Unveiling Melanoma: A Deep Dive into Disparities at a Latin-American Cancer Institute.

INTRODUCTION: The worldwide incidence of melanoma has increased in the last 40 years. Our aim was to describe the clinic-pathological characteristics and outcomes of three cohorts of patients diagnosed with melanoma in a Latin-American cancer institute during the last 20 years. METHODS: We evaluated three retrospective patient cohorts diagnosed with melanoma at Instituto Nacional de Enfermedades Neoplasicas (INEN), a public hospital in Lima, Peru, for the years 2005-2006, 2010-2011, and 2017-2018. Survival rate differences were assessed using the Log-rank test. RESULTS: Overall, 584 patients were included (only trunk and extremities); 51% were male, the mean age was 61 (3-97) years, and 48% of patients resided in rural areas. The mean time to diagnosis was 22.6 months, and the mean Breslow thickness was 7.4 mm (T4). Lower extremity was the most common location (72%). A majority of the patients (55%) had metastases at the time of presentation, with 36% in stage III and 19% in stage IV. Cohorts were distributed as 2005-2006 (n = 171), 2010-2011 (n = 223), and 2017-2018 (n = 190). No immunotherapy was used. Cohort C exhibited the most significant increase in stage IV diagnoses (12.3%, 15.7%, 28.4%, respectively; p < 0.01). The median overall survival rates at the three-year follow-up demonstrated a decline over the years for stages II (97%, 98%, 57%, respectively; p < 0.05) and III (66%, 77%, 37%; p < 0.01). CONCLUSIONS: There has been a worsening in the incidence of late-stage metastatic melanoma in Peru throughout the years, coupled with a significant decline in overall survival rates. This is underscored by the fact that half of the population lives in regions devoid of oncological access.

Assessing the impact of palliative care admission of end-of-life cancer adults.

Background: There is evidence that early admission to the palliative care (PC) program in adult cancer patients improves symptoms management, reduces unplanned hospital admissions, minimizes aggressive cancer treatments, and enables patients to make decisions about their end-of-life (EOL) care. Objectives: This retrospective cohort study aimed to determine whether late admission to a PC program is associated with aggressive treatment at the EOL in adult patients with oncological diseases from their admission until death. Design/Methods: The study evaluated the aggressiveness in EOL management in patients with advanced stage oncological diseases who died between 2017 and 2019. The study population was divided into two groups based on the time of admission to the PC program. Aggressiveness at the EOL was measured using five criteria: treatment, hospital admission and duration, emergency department care, and/or intensive care unit utilization. Results: The study found a significant difference in the rate of aggressive EOL treatments between late admission to PC care and early admission [adjusted EOL 79.6% versus 70.4%; relative risk (RR): 1.98, 90% CI: 1.08-3.59, p: 0.061]; In the analysis of secondary variables, a significant association was observed between early admission to PC and the suspension of active treatments at the EOL, leading to a decrease in aggressiveness (77% versus 55.8%; RR: 1.38, 95% CI: 1.14-1.67, p: 0.004). Conclusion: Our findings suggest that early referral to PC services is associated with less aggressive treatment at the EOL, including suspension of active treatments.

Promoter hypermethylation of RARB and GSTP1 genes in plasma cell-free DNA as breast cancer biomarkers in Peruvian women.

BACKGROUND: Promoter hypermethylation is one of the enabling mechanisms of hallmarks of cancer. Tumor suppressor genes like RARB and GSTP1 have been reported as hypermethylated in breast cancer tumors compared with normal tissues in several populations. This case-control study aimed to determine the association between the promoter methylation ratio (PMR) of RARB and GSTP1 genes (separately and as a group) with breast cancer and its clinical-pathological variables in Peruvian patients, using a liquid biopsy approach. METHODS: A total of 58 breast cancer patients and 58 healthy controls, matched by age, participated in the study. We exacted cell-free DNA (cfDNA) from blood plasma and converted it by bisulfite salts. Methylight PCR was performed to obtain the PMR value of the studied genes. We determined the association between PMR and breast cancer, in addition to other clinicopathological variables. The sensitivity and specificity of the PMR of these genes were obtained. RESULTS: A significant association was not found between breast cancer and the RARB PMR (OR = 1.90; 95% CI [0.62-6.18]; p = 0.210) or the GSTP1 PMR (OR = 6.57; 95% CI [0.75-307.66]; p = 0.114). The combination of the RARB + GSTP1 PMR was associated with breast cancer (OR = 2.81; 95% CI [1.02-8.22]; p = 0.026), controls under 50 years old (p = 0.048), patients older than 50 (p = 0.007), and postmenopausal (p = 0.034). The PMR of both genes showed a specificity of 86.21% and a sensitivity of 31.03%. CONCLUSION: Promoter hypermethylation of RARB + GSTP1 genes is associated with breast cancer, older age, and postmenopausal Peruvian patients. The methylated promoter of the RARB + GSTP1 genes needs further validation to be used as a biomarker for liquid biopsy and as a recommendation criterion for additional tests in asymptomatic women younger than 50 years.

Optimised Sunflower Oil Content for Encapsulation by Vibrating Technology as a Rejuvenating Solution for Asphalt Self-Healing.

This study aimed to determine an optimal dosage of sunflower oil (i.e., Virgin Cooking Oil, VCO) as a rejuvenator for asphalt self-healing purposes, evaluating its effect on the chemical (carbonyl, and sulfoxide functional groups), physical (penetration, softening point, and viscosity), and rheological (dynamic shear modulus, and phase angle) properties of long-term aged (LTA) bitumen. Five concentrations of sunflower oil (VCO) were used: 1%, 2%, 3%, 4%, and 5% vol. of LTA bitumen. VCO was encapsulated in alginate biopolymer under vibrating jet technology using three biopolymer:oil (B:O) mass ratios: 1:1, 1:5, and 1:9. The physical, thermal, and mechanical properties of the capsules were studied, as well as their effect on the physical properties of dense asphalt mixtures. The main results showed that an optimal VCO content of 4% vol. restored the chemical, physical, and rheological properties of LTA bitumen to a short-term ageing (STA) level. VCO capsules with B:O ratios of 1:5 presented good thermal and mechanical stability, with high encapsulation efficiency. Depending on the B:O ratio, the VCO capsule dosage to rejuvenate LTA bitumen and asphalt mixtures varied between 5.03-15.3% wt. and 0.24-0.74% wt., respectively. Finally, the capsule morphology significantly influenced the bulk density of the asphalt mixtures.

Biopolymeric Capsules Containing Different Oils as Rejuvenating Agents for Asphalt Self-Healing: A Novel Multivariate Approach.

This study evaluated the effect of two encapsulation methods (i.e., dropping funnel and syringe pump), two concentrations of the alginate-based encapsulating material (2%, and 3%), and three oils as bitumen rejuvenators (virgin sunflower oil, waste cooking oil, and virgin engine oil) on the morphological, physical, chemical, thermal, and mechanical properties of encapsulated rejuvenators for asphalt self-healing purposes. A general factorial design 2 × 2 × 3 was proposed to design 12 different Ca-alginate capsules. Significant differences on the morphological, physical, and mechanical properties of the capsules were analysed by three-way ANOVA and Tukey HSD Post Hoc analyses. The effect of the type of oil on the self-healing capacity of cracked bitumen samples was also evaluated. The main results showed that the design parameters and their interactions significantly affected the morphological, physical, and mechanical properties of the capsules. Capsules synthesised via syringe pump method, with virgin cooking oil and 2% alginate was the most appropriate for asphalt self-healing purposes since its uniform morphology, encapsulation efficiency up to 80%, thermal degradation below 5% wt., and compressive strength above the reference asphalt compaction load of 10 N. Finally, the healing tests showed that virgin cooking oil can be potentially used as a rejuvenator to promote asphalt crack-healing.

Chip-based digital Polymerase Chain Reaction as quantitative technique for the detection of PIK3CA mutations in breast cancer patients.

Background: PIK3CA is a gene frequently mutated in breast cancer. With the FDA approval of alpelisib, the evaluation of PIK3CA for activating mutations is becoming routinely. Novel platforms for gene analysis as digital PCR (dPCR) are emerging as a potential replacement for the traditional Sanger sequencing. However, there are still few studies on chip-based dPCR to detect mutations in tumor samples. Thus, this cross-sectional study aimed to assess the sensibility of a chip-based dPCR to detect and quantify PIK3CA mutations and compare its performance with Sanger sequencing. Materials and Methods: Tumor samples from 57 breast cancer patients (22 pre-treatment samples, 32 tumors after neoadjuvant chemotherapy, and three lymph nodes) were collected and analyzed by Sanger sequencing and dPCR for the three PIK3CA most relevant mutations (p.E545K, p. H1047R, and p. H1047L). Digital PCR sensitivity, specificity, and overall performance were estimated by contingency tables, receptor operator characteristic (ROC), and area under the curve (AUC). Association of PIK3CA mutations with clinicopathological variables was conducted. Results: Sanger sequencing identified PIK3CA mutations in six patients (10.5%), two with p. H1047R, and four with p. E545K. Digital PCR confirmed those mutations and identified 19 additional patients with at least one mutation. Comparison between dPCR and Sanger sequencing showed a sensitivity of 100% (95% CI 53-100%), and a specificity of 84.2% (95% CI 83-84.2%). Besides, p. H1047R mutation detected by dPCR showed a significant association with breast cancer phenotype (p = 0.019) and lymphatic nodes infiltration (p = 0.046). Conclusions: Digital PCR showed a high sensitivity to detect mutations in tumor samples and it might be capable to detect low-rate mutations and tumor subpopulations not detected by Sanger sequencing.

Quinoa Snack Production at an Industrial Level: Effect of Extrusion and Baking on Digestibility, Bioactive, Rheological, and Physical Properties.

This research aimed to produce gluten-free snacks on a pilot scale from quinoa flour. These snacks experienced an extrusion process, followed by baking. The effects of these technological processes on carbohydrate and protein digestibility, extractable phenolic compounds (EPP), hydrolyzable phenolic compounds (HPP), antioxidant capacity, and physical properties were evaluated in raw quinoa flour and extruded snacks. Extrusion increased digestible starch (RDS) from 7.33 g/100 g bs to 77.33 g /100 g bs. Resistant starch (RS) showed a variation of 2 g/100 g bs. It is noteworthy that protein digestibility increased up to 94.58 g/100 bs after extrusion and baking. These processes increased HPP content, while EPP and carotenoid content decreased. The samples showed significant differences (p < 0.05) in the antioxidant properties determined through the DPPH and ABTS methods. Values of 19.72 ± 0.81 µmol T/g were observed in snacks and 13.16 ± 0.2 µmol T/g in raw flour, but a reduction of up to 16.10 ± 0.68 µmol T/g was observed during baking. The baking process reduced the work of crispness (Wcr) from 0.79 to 0.23 N.mm, while the saturation (C*) was higher in baked ones, showing higher color intensity. The baking process did not influence the viscosity profile. The results in this study respond to the growing interest of the food industry to satisfy consumer demand for new, healthy, and expanded gluten-free snacks with bioactive compounds.

Biobased Spore Microcapsules for Asphalt Self-Healing.

Asphalt pavements and bituminous composites are majorly damaged by bitumen aging and fatigue cracking by traffic load. To add, maintenance and reparation of asphalt pavements is expensive and also releases significant amounts of greenhouse gases. These issues can be mitigated by promoting asphalt self-healing mechanisms with encapsulated rejuvenators. The ability of the required microcapsules to be resilient against high temperatures, oxidation, and mechanical stress is essential to promote such self-healing behavior without compromising the field performance of the asphalt pavement. This work proposes, for the first time, the use of extremely resistant biobased spores for the encapsulation of recycled oil-based rejuvenators to produce more resilient self-healing pavements. Spore encapsulants were obtained from natural spores (Lycopodium clavatum) by applying different chemical treatments, which enabled the selection of the best morphologically intact and clean spore encapsulant. The physical, morphological, and physicochemical changes were examined using fluorescence images, ATR-FTIR, SEM, size distribution, XRD, TGA and DSC analyses. Sunflower oil was used as the encapsulated rejuvenator with an optimal sol colloidal mixture for sporopollenin-oil of 1:5 (gram-to-gram). Vacuum, passive, and centrifugal encapsulation techniques were tested for loading the rejuvenator inside the clean spores and for selecting the best encapsulation technology. The encapsulation efficiency and the profiles of the accelerated release of the rejuvenator from the loaded spores over time were studied, and these processes were visualized with optical and inverted fluorescence microscopy. Vacuum encapsulation was identified as the best loading technique with an encapsulation efficiency of 93.02 ± 3.71%. The rejuvenator was successfully encapsulated into the clean spores, as observed by optical and SEM morphologies. In agreement with the TGA and DSC, the microcapsules were stable up to 204 °C. Finally, a self-healing test was conducted through fluorescence tests to demonstrate how these biobased spore microcapsules completely heal a crack into an aged bitumen sample in 50 min.

Effect of the Addition of High-Protein Hydrolyzed Flour from Oncorhynchus mykiss Byproducts on the Properties of an Extruded Feed.

This work aims to evaluate the effect of the addition of a high-protein hydrolyzed (HPH) flour from the chemical silage of trout (Oncorhynchus mykiss) residues on the parameters of the extrusion system physicochemical transformations and the microstructure of the extrudate. During the extrusion process, the materials used for the study were the HPH flour obtained from trout by chemical silage, fishmeal, and cassava starch. The extrudate's microstructural changes were evaluated by determining the porosity, scanning electron microscopy, the chemical changes, the amino acid profile, residual formic and lactic acid content, the molecular mass profile, the grade of hydrolysis, and in vitro digestibility. The results showed pellets with high durability due to the cohesiveness of the hydrolyzed protein flour but at the same time with low hardness due to the high porosity achieved. The monitoring carried out to the changes in the protein, such as the degree of hydrolysis, water-soluble protein, and molecular mass profile, verify the binding effect of the high-protein hydrolyzed flour during the extrusion process. Finally, the high-resolution optical microscopy methodology presented a high correlation with the phenomena presented in the experiment.

Mortality in cutaneous malignant melanoma and its association with Neutrophil-to-Lymphocyte ratio.

INTRODUCTION: Cutaneous malignant melanoma (CMM) incidence has risen rapidly in the last 50 years. Poor progression and high mortality characterize CMM, making a thorough understanding of progression and associated factors essential for optimizing care. AIMS: We assessed the association between the Neutrophil-to-Lymphocyte Ratio (NLR) and mortality in adults with CMM from an entirely mixed-race Hispanic population during 12 consecutive years of extensive follow-up. MATERIAL & METHODS: We performed a retrospective cohort study in a tertiary hospital in Peru. NLR was categorized with a cutoff value higher or equal than 3. We collected demographic variables, laboratory results and treatments at baseline of follow-up. Cox regression analysis was performed, and we calculated crude and adjusted hazard ratios (HR) and their 95% confidence interval (95%CI). RESULTS: The analysis was from 615 CMM cases, and there were 378 deaths. Most melanomas (63.6%) were acral lentiginous. The crude analysis showed that high NLR is a risk factor for mortality, HR = 2.52; 95%CI (2.03-3.14). High NRL ratio remains statistically significant after adjusting for confounding variables, aHR = 1.61; 95%CI (1.16-2.24). Other risk factors for mortality were clinical stages III and IV, older than 60 years, females and greater Breslow thickness. CONCLUSIONS: We concluded that high NRL ratio is a risk factor for mortality and should be monitored in every patient who is diagnosed with malignant melanoma during their first blood count. It should then be carried out in follow-up controls for patients of clinical stage III and IV only, or in patients who present a relapse.

Propuesta de modelo de gestión de innovación para una empresa de ventas al consumidor final / Proposal of innovation management model for a final consumer sales company / Proposta de modelo de gestão de inovação para uma empresa de vendas ao consumidor final

Resumen Introducción: En el artículo se realiza el planteamiento de un modelo conceptual para la gestión de la innovación en una empresa de ventas al consumidor final Objetivos: Identificar patrones o consensos que permitan determinar cuál es el modelo adecuado de la gestión para la innovación en una empresa de venta al consumidor final, un modelo que fortalezca los procesos de la innovación, que permita a las empresas mejorar su posición competitiva y elevar su desempeño de innovación. Materiales y métodos: Para tal efecto se realizó un análisis de la literatura especializada a través de ecuaciones de búsqueda en la base de datos Scopus en modelos para la gestión de la innovación arrojando un total de 41 variables clave, posteriormente se generaron tres encuestas con preguntas cerradas en escala Likert las cuales se aplicaron a actores en innovación en empresas de ventas al consumidor final con el fin de priorizar las variables del modelo, ubicarlas dentro del concepto de entradas, proceso de transformación y salidas y priorizar los prototipos de modelos de gestión de innovación propuestos. Resultados: De acuerdo con el análisis de la información encontrada se definieron 26 variables críticas del modelo para este tipo de empresas, entre las más importantes se resaltan: co-working, capacidad digital con foco en consumidor, innovación abierta, análisis de información de cliente y consumidor, tendencias tecnológicas enfocadas en consumidor y visión a largo plazo de innovación. Conclusiones: De acuerdo con la revisión de artículos, patentes, documentos técnicos se encontraron un total de 41 variables relacionadas con un modelo de gestión de innovación de las cuales las 26 variables fueron priorizadas por los actores como altamente importantes en el modelo sugerido para empresas de venta al consumidor final, además, los lineamientos y metodología aplicada en el trabajo realizado, permiten tener mayor claridad sobre la propuesta a futuro de diseños de modelos específicos en gestión de la innovación para determinado sector.

Abstract In the article proposes a conceptual model for the management of innovation in a sales company to the final consumer, the objective of de paper is to identify patterns or consensus that allow to determine which is the appropriate model of management for innovation in a sales company to the final consumer, a model that strengthens innovation processes, which allows companies to improve their competitive position and raise its innovation performance, for that effect, an analysis of specialized literature was made through search equations in the database Scopus regarding management innovation models, throwing a total of 41 key variables. Later, three surveys were generated with closed questions in scale Likert which were applied to experts in innovation in sales companies to the final consumer in order to prioritize the variables of the Model, locate them within the concept of inputs, process transformation and outputs, and prioritize the prototypes of proposed innovation management models, according to the analysis of the information, 26 critical variables of the model were found and defined for this type of companies. Amongst the most important are: co-working, digital capacity with a focus on consumers, open innovation, customer and consumer information analysis, consumer-focused technology trends and long-term innovation vision. a total of 41 variables related to an innovation management model were found, of which the 26 variables were prioritized by the actors as highly important in the model suggested for a sales companies to the final consumer, in addition, the guidelines and methodology applied in the work done, allow to have greater clarity about the future proposal of designs of specific models in innovation management for a given sector.

Resumo Este artigo apresenta a abordagem de um modelo conceitual para a gestão da inovação numa empresa de vendas ao consumidor final. O objetivo do artigo é identificar patrões ou acordos que permitam determinar qual é o modelo adequado da gestão para a inovação numa empresa de venda ao consumidor final, que fortaleça os processos da inovação, que permita ás empresas melhorar sua posição competitiva e elevar seu desempenho de inovação; para tal efeito realizou-se um análise da literatura especializada através de equações de pesquisa na base de dados Scopus em modelos para a gestão da inovação jogando um total de 41 variáveis chave, posteriormente geraram-se três pesquisas com questões fechadas na escala Likert que aplicaram-se em atores de inovação em empresas de vendas ao consumidor final com o fim de priorizar as variáveis do modelo, coloca-las no conceito de entradas, processo de transformação e saídas e priorizar os protótipos de modelos de gestão de inovação propostos. Segundo o análise da informação encontrada definiram-se 26 variáveis críticas do modelo para este tipo de empresas, entre as mais importantes destacam-se: co-working, capacidade digital com foco no consumidor, inovação aberta, análise de informação de cliente e consumidor, tendências tecnológicas focadas no consumidor e visão ao longo prazo de inovação. Um total de 41 variáveis foram encontradas no modelo de gestão de inovação das quais 26 variáveis foram priorizadas pelos atores como altamente importantes no modelo sugerido para empresas de venta ao consumidor final, além, os lineamentos e metodologia aplicada no trabalho realizado, permitem ter maior claridade sobre a proposta para futuro de desenhos de modelos específicos na gestão da inovação para determinado setor.

Oncoplastic surgery for the conservative treatment of breast cancer in Perú's National Cancer Institute.

BACKGROUND: Oncoplastic surgery for breast cancer (OPS) has been a surgical trend for the past 25 years. In 2012, OPS has been introduced as the standard treatment for a selected group of patients at the National Cancer Institute of Peru (INEN). The aim of this study is to describe our findings. METHODS: This is a retrospective and descriptive study that identified demographics, tumour-pathologic features and includes patients solely treated since diagnosis until late follow-up at INEN. These OPS patients were identified from the conservative treatment patients group by review of medical charts and creation of a database for periods December 2005 through December 2015. RESULTS: A total of 146 patients were ruled in by the inclusion criteria. All patients were Peruvian females, 56.2% being 51 or older. 93.8% had core biopsy diagnosis of breast cancer and 52.1% located at the upper outer quadrant. 79.5% patients had upfront OPS and the round block (43.2%) and reduction/mastopexy (23.3%) were the most used techniques. pT2 was the most frequent size (54.7%). We achieved negative margins in 134 patients (93.2%) in a single procedure. Of 29 patients, who had neoadjuvant treatment, 11 achieved pCR. Only 5.5% had pN2 or higher. 95.2% received complimentary external beam radiotherapy. CONCLUSIONS: OPS has proven to be a reliable surgical option, both for aesthetic and oncologic outcomes. Important points for achieving these results are breast surgeons having properly trained under the OPS philosophy and knowing the patients' characteristics for correct technique selection.

Absceso subpectoral como diagnóstico diferencial de hombro doloroso: reporte de un caso / Subpectoral abscess as a differential diagnosis of painful shoulder: a case report

Los síndromes dolorosos del hombro son relativamente comunes en la práctica clínica. Habitualmente son causados por un número limitado de patologías. Dentro de los diagnósticos diferenciales, el pinzamiento subacromial, las lesiones aisladas del manguito rotador, capsulitis adhesiva, tendinitis cálcica, patología degenerativa de las articulaciones glenohumeral y acromioclavicular, y la inestabilidad crónica del hombro, son causas comunes. Causas infrecuentes son la rotura del tendón del bíceps, neuralgias, patología infecciosa articular y tumores del hombro. Un absceso subpectoral sin sintomatología infecciosa clara es una causa extremadamente rara de hombro doloroso en el adulto. Presentamos el caso de un paciente de 60 años, que inicia con un cuadro de hombro doloroso cuya causa se identifica como un absceso subpectoral por staphylococcus aureus que se maneja con drenaje quirúrgico y tratamiento antibiótico endovenoso con buenos resultados.

Painful shoulder syndromes are commonly caused by a limited assortment of pathologies. Differential diagnosis include rotator cuff impingement syndrome, rotator cuff tears, adhesive capsulitis, calcific tendonitis, degenerative disease of the joint including acromio-clavicular and gleno-humeral joints and chronic instability. Less common causes are labral tears, biceps tendon rupture, soft tissue infection, neurologic disease, joint infection and shoulder tumors. A subpectoral abscess without infectious clinical features is a very rare cause of shoulder pain in adults. We present the case of a 52 years old male who develops a painful shoulder syndrome caused by a staphylococcus aureus subpectoral abscess, treated by surgical drainage and intravenous antibiotic therapy with good results.

Priority technologies and innovations in the fishing agribusiness by the year 2032. Foresight study through the Delphi method / Tecnologías prioritarias e innovaciones del sector pesquero para el año 2032. Estudo de prospectiva por el método Delphi / Tecnologias prioritárias e inovações no setor pesqueiro para o ano 2032. Estudo de prospectiva através do método Delphi

Abstract Introduction. This paper is presented in the framework of the project "Alternatives for the use of by-products derived from fishing agribusiness", Universidad del Cauca, through the research group: Harvesting of Byproducts and Agro-industrial Residues, ASUBAGROIN, which aims at the development and implementation of technologies and innovations for the use of by-products generated by the fishery activity, in order to improve research and innovation capacities in that specific subsector. Objective. The purpose of this paper is to prioritize innovations in fish by-products by consulting experts to identify innovation, technology and knowledge management activities for the institutions involved in the sector. Materials and methods. The methodology consisted in the application of the Delphi method through a structured and anonymous survey with national and international experts on topics related to the fish farming industry, using a questionnaire of 143 items divided in five groups, in order to choose priority topics. Results. The questionnaires were filled out by 37 experts from Colombia, Brazil, the United States, Mexico and Uruguay; a total of 54 priority themes were obtained, corresponding to 38 % of the topics presented. Among the topics of greatest consensus and mode are the formulation of concentrated foods, partial substitution of fishmeal, extrusion of concentrated foods, Omega-3 rich oil, probiotics, bioaccumulation, microalgae of fish processing wastewater, technological appropriation, technological evaluation, measurement of intellectual capital, innovation processes, and technological strategies. Conclusions. One of the main contributions of the study is the benefit for current players in the fish innovation system and new ones, such as technology development centers and new ventures, since they will have a route map of innovations on which to focus their investments and project initiatives.

Resumen Introducción. Este artículo se presenta en el marco del proyecto "Alternativas para el uso de subproductos derivados de la agroindustria piscícola", Universidad del Cauca, a través del grupo de investigación "Aprovechamiento de Subproductos, Residuos y Desechos Agroindustriales", ASUBAGROIN, relacionado con la aplicación de tecnologías e innovaciones para el uso de los subproductos generados por la actividad piscícola, con el fin de mejorar las capacidades de investigación e innovación en ese subsector específico. Objetivo. El propósito de este artículo es priorizar innovaciones en subproductos piscícolas a través de consulta a expertos, así como actividades de gestión de innovación, tecnología y conocimiento para las instituciones pertenecientes al sector. Materiales y métodos. La metodología utilizada consiste en la aplicación del método Delphi, a través de consulta anónima y estructurada a expertos nacionales e internacionales en temas relacionados con la industria piscícola, con un cuestionario de 143 ítems en 5 grupos, para elegir los temas prioritarios. Resultados. Los cuestionarios fueron diligenciados por 37 expertos de Colombia, Brasil, Estados Unidos, México y Uruguay; un total de 54 temas prioritarios fueron obtenidos correspondiente al 38 % de los temas presentados. Entre los temas de mayor consenso y moda están la formulación de alimentos concentrados, sustitución parcial de harina de pescado, extrusión de alimentos concentrados, aceite rico en Omega-3, probióticos, bioacumulación, microalgas de aguas residuales de procesamiento de pescado, apropiación tecnológica, evaluación tecnológica, medición de capital intelectual, proceso de innovación y estrategias tecnológicas. Conclusiones. Uno de las principales contribuciones del estudio está relacionada con los actuales actores del sistema de innovación piscícola y de los nuevos, tales como centros de desarrollo tecnológico y nuevos emprendimientos, ya que ellos tendrán un mapa de ruta de innovaciones sobre las cuales enfocar sus inversiones e iniciativas de proyectos.

Resumo Introdução. Este artigo se apresenta no marco do projeto "Alternativas para o uso de subprodutos derivados da agroindustria piscícola", Universidad del Cauca, através do grupo de investigação "Aproveitamento de Subprodutos, Resíduos e lixo Agroindustriais", ASUBAGROIN, relacionado com a aplicação de tecnologias e inovações para o uso dos subprodutos gerados pela atividade piscícola, com o fim de melhorar as capacidades de investigação e inovação nesse subsetor específico. Objetivo. O propósito deste artigo é priorizar inovações em subprodutos piscícolas através de consulta a especialistas, assim como atividades de gestão de inovação, tecnologia e conhecimento para as instituições pertencentes ao setor. Materiais e métodos. A metodologia utilizada consiste na aplicação do método Delphi, através de consulta anónima e estruturada a especialistas nacionais e internacionais em assuntos relacionados com a indústria piscícola, com um questionário de 143 itens em 5 grupos, para eleger os assuntos prioritários. Resultados. Os questionários foram diligenciados por 37 especialistas da Colómbia, Brasil, Estados Unidos, México e Uruguai; um total de 54 assuntos prioritários foram obtidos correspondente a 38 % dos assuntos apresentados. Entre os assuntos de maior consenso e moda estão a formulação de alimentos concentrados, substituição parcial de farinha de peixe, extrusão de alimentos concentrados, aceite rico em Omega-3, probióticos, bio-acumulação, microalgas de águas residuais de processamento de peixe, apropriação tecnológica, avaliação tecnológica, medição de capital intelectual, processo de inovação e estratégias tecnológicas. Conclusões. Um das principais contribuições do estudo está relacionada com os atuais atores do sistema de inovação piscícola e dos novos, tais como centros de desenvolvimento tecnológico e novos empreendimentos, já que eles terão um mapa de rota de inovações sobre as quais enfocar seus investimentos e iniciativas de projetos.

[Core competencies in public health: a regional framework for the Americas]. / Competencias esenciales en salud pública: un marco regional para las Américas.

The response is described to the 2010 call from the Pan American Health Organization to develop a Regional Framework on Core Competencies in Public Health, with a view to supporting the efforts of the countries in the Americas to build public health systems capacity as a strategy for optimal performance of the Essential Public Health Functions. The methodological process for the response was divided into four phases. In the first, a team of experts was convened who defined the methodology to be used during a workshop at the National Institute of Public Health of Mexico in 2010. The second phase involved formation of the working groups, using two criteria: experience and multidisciplinary membership, which resulted in a regional team with 225 members from 12 countries. This team prepared an initial proposal with 88 competencies. In the third phase, the competencies were cross-validated and their number reduced to 64. During the fourth phase, which included two workshops, in March 2011 (Medellín, Colombia) and June 2011 (Lima, Peru), discussions centered on analyzing the association between the results and the methodology.

Competencias esenciales en salud pública: un marco regional para las Américas / Core competencies in public health: a regional framework for the Americas

Se describe la respuesta a un llamado de la Organización Panamericana de la Salud, realizado en 2010, para conformar el Marco Regional de Competencias Esenciales en Salud Pública, con el propósito de apoyar a los Estados de las Américas en sus esfuerzos por fortalecer las capacidades de sus sistemas de salud pública, en tanto estrategia para el desempeño óptimo de las Funciones Esenciales de Salud Pública. El proceso metodológico de dicha respuesta se dividió en cuatro fases. En la primera se convocó a un equipo de expertos que definieron la metodología a seguir durante un taller en el Instituto Nacional de Salud Pública de México en 2010. La segunda fase fue la constitución de grupos de trabajo, utilizando dos criterios: experiencia y composición multidisciplinaria, lo cual derivó en un equipo regional con 225 integrantes de 12 países. Estos equipos elaboraron una propuesta inicial de 88 competencias. En la tercera fase se realizó una validación cruzada de las competencias, cuyo número se redujo a 64. Durante la cuarta fase, que incluyó dos talleres en marzo (Medellín, Colombia) y junio (Lima, Perú) de 2011, las discusiones se centraron en analizar la correspondencia de los resultados con la metodología.

The response is described to the 2010 call from the Pan American Health Organization to develop a Regional Framework on Core Competencies in Public Health, with a view to supporting the efforts of the countries in the Americas to build public health systems capacity as a strategy for optimal performance of the Essential Public Health Functions. The methodological process for the response was divided into four phases. In the first, a team of experts was convened who defined the methodology to be used during a workshop at the National Institute of Public Health of Mexico in 2010. The second phase involved formation of the working groups, using two criteria: experience and multidisciplinary membership, which resulted in a regional team with 225 members from 12 countries. This team prepared an initial proposal with 88 competencies. In the third phase, the competencies were cross-validated and their number reduced to 64. During the fourth phase, which included two workshops, in March 2011 (Medellín, Colombia) and June 2011 (Lima, Peru), discussions centered on analyzing the association between the results and the methodology.

Diagnóstico y tratamiento de las lesiones no palpables de la mama en el Instituto Nacional de Enfermedades Neoplásicas durante el año 2010 / Diagnosis and treatment of non palpable lesions of the breast at the Instituto Nacional de Enfermedades Neoplasicas diseases during 2010

Se revisaron los registros de 211 pacientes con lesiones no palpables sometidos a cirugía en el año 2010 en el Instituto Nacional de Enfermedades Neoplásicas. La edad promedio del grupo fue 50.82 años, 41.2% eran pre menopausicas y 57,8% post menopausicas, 20.4%(43 pacientes) tenían antecedente familiar de cáncer de mama. 130 biopsias (61.6%) fueron realizadas bajo guía ecográfica, 41(19.4%) guiadas por mamografía (arpón) y 40 (19%) correspondieron a resección de conductos terminales. 168 procedimientos (79.6%) fueron realizadas en cirugía menor con anestesia local, 24 procedimientos (11,4%)en sala de operaciones con anestesia general y 19 (9%) en cirugía menor con sedación. Se diagnosticaron 37 casos de cáncer (17,5% del total de casos registrados en la serie). 23 de los cuales fueron sometidos a cirugía de conservación y 8 a tratamiento radical.

We reviewed the records of 211 patients with nonpalpable lesions underwent surgery in 2010 at the Peruvian National Cancer Institute. The average age group was 50.82 years, 41.2% were premenopausal and postmenopausal 57.8%, 20.4% (43 patients) had family history of breast cancer. 130 biopsies (61.6%) were performed under ultrasound guidance, 41 (19.4%) guided by mammography (Howpkins needle) and 40 (19%) were terminal duct resection. 168 procedures (79.6%) were performed in minor surgery under local anesthesia, 24 procedures (11.4%) in the operating room under general anesthesia and 19 (9%) in minor surgery with sedation. We diagnosed 37 cases of cancer (17.5% of total cases in the series). 23 of whom underwent conservation surgery and 8 radical treatment.

Caries prevalence and its association with brushing habits, water availability, and the intake of sugared beverages.

BACKGROUND. With Dental Caries being the most common disease amongst children in the world today, there is a need to fully understand risk factors that may be related to caries prevalence and how they could be best addressed. AIM. The aim of this study was to evaluate soda, juice, sugared-beverage intake, brushing habits, and community water source availability as they relate to the prevalence of both noncavitated and cavitated caries lesions in small rural villages in Mexico. DESIGN. The International Caries Detection and Assessment System (ICDAS) was used in children from small, isolated, villages in Mexico. Risk factors were assessed via questionnaires. RESULTS. Caries prevalence in the villages was very high, ranging from 94.7% to 100% of the children studied. The mean number of surfaces with lesions per child (D1MFS + d1mfs) having scores ≥1 (noncavitated and cavitated) ranged from 15.4 ± 11.1 to 26.6 ± 15.2. Many of the children reported drinking beverages containing sugar. CONCLUSIONS. Drinking sugared beverages, poor oral hygiene habits, and lack of access to tap water were identified as risk factor for caries in this sample of residents of rural Mexico.

Carcinoma epidermoide de piel de tronco y extremidades: experiencia en el Instituto Nacional de Enfermedades Neoplásicas / Squamous cell carcinoma of skin of trunk and extremities: experience at the National Institute of Neoplastic Diseases

El carcinoma de células escamosas de la piel constituyen aproximadamente el 20% de los casos de cáncer de piel. Los objetivos de este estudio fueron determinar la frecuencia de carcinoma de células escamosas de la piel de tronco y las extremidades, el cálculo de la supervivencia global y determinar los factores que influyen en el pronóstico.