Human mucocutaneous leishmaniasis in Três Braços, Bahia - Brazil : an area of Leishmania braziliensis braziliensis transmission. II. Cutaneous disease. Presentation and evolution

Foram analisados os dados clínicos de 182 pacientes com leishmaniose cutânea, provavelmente causada por Leishmania braziliensis braziliensis. Sessenta e oito por cento apresentavam uma única lesão, usualmente uma úlcera, na terça parte inferior anterior da tíbia. Todos os grupos etários estavam representados e muitos apresentaram histórico de um a dois meses. Treze por cento apresentavam lesões fechadas de natureza verrucosa ou em placa. Após tratamento, a evolução destas lesões foi relacionada à regularidade da terapia por antimônio. Embora a cura usualmente ocorresse em três meses, o tempo de cicatrização, após o início de tratamento, foi variável e relativo ao tamanho da lesão (p < 0.01). Em geral a lesão fechava quando era dado suficiente antimônio como tratamento. Sete entre dez pacientes que apresentavam teste cutâneo negativo para leishmania tomavam positivos após o tratamento. Observou-se por fluorescência indireta, um declínio significante nos títulos de anticorpos em pacientes acompanhados durante e após a terapia. _________________________________________________________________________________ ABSTRACTThe clinical records of 182 patients with cutaneous leishmaniasis probably due to Leishmania braziliensis braziliensis are analysed. 68% had a single lesion which was usually an ulceron the lower anterior tibial third. Many had short histories of one to two months and all age groups were represented 13% had closed lesions of a verrucose or plaque like nature. Evolution of these skin lesions after treatment was related to the regularity of antimony therapy. Although healing usually occurred in three months, the time to scarring after commencing treatment was variable and related to the size ofthe lesion (p < 0.01). Usually if sufficient antimony treatment was given the lesion closed. Seven of the ten patients with initially negative leishmanin skin tests converted to positive after treatment. A significant decline of indirect fluorescent antibody titres occurred in patients followed, during and after therapy

Procedimiento para la formación de juristas en la jurisdicción contenciosa

The formation process of law students to the legal debate on the contentious jurisdiction has deficiencies in design teaching, which is manifested in their fragmentation, nonsystemic nature and inadequacies in oral argumentative skills of these students, and it affects the optimal development of the skills of the lawyer litigants. The objective of the study was to explain the main components of the training process for the legal debate on the contentious jurisdiction. As a result a method that integrates three phases is obtained, allowing its improvement on the basis of the diagnosis made at the University of Pinar del Río.El proceso de formación de estudiantes de Derecho para el debate jurídico en la jurisdicción contenciosa presenta carencias en su concepción didáctica, lo que se manifiesta en su atomización, asistematicidad y en insuficiencias en las habilidades argumentativas orales de dichos estudiantes, e incide en el desarrollo óptimo de las competencias litigantes del jurista. El objetivo del trabajo consistió en fundamentar los componentes principales del proceso de formación para el debate jurídico en la jurisdicción contenciosa. Como resultado se obtiene un procedimiento que integra tres fases y que sobre la base del diagnóstico realizado en la Universidad de Pinar del Río permite su perfeccionamiento

Temporal interpolation of groundwater level hydrographs for regional drought analysis using mixed models

Large-scale studies of the spatial and temporal variation of groundwater drought status require complete inventories of groundwater levels on regular time steps from many sites so that a standardised drought index can be calculated for each site. However, groundwater levels are often measured sporadically, and inventories include missing or erroneous data. A flexible and efficient modelling framework is developed to fill gaps and regularise data in such inventories. It uses linear mixed models to account for seasonal variation, long-term trends and responses to precipitation and temperature over different temporal scales. The only data required to estimate the models are the groundwater level measurements and freely available gridded weather products. The contribution of each of the four types of trends at a site can be determined and thus the causes of temporal variation of groundwater levels can be interpreted. Validation reveals that the models explain a substantial proportion of groundwater level variation and that the uncertainty of the predictions is accurately quantified. The computation for each site takes less than 130 s and requires little supervision. Hence, the approach is suitable to be upscaled to represent the variation of groundwater levels in large datasets consisting of thousands of boreholes

Scoping review of measures of treatment burden in patients with multimorbidity: advancements and current gaps

Objectives: To identify, assess, and summarize the measures to assess burden of treatment in patients with multimorbidity (BoT-MMs) and their measurement properties. Study Design and Setting: MEDLINE via PubMed was searched from inception until May 2021. Independent reviewers extracted data from studies in which BoT-MMs were developed, validated, or reported as used, including an assessment of their measurement properties (e.g., validity and reliability) using the COnsensus-based Standards for the selection of health Measurement INstruments. Results: Eight BoT-MMs were identified across 72 studies. Most studies were performed in English (68%), in high-income countries (90%), without noting urban-rural settings (90%). No BoT-MMs had both sufficient content validity and internal consistency; some measurement properties were either insufficient or uncertain (e.g., responsiveness). Other frequent limitations of BoT-MMs included absent recall time, presence of floor effects, and unclear rationale for categorizing and interpreting raw scores. Conclusion: The evidence needed for use of extant BoT-MMs in patients with multimorbidity remains insufficiently developed, including that of suitability for their development, measurement properties, interpretability of scores, and use in low-resource settings. This review summarizes this evidence and identifies issues needing attention for using BoT-MMs in research and clinical practice