de luta pela saúde para, em seguida, recuperarmos deste legado o sentido de classe na relação entre ciência e experiência. Na sexta seção, apresentamos experiências de resistência dos trabalhadores brasileiros à exploração capitalista relacionadas à luta pela saúde, com o que retomamos a questão inicial. Destacamos, na problemática apontada, os sentidos que o direito à saúde e da saúde entendida como luta da classe trabalhadora passam a assumir no âmbito da produção do conhecimento e das ações em saúde.

A predominância da agricultura convencional, caracterizada sobretudo pelo uso indiscriminado de agrotóxicos, tem levado a pesquisas acerca da percepção sobre a saúde e o ambiente implicados nas práticas agrícolas. Neste estudo, buscou-se compreender a percepção dos limites da agricultura convencional por agricultores familiares e as razões de sua persistência. Consistiu em pesquisa empírica observacional e participativa realizada em Sumidouro, RJ, entre 2006 e 2008. Verificou-se que a agricultura convencional é avaliada positivamente em termos de ganhos econômicos e sociais - dada a redução do tempo de trabalho socialmente necessário resultante do uso de agrotóxicos - e que, apesar da persistência de elementos da agricultura tradicional na memória e da percepção da dependência dos insumos e dos seus impactos, é percebida pelos agricultores como uma determinação de suas vidas. Esses elementos sugerem que, da mesma forma como o sistema agrícola convencional se impôs mediante crédito subsidiado e assistência técnica pública, alterações profundas nessa percepção e no sistema agrícola vigente devem integrar política pública ampla e de longa duração. Esta, por sua vez, deve considerar, dentre outros, a dependência do poder político local em relação aos maiores produtores e comerciantes, inclusive de agrotóxicos, e a necessidade de articulação entre pesquisa e extensão rural com a participação direta dos agricultores. The predominance of conventional agriculture, characterized mainly by the indiscriminate use of pesticides, has led to researches on health and environment perception associated with these practices. An observational and participatory research was conducted in Sumidouro, Rio de Janeiro State, between 2006 and 2008, which aimed to understand the family farmer's perception on the limits of conventional agriculture and the reasons for its persistence. Conventional agriculture was positively evaluated by the interviewed in terms of economic and social gains, because socially-necessary labor time is reduced when pesticides were used. It was also perceived as determinative of their lives, despite the persistence of elements of traditional agriculture in their memory and their perception of the dependency on agricultural inputs and their impacts. These elements suggest that a broad and long term public policy needs to be established in order to introduce profound changes in perception and in current agricultural system, in the same way that the conventional one was imposed to the community by subsidized credit programs and technical assistance service. This policy should consider, among others issues, the dependence of the local political power on large agricultural producers and traders, including pesticide dealers, and the need for integration of agricultural research and extension that includes active participation of farmers.

We aim to study the educational impact of a clinical anatomy workshop in 1st-year orthopedic and rheumatology fellows. First-year rheumatology fellows (N = 17) and a convenience sample of 1st-year orthopedic fellows (N = 14) from Mexico City in the 9th month of training participated in the study. The pre- and the post- workshop tests included the same 20 questions that had to be answered by identification or demonstration of relevant anatomical items. The questions, arranged by anatomical regions, were asked in five dynamic stations. Overall, the 31 participants showed an increase of correct answers, from a median of 6 (range 1 to 12) in the pre-workshop test, to a median of 14 (range 7 to 19) in the post-workshop test. In the pre-workshop test, the correct median answers were 7 (range 2 to 12) in the orthopedic fellows and 5 (range 1 to 10) in the rheumatology fellows (p = 0.297). Corresponding scores in the post-workshop were 15 (range 10 to 19) and 12 (range 7 to 18) (p = 0.026) showing a significant difference favoring the orthopedic group. Our clinical anatomy workshop was efficacious, in the short term, as a teaching instrument for 1st-year orthopedic and rheumatology fellows. The post-workshop scores, although significantly improved in both groups, particularly in the orthopedic fellows, were still suboptimal. Further refinements of our workshop might yield better results.

Objetivo construir uma definição conceitual para o processo intensificação do trabalho e saúde do trabalhador enquanto um objeto de estudo. Métodos a abordagem teórica baseia-se no materialismo histórico que, na Saúde Coletiva/Saúde do Trabalhador, encontra sua expressão na determinação social do processo saúde-doença. A discussão se apoia na recente produção de conhecimento científico sobre essa problemática estruturada em dois eixos: intensificação do trabalho e intensificação do trabalho e saúde dos trabalhadores. Discussão a análise mostrou que a intensificação do trabalho está implicada em práticas de exploração como o prolongamento da jornada, o intenso ritmo de trabalho e a administração por estresse e, ao mesmo tempo, de expropriação do saber do trabalhador pela gerência, isto é, de suas capacidades físicas, psíquicas e intelectuais. Esses processos determinam uma pluralidade de agravos à saúde e na manifestação do desgaste e do sofrimento difuso dos trabalhadores. Conceitualmente, o objeto intensificação do trabalho e saúde do trabalhador pode ser definido e estudado nas práticas específicas de exploração e expropriação do saber do trabalhador tendentes a enfraquecer sua capacidade coletiva para proteger a saúde e para questionar as determinações dos problemas e agravos à saúde. Objective to construct a conceptual definition of the work intensification process and workers’ health as an object of study. Methods the theoretical approach is based on the historical materialism, which, in the field of Collective Health/Worker’s Health, is expressed on the social determination of the health-disease process. The discussion is grounded on the recent scientific knowledge production on this issue, structured on two axes: work intensification, and work intensification and workers' health. Discussion the analysis showed that labor intensification is associated with exploitation practices, such as longer working hours, intense work pace, management by stress and, at the same time, worker's knowledge expropriation by the management, i.e., expropriation of their physical, intellectual and psychic capabilities. These processes determine a variety of health problems and the manifestation of wearing down and diffuse suffering among workers. Conceptually, the object "work intensification and workers' health" can be defined and studied in the exploitation specific practices and worker's knowledge expropriation, tending to weaken their collective ability to protect health and question the determination of health problems.

De todas las Regiones Hidrologicas Espanolas existentes, a Canarias le corresponde la Numero 9. Desde el punto de vista del termalismo se considera la menos conocida, aunque ha sido estudiada por gran cantidad de investigadores europeos, espanoles de La Peninsula o de las Islas Canarias. La cultura balnearia en Canarias se remonta casi a la epoca de la Conquista de las islas. Desde que en 1575 Bartolome Cairasco de Figueroa hablase de la calidad de las Aguas de Teror (Gran Canaria) hasta la actualidad son muchas las aguas minero-medicinales que han sido investigadas desde diferentes puntos de vista. Son nueve los centros balneoterapicos mas conocidos en las Islas Canarias, seis en Gran Canaria (Balneario de Santa Catalina, Balneario de Cristo Rincon, Banos de San Roque, Banos de Teror, Balneario de Azuaje, Balneario de Los Berrazales). Dos en la isla de la Palma (Banos de la Fuente Santa, Banos del Charco Verde). Uno en la Isla de El Hierro (Balneario del Pozo de la Salud). De todos los balnearios de las Islas Canarias, solo el Balneario del Pozo de la Salud (El Hierro) se encuentra en activo. Mientras que los balnearios de Azuaje y Los Berrazales, en Gran Canaria y los de El Charco Verde y La Fuente Santa, en La Palma, se encuentran en avanzadas conversaciones con las Mancomunidades de las islas y los respectivos Cabildos Insulares para su restauracion y puesta en funcionamiento. En el presente trabajo se aporta una sintesis de la historia y caracteristicas mas significativas de los Balnearios Canarios, asi como su estado actual y perspectivas de futuro dentro del termalismo de las Islas Canarias. Balneario de Teror: Manantial descubierto a mitad del siglo XVI. Declaradas MM. 1844. Balneario de Azuaje situado en el Bco. de Azuaje. (Firgas). El Dr. Anastasio Garcia Lopez las clasifica como Bicarbonatado sodicas. En la actualidad la Mancomunidad del Norte de Gran Canaria gestiona su restauracion. Balneario de Santa Catalina: Manantial descubierto entre 1860-1865. El Dr. Mariano Carretero 1876 dice que son Aguas Clorurado sodicas. Seis medicos compran el Balneario y construyen la Clinica Santa Catalina que funciona entre 1935-1998. Pertenece en la actualidad a Vithas Hospital Santa Catalina. Balneario Cristo-Rincon: Manantial descubierto a principios del Siglo XX. Situado en el Pago de El Rincon. Balneario construido en 1932. Declaradas de Utilidad Publica 21/01/1934. En 1944 y 46 descritas por la Guia Oficial de Balnearios y A. M-M de Espana. En 2001el Instituto Geologico y Minero de Espana dice que son aguas clorurado-sodicas. En la actualidad pendiente de restauracion por CCAA de Canarias. Balneario de San Roque: Manantial conocido desde 1600. Emerge en Bco. de Casares (Valsequillo). Estudiado por D. Jose de Viera y Clavijo en 1876 y clasificadas como “aguas acidulas con hierro”. Declaradas de Utilidad Publica en el BOE de 29 de abril de 1916. En 2001 la Dra. Baeza la incluye en “Las Aguas Minerales de Espana”. En 2012 el Dr. E. Navarro estudia sus acciones farmacologicas e indicaciones clinicas. En la actualidad el manantial pertenece a la Constructora Santana Cazorla. Clausurado. Balneario de Agaete: Manantial descubierto en Montana Gorda (Agaete) decada de 1870. En 2001 se incluye en libro “Las Aguas Minerales en Espana” del IGME. En 2012 la Constructora “Hermanos Tito” restaura el Hotel. En la actualidad el Ayuntamiento intenta recuperar el Balneario. Balneario del Charco Verde: Conocidas como Banos del Charco Verde. Mac Gregor, entre otros, dice que en el siglo XVII ya eran conocidas. En los siglos XX y XXI siguen teniendo gran predicamento como aguas minero-medicinales. Balneario de la Fuente Santa: Situado en Fuencaliente. Propiedad del Cabildo de La Palma. Aguas clorurado-sodicas, carbonicas e hipertermales. Estudiadas por George Glas (1764) y Viera y Clavijo (1779) Actualmente aprobado el proyecto para construir un moderno Balneario. Balneario del Pozo de La Salud: Situado en Frontera (El Hierro). Aguas clorurado-sodicas. Declarado de aguas M-M en el BOPC No 113 21/07/1844. De Utilidad Publica en el BOE de 19/05/1949. Estudiadas en 1884 por Dr. Mateo Orfila y por Dr. Eduardo Navarro en 2010. Unico Balneario canario en activo.

Em uma abordagem interdisciplinar, discute-se criticamente o conceito de risco epidemiológico. Apresenta-se o trabalho de Elizabeth Teixeira, que utiliza as ideias de Boaventura de Sousa Santos. Esboça-se a proposta de uma cartografia simbólica do risco epidemiológico, definindo-se escalas analíticas que vão da exterioridade e do distanciamento do campo da ciência à proximidade do território e do lugar, conceituados a partir da geografia de Milton Santos, em que concepções de risco são elaboradas na perspectiva da cotidianidade da existência social. Questões relativas a espaço, territorialidade, subjetividade e tempo dão sentido à cartografia do risco proposta como modelo para investigações epidemiológicas. Adopting an interdisciplinary approach, the concept of epidemiological risk is critically discussed. The work of Elizabeth Teixeira, who uses the ideas of Boaventura de Sousa Santos, is presented. The proposal for symbolic cartography of epidemiological risk is sketched out, defining analytical scales ranging from exteriority and distancing from the field of science to the proximity of territory and place, conceptualized on the basis of the geography of Milton Santos, in which conceptions of risk are drawn up from the perspective of the everyday routine of social existence. Questions relating to space, territoriality, subjectivity and time give meaning to a cartography of risk which is proposed as a model for epidemiological investigations.