Clinical Review of Non-invasive Ventilation.

Noninvasive ventilation (NIV) is the mainstay to treat patients who need augmentation of ventilation for acute and chronic forms of respiratory failure. The last several decades has witnessed an extension of the indications for NIV to a variety of acute and chronic lung diseases. Evolving advancements in technology and personalised approaches to patient care make it feasible to prioritise patient centered care models that deliver home-based management using telemonitoring and telemedicine systems support. These trends may improve patient outcomes, reduce healthcare costs, and improve the quality of life for patients who suffer from chronic diseases that precipitate respiratory failure.

Stent Duodenal in Malignant Obstruction of the Gastric Outflow Tract in a Reference Center in Cundinamarca: Case Series / Stent duodenal en obstrucción maligna del tracto de salida gástrico en un centro de referencia de Cundinamarca: serie de casos

Abstract Objective: To describe the experience of the insertion of the duodenal stent in patients with malignant obstruction of the gastric outflow tract in a third-level reference center in Cundinamarca. Materials and methods: Observational study, case series. Patients with Malignant gastric outlet obstruction (MGOO) diagnosed between December 2019 and February 2022 underwent the insertion of a self-expanding duodenal metal stent in the Gastroenterology unit of Hospital Universitario de la Samaritana. Results: 17 patients were enrolled, 76% of whom were male, with a mean age of 69 years (standard deviation [SD]: 11 years). Histology confirmed gastric adenocarcinoma was found in 82% of the patients, and 41% reported peritoneal carcinomatosis. We achieved total technical success (100%) and clinical success (88%) (15 patients). Regarding the size of the stent used, 35% (6 patients) were 12 cm, 53% (9 patients) were 9 cm, and 12% (2 patients) were 6 cm. Fluoroscopic and endoscopic guidance was used in 88% of cases. Patient survival at follow-up was an average of 84 days (2.8 months; range: 0-414 days) and currently, 1 patient continues in post-insertion surveillance for stent at the time described in the study. Conclusion: Duodenal stent is an effective and safe palliative management alternative in patients with MGOO that improves symptoms, particularly, oral tolerance and early hospital discharge in this group of patients (with advanced terminal neoplastic disease in the palliative management phase), reducing the need for surgical management.

Resumen Objetivo: Describir la experiencia de la inserción del stent duodenal en pacientes con obstrucción maligna del tracto de salida gástrico en un centro de referencia de tercer nivel de Cundinamarca. Materiales y métodos: Estudio observacional, serie de casos. Pacientes con obstrucción maligna del tracto de salida gástrico (OTSG) diagnosticados entre diciembre de 2019 y febrero de 2022 llevados a inserción de stent metálico autoexpandible duodenal en la unidad de Gastroenterología del Hospital Universitario de la Samaritana. Resultados: 17 pacientes fueron incluidos, de los cuales el 76 % eran hombres, con una edad promedio de 69 años (desviación estándar [DE]: 11 años). Se encontró adenocarcinoma gástrico confirmado por histología en el 82 % de los pacientes, y el 41 % tenía carcinomatosis peritoneal. El éxito técnico fue del 100 % y el éxito clínico fue del 88 % (15 pacientes). En cuanto al tamaño del stent utilizado, el 35 % (6 pacientes) fue de 12 cm, el 53 % (9 pacientes) de 9 cm y el 12 % (2 pacientes) de 6 cm. Se utilizó guía fluoroscópica y endoscópica en el 88 % de los casos. La sobrevida de los pacientes en el seguimiento fue en promedio de 84 días (2,8 meses; rango: 0-414 días) y actualmente 1 paciente continúa en vigilancia posterior a la inserción de stent en el tiempo descrito del estudio. Conclusión: El stent duodenal es una alternativa de manejo paliativo efectiva y segura en los pacientes con OTSG que permite mejorar los síntomas y, en especial, la tolerancia a la vía oral y el egreso hospitalario temprano en este grupo de pacientes con una enfermedad neoplásica avanzada terminal en fase de manejo paliativo, lo que disminuye la necesidad de manejo quirúrgico.

Model-based impact evaluation of new tuberculosis vaccines in aging populations under different modeling scenarios: the case of China.

Introduction: The slow descent in TB burden, the COVID-19 pandemic, along with the rise of multidrug-resistant strains of Mycobacterium tuberculosis, seriously threaten TB control and the goals of the End TB strategy. To fight back, several vaccine candidates are under development, with some of them undergoing the phases 2B and 3 of the development pipeline. The impact of these vaccines on the general population needs to be addressed using disease-transmission models, and, in a country like China, which last year ranked third in number of cases worldwide, and where the population is aging at a fast pace, the impact of TB vaccination campaigns may depend heavily upon the age of targeted populations, the mechanistic descriptions of the TB vaccines and the coupling between TB dynamics and demographic evolution. Methods: In this work, we studied the potential impact of a new TB vaccine in China targeting adolescents (15-19 y.o.) or older adults (60-64 y.o.), according to varying vaccine descriptions that represent reasonable mechanisms of action leading to prevention of disease, or prevention of recurrence, each of them targetting specific routes to TB disease. To measure the influence of the description of the coupling between transmission dynamics and aging in TB transmission models, we explored two different approaches to compute the evolution of the contact matrices, which relate to the spreading among different age strata. Results: Our findings highlight the dependence of model-based impact estimates on vaccine profiles and the chosen modeling approach for describing the evolution of contact matrices. Our results also show, in line with previous modeling works, that older adult vaccination is a suitable option in China to reduce the incidence of TB as long as the vaccine is able to protect already exposed individuals. Discussion: This study underscores the importance of considering vaccine characteristics and demographic dynamics in shaping TB control strategies. In this sense, older adult vaccination emerges as a promising avenue for mitigating TB transmission in China but also remarks the need for tailored intervention strategies aligned with demographic trends.

Ecological risk assessment associated with five endocrine-disrupting compounds in wastewater treatment plants of Northeast Mexico.

The ecological risk associated with five endocrine-disrupting compounds (EDCs) was studied in four wastewater treatment plants (WWTPs) in Monterrey, Mexico. The EDCs, 17ß-estradiol (E2), 17α-ethinylestradiol (EE2), bisphenol A (BPA), 4-nonylphenol (4NP), and 4-tert-octylphenol (4TOP) were determined by SPE/GC-MS method, where EE2 and 4TOP were the most abundant in effluents at levels from 1.6 - 26.8 ng/L (EE2) and < LOD - 5.0 ng/L (4TOP), which corroborate that the wastewater discharges represent critical sources of EDCs to the aquatic environments. In this study, the potential risk associated with selected EDCs was assessed through the risk quotients (RQs) and by estimating the estrogenic activity (expressed as EEQ). This study also constitutes the first approach for the ecological risk assessment in effluents of WWTPs in Northeast Mexico. The results demonstrated that the effluents of the WWTPs represent a high risk for the organisms living in the receiving water bodies because the residual estrogens effect E2 and EE2 with RQ values up to 49.1 and 1165.2. EEQ values between 6.3 and 24.6 ngEE2/L were considered the most hazardous compounds among the target EDCs, capable of causing some alterations in the endocrine system of aquatic and terrestrial organisms due to chronic exposition.

Modeling the impact of COVID-19 on future tuberculosis burden.

Background: The ongoing COVID-19 pandemic has greatly disrupted our everyday life, forcing the adoption of non-pharmaceutical interventions in many countries and putting public health services and healthcare systems worldwide under stress. These circumstances are leading to unintended effects such as the increase in the burden of other diseases. Methods: Here, using a data-driven epidemiological model for tuberculosis (TB) spreading, we describe the expected rise in TB incidence and mortality if COVID-associated changes in TB notification are sustained and attributable entirely to disrupted diagnosis and treatment adherence. Results: Our calculations show that the reduction in diagnosis of new TB cases due to the COVID-19 pandemic could result in 228k (CI 187-276) excess deaths in India, 111k (CI 93-134) in Indonesia, 27k (CI 21-33) in Pakistan, and 12k (CI 9-18) in Kenya. Conclusions: We show that it is possible to reverse these excess deaths by increasing the pre-covid diagnosis capabilities from 15 to 50% for 2 to 4 years. This would prevent almost all TB-related excess mortality that could be caused by the COVID-19 pandemic if no additional preventative measures are introduced. Our work therefore provides guidelines for mitigating the impact of COVID-19 on tuberculosis epidemic in the years to come.

The COVID-19 pandemic has disrupted everyday life and put public health services and healthcare systems worldwide under stress. This has compromised the ability to control other diseases such as Malaria, Cancer and Tuberculosis. In this work we predict the rise in Tuberculosis occurrence and mortality when healthcare systems are impacted and diagnosis capabilities blocked in 4 countries where TB is prevalent. Our calculations show that an increase in new TB cases due to the COVID-19 pandemic could result in almost 400,000 additional deaths from TB in India, Indonesia, Pakistan and Kenya. We also show that increased diagnosis capabilities after the pandemic could reduce the additional deaths from TB resulting from the COVID-19 pandemic impact.

Serum and Urine Osmolality as Predictors of Adequate Diuresis in Acute Decompensated Heart Failure: A Prospective Cohort Study.

BACKGROUND: Determination of adequacy of decongestion remains a significant challenge in the management of acute heart failure (AHF). METHODS: This is a prospective single center cohort study of patients (>18 years old) admitted for AHF on intravenous diuretics, with BNP >100 pg/mL or echocardiographic findings of reduced ejection fraction or diastolic dysfunction, and at least 1 clinical sign of volume overload. Patients with eGFR ≤45 mL/min or on dialysis, and with exposure to contrast dye or nephrotoxins were excluded. Serum and spot urine osmolality were obtained in the early morning simultaneously daily for 5 days or until discharge. Receiver operating characteristic curves were used to analyze the optimal cutoffs for the osmolality values in the prediction of heart failure (HF) readmissions Results: Of the total 100 patients, 62% were male and 59% were Black American. The mean age was 64.41 ± 12.53 and 34% had preserved ejection fraction. Patients with 30-day readmission had higher serum osmolality (mOsm/kg) on admission (305 [299-310] vs. 298 [294-303]; p = 0.044) and had higher drop in serum osmolality between admission and discharge (-7.5 [-9.0, -1.25] vs. -1.0 [-4.0, 4.0]; p = 0.044). Serum osmolality on admission of >299 mOsm/kg (sensitivity: 83%, specificity: 61%) and drop in serum osmolality between admission and discharge of >2 mOsm/kg (sensitivity: 83%, specificity: 65%) was associated with 30-day HF readmissions. No patients discharged with urine osmolality more than 500 mOsm/kg had 30-day readmissions, but this was not statistically significant, p = 0.334. CONCLUSION: Measurement of serum osmolality and urine osmolality may have some utility in AHF, but interpretation should consider baseline values and dynamic changes to account for individual differences in sodium and water handling.

Anaphylaxis due to Hymenoptera sting progressing to thoracic aortic dissection.

Here we present an 83-year-old woman with truncal pain, hypoxemia, and nausea after a Hymenoptera sting. Due to progressive truncal pain, emergent computed tomography angiography was ordered and confirmed an acute Stanford type A aortic dissection extending from the aortic root and terminating in the left common iliac artery. She was emergently transferred to a quaternary care center and managed surgically. This case highlights anaphylaxis as a unique potential trigger of aortic dissection and the need for a high index of suspicion for early diagnosis.

Spectral Characteristics Related to Chemical Substructures and Structures Indicative of Organic Precursors from Fulvic Acids in Sediments by NMR and HPLC-ESI-MS.

The aim of this work was to determine Fulvic Acids (FAs) in sediments to better know their composition at the molecular level and to propose substructures and structures of organic precursors. The sediment samples were obtained from a priority area for the conservation of ecosystems and biodiversity in Mexico. FAs were extracted and purified using modifications to the International Humic Substances Society method. The characterization was carried out by 1D and 2D nuclear magnetic resonance (NMR) and high-performance liquid chromatography-electrospray ionization-mass spectrometry (HPLC-ESI-MS) in positive (ESI+) and negative (ESI-) modes. Twelve substructures were proposed by the COSY and HSQC experiments, correlating with compounds likely belonging to lignin derivatives obtained from soils as previously reported. The analysis of spectra obtained by HPLC-ESI-MS indicated likely presence of compounds chemically similar to that of the substructures elucidated by NMR. FAs studied are mainly constituted by carboxylic acids, hydroxyl, esters, vinyls, aliphatics, substituted aromatic rings, and amines, presenting structures related to organic precursors, such as lignin derivatives and polysaccharides.

Early psychological health outcomes among United States healthcare professionals, essential workers, and the general population during the COVID-19 pandemic: The influence of occupational status.

The primary purpose of this study was to determine variations in psychological experiences of the COVID-19 pandemic among US healthcare workers, non-healthcare essential workers, and the general population. A cross-sectional survey was conducted online from June 22, 2020 to July 5, 2020, with 5,023 participants aged 18 years and older. The prevalence of fear of COVID-19 and symptoms of depression, anxiety, and posttraumatic stress disorder were evaluated, using the Fear of COVID-19 Scale, Patient Health Questionnaire-8, Generalized Anxiety Disorder-7, and Posttraumatic Diagnostic Scale. Generalized linear mixed-effects models were used to explore sociodemographic and COVID-19-related risk factors. Using models unadjusted for working status, it was found healthcare workers endorsed less fear of COVID-19, depression, and PTSD symptoms, than the general public. After adjusting for working status, no further significant differences were found between occupational groups. Across all psychological distress outcomes, those who were not working or were unemployed due to COVID-19 reported more symptoms than did individuals who continued to work from their normal location or remotely. A similar trend was found for nurses and physicians, with members of both groups reporting symptoms of depression, anxiety, and PTSD less when working from their normal location than when unemployed due to COVID-19.

Occurrence and seasonal distribution of five selected endocrine-disrupting compounds in wastewater treatment plants of the Metropolitan Area of Monterrey, Mexico: The role of water quality parameters.

Five endocrine-disrupting compounds (EDCs) were determined in four urban wastewater treatment plants (WWTPs) of the Metropolitan Area of Monterrey (MAM) in two seasonal periods (winter and summer). The MAM, one of the most urbanized areas in Mexico, is characterized by high industrial activity and population density, leading to extensive use of several EDCs. In the MAM, ∼90% of urban and industrial wastewater is treated in WWTPs, where EDCs can be partially eliminated. In this work, dissolved levels of 17ß-estradiol (E2), 17α-ethinyl estradiol (EE2), bisphenol A (BPA), 4-nonylphenol (4NP), and 4-tert-octylphenol (4TOP) in wastewater were determined. The EDCs' determination was carried out through solid-phase extraction (SPE) and gas chromatography coupled to mass spectrometry (GC-MS). High EDCs levels (0.4-450 ng/L) were found in the influents of WWTPs, while concentrations in the effluents ranged from 0.2 to 26.8 ng/L, with E2, EE2, and 4TOP being the most persistent. The Spearman correlation analysis revealed the association between E2 and EE2 (r = 0.4835, p < 0.05), and between BPA and 4NP (r = 0.5180, p < 0.05), suggesting that these EDCs have similar sources. Also, E2, BPA, and 4TOP were positively correlated with the chemical oxygen demand (COD), biochemical oxygen demand (BOD), and total suspended solids (TSS) (r = 0.4080-0.5694, p < 0.05), indicating the association of the EDCs with the organic matter in the wastewater. The factor analysis confirmed the significant correlation of COD, BOD, TSS, temperature, and pH with the high occurrence of 4TOP during the summer. It was also confirmed that summer warmer temperatures favored the removal of BPA and 4NP in the studied WWTPs. Finally, the studied sites were classified by cluster analysis in three groups, revealing the impact that seasonality has on the behavior of the selected EDCs.

Tamización para el virus de la hepatitis C en tres hospitales de Cundinamarca, Colombia / Screening for hepatitis C virus in three hospitals in Cundinamarca, Colombia

Introducción. La infección por el virus de la hepatitis C (VHC) es un problema de salud pública en el mundo. La Organización Mundial de la Salud (OMS) calcula en más de 70 a 100 millones las personas infectadas. La mayoría de ellas, a lo largo del mundo entero, no han sido diagnosticadas y permanecen sin tratamiento. Objetivo. Determinar la prevalencia de anticuerpos contra el VHC en pacientes con factores de riesgo para la infección, en tres hospitales del departamento de Cundinamarca, Colombia, mediante la prueba rápida SD Bioline en sangre capilar, y la confirmación de la infección por la prueba de ARN-PCR en tiempo real (PCR-RT). Metodología. Estudio de tipo observacional descriptivo donde se incluyeron pacientes adultos atendidos en los servicios de consulta externa de los hospitales de La Mesa, Ubaté y Zipaquirá. Se definieron como factores de riesgo para hepatitis C: antecedente transfusional antes de 1996, cirugías mayores (tórax, abdomen, ortopédicas), tatuajes, piercing. Se empleó como prueba rápida el kit comercial SD Bioline HCV (Standard Diagnostics, INC. Corea). Esta prueba contiene una membrana recubierta con antígenos recombinantes del VHC (core, NS3, NS4, NS5). Resultados. Entre enero y octubre de 2018 se tamizaron 1.856 pacientes, 1.531 mujeres (82%) y 325 (18%) hombres, con edad promedio de 45 años y rango de edad de 18 a 89 años. Los principales factores de riesgo identificados fueron los antecedentes de cirugía y las transfusiones antes de 1996. Se detectaron 2 pacientes mujeres positivas, mayores de 50 años, y como factor de riesgo el haber sido sometidas a cirugía mayor y el antecedente transfusional antes de 1996, confirmadas por la técnica de PCR-RT, lo que da una prevalencia global de la infección del 0,1%, pero del 0,05% en las personas con antecedente quirúrgico, 0,25% entre los mayores de 50 años, y 0,6% en los pacientes con antecedente transfusional antes de 1996. Conclusiones. Este estudio realizado en una población seleccionada por factores de riesgo asociados, mostró una prevalencia global de infección por VHC de 0,1%. Nuestros resultados de tamización con prueba rápida en una población seleccionada con factores de riesgo, sugieren que la estrategia de tamización se debe dirigir a personas mayores de 50 años con antecedente transfusional y cirugía mayor.

Introduction. Infection with hepatitis C virus (HCV) is a worldwide public health problem. The World Health Organization (WHO) estimates that more than 70 to 100 million people are infected. Most of them, throughout the world, have not been diagnosed and remain untreated. Objective. To determine the prevalence of antibodies against HCV in patients with risk factors for infection, in three hospitals in the department of Cundinamarca, Colombia, by means of the rapid SD Bioline test in capillary blood, and the confirmation of infection by real-time PCR (RT-PCR). Methodology. Adult patients treated in the outpatient services of the La Mesa, Ubaté and Zipaquirá hospitals. Risk factors for hepatitis C were defined as: transfusion history before 1996, major surgeries (chest, abdomen, orthopedic), tattoos, and piercing. The commercial SD Bioline HCV kit (Standard Diagnostics, INC. Korea) was used as the rapid test. This kit contains a membrane coated with recombinant HCV antigens (core, NS3, NS4, NS5). Results. Between January and October 2018, 1,856 patients were screened, 1,531 women (82%) and 325 (18%) men, with an average age of 45 years and an age range of 18 to 89 years. The main risk factors identified were a history of surgery and transfusions before 1996. Two positive female patients were detected, older than 50 years, and as a risk factor, having undergone major surgery and a history of transfusion before 1996, confirmed by the RT-PCR assay, which gives a global prevalence of infection of 0.1%, but of 0.05% in people with surgery history, 0.25% among those over 50 years of age, and 0.6% in patients with a transfusion history before 1996. Conclusions. This study, carried out in a population selected for associated risk factors, showed an overall prevalence of HCV infection of 0.1%. Our results suggest that screening with a rapid test in a selected population with risk factors should be directed at people over 50 years of age with a history of transfusion and major surgery.

Beneficios de la ludoterapia en el deterioro cognitivo de adultos mayores en una casa de reposo de Aguascalientes / Benefits of ludotherapy in elderly cognitive decline in a Aguascalientes rest home

Introducción: durante el envejecimiento se producen cambios a nivel biológico, psicológico y social convirtiendo a los individuos susceptibles a desarrollar deterioro cognitivo. Se ha implementado la ludoterapia para fomentar la afectividad, creatividad y sociabilidad en el adulto mayor. El juego favo-rece la descarga de energía y tensión, pues facilita el proceso de estimulación cognitiva. Objetivo: identificar los beneficios de la ludoterapia en el deterioro cognitivo de adultos mayores en una casa de reposo de Aguascalientes. Material y métodos: estudio relacional, cuasi experimental, longitudinal y prospectivo, con muestra no probabilística por criterios de 19 adultos mayores de dos estancias geriátricas de Aguascalientes, que participaron en una intervención lúdica de 6 semanas, fueron evaluados con el Mini examen del estado mental de Folstein en tres momentos temporales (preintervención, posintervención in-mediata y posintervención tardía). Para el análisis de datos se utilizó el paquete estadístico SPSS 25, usando la prueba estadística de rangos con signo Wilcoxon. Resultados: los adultos mayores mejoran su rendimiento cognitivo en las evaluaciones posteriores a la ludoterapia (W= -3.85; p=0.0002), los beneficios permanecen después de 6 semanas del programa (W= -3.53; p=0.0004). Conclusión: el funcionamiento cognitivo de los adultos mayores en una casa de reposo mejora y se mantiene al desarrollar actividades lúdicas, fomentando la interacción social y la diversión.

Embarazo y lesión hepática inducida por medicamentos. Reporte de un caso y revisión de la literatura / Pregnancy and drug-induced liver injury. Case report and literature review

La lesión hepática inducida por medicamentos o DILI (del inglés, Drug-Induced Liver Injury) es una condición relativamente rara, y más aún durante el embarazo. Usualmente es subdiagnosticada, y cuando se presenta en nuestro medio, pocas veces es notificada a los sistemas de registros nacionales, con un importante subregistro a nivel nacional y de Latinoamérica. Su forma de presentación clínica, tiempo de latencia, patrón de lesión hepática y reacciones idiosincráticas dificultan el diagnóstico oportuno, así como la ausencia tanto de pruebas diagnósticas objetivas, como de cambios histológicos patognomónicos que confirmen esta entidad. Se presenta el primer caso reportado en la literatura de una mujer en primer trimestre de gestación, quien cursó con DILI secundario al uso de tionamidas por sospecha clínica de hipertiroidismo.

Drug-induced liver injury (DILI) is a relative rare condition among general population and among pregnant women. It is usually underdiagnosed, and when identified, it is rarely notified to the national registry systems, especially locally, and in general in Latin America. Clinical presentation, time before symptom onset, patterns of liver injury and idiosyncratic reactions make an early diagnosis difficult, as well as the absence of diagnostic tests or histological changes that are unique to this pathology to confirm the diagnosis. We present the first case reported in the literature of a woman, who during the first trimester of pregnancy presented with DILI, secondary to the use of thionamides due to suspected hyperthyroidism.

Bridging the gap between efficacy trials and model-based impact evaluation for new tuberculosis vaccines.

In Tuberculosis (TB), given the complexity of its transmission dynamics, observations of reduced epidemiological risk associated with preventive interventions can be difficult to translate into mechanistic interpretations. Specifically, in clinical trials of vaccine efficacy, a readout of protection against TB disease can be mapped to multiple dynamical mechanisms, an issue that has been overlooked so far. Here, we describe this limitation and its effect on model-based evaluations of vaccine impact. Furthermore, we propose a methodology to analyze efficacy trials that circumvents it, leveraging a combination of compartmental models and stochastic simulations. Using our approach, we can disentangle the different possible mechanisms of action underlying vaccine protection effects against TB, conditioned to trial design, size, and duration. Our results unlock a deeper interpretation of the data emanating from efficacy trials of TB vaccines, which renders them more interpretable in terms of transmission models and translates into explicit recommendations for vaccine developers.

Complete Genome Sequence of Cluster A1 Mycobacterium smegmatis Bacteriophage Arlo.

Mycobacteriophage Arlo is a newly isolated Siphoviridae bacteriophage isolated from soil samples collected in Bluff Dale, Texas. Mycobacteriophage Arlo has a 52,960 base-pair double-stranded DNA genome that is predicted to contain 96 protein-coding genes. Mycobacteriophage Arlo is related to mycobacteriophage DD5 and other cluster A1 bacteriophages.

Currículo para la administración de sedación fuera del quirófano en pacientes mayores de 12 años / Curriculum for the administration of sedation outside the operating room in patients over 12 years of age ,

Abstract Introduction: The "Curriculum for the administration of sedation outside the OR in patients over 12 years of age" was developed by the Universidad Nacional de Colombia, by invitation of the Colombian Society of Anesthesiology and Resuscitation - S.C.A.R.E. Objective: Identify the essential knowledge and the skills required by practitioners for the safe and effective administration of sedation to develop of a curriculum for the administration of sedation outside the operating room in patients over 12 years of age. Materials and methods: The curriculum was developed based on the methodological guiding principles of the Clinical Practice Guidelines for the administration of sedation outside the OR, using the PICO approach, in addition to the recommendations according to levels of evidence under the GRADE methodology. Results: The Curriculum was designed with ten (10) recommendations about the competencies that the professional administering sedation to patients older than 12 years of age must have, for diagnostic or therapeutic procedures outside the OR. Conclusions: The Curriculum collects the best available evidence with a view to determine the competencies that the professional administering sedation to patients older than 12 years old shall develop, for diagnostic or therapeutic procedures outside the OR, and hence to contribute to improved quality, reducing the variability and morbidity of patients requiring sedation outside the OR.

Resumen Introducción: El «Currículo para 1a administración de sedación fuera del quirófano en pacientes mayores de 12 años¼ fue desarrollado por la Universidad Nacional de Colombia por convocatoria de la Sociedad Colombiana de Anestesia y Reanimación (S.C.A.R.E.). Objetivo: Identificar los conocimientos indispensables y las competencias necesarias en los profesionales proveedores para que administren sedación de manera segura y efectiva para el desarrollo de un currículo para la administración de sedación fuera del quirófano en pacientes mayores de 12 años. Materiales y métodos: La construcción del Currículo se basó en los lineamientos metodológicos de la Guía Práctica Clínica para la administración de sedación fuera del quirófano en pacientes mayores de 12 años (publicada en este número), en los resultados de la búsqueda sistemática de la literatura orientada por la pregunta PICO y en la formulación de recomendaciones según niveles de evidencia graduados bajo la metodología GRADE. Resultados: Se desarrolló el Currículo con 10 recomendaciones de las competencias que debe tener el profesional que administra sedación a los pacientes mayores de 12 años para procedimientos diagnósticos o terapéuticos fuera del quirófano. Conclusiones: El Currículo recoge la mejor evidencia disponible, con el propósito de determinar las competencias que debe desarrollar el profesional que administra sedación a los pacientes mayores de 12 anos sometidos a procedimientos diagnósticos o terapéuticos fuera del quirófano, y así contribuir a mejorar la calidad, disminuir la variabilidad y la morbilidad de los pacientes que requieran sedación fuera del quirófano.

Influence of water salinity on genes implicated in somatic growth, lipid metabolism and food intake in Pejerrey (Odontesthes bonariensis).

Pejerrey, Odontesthes bonariensis, is an euryhaline fish of commercial importance in Argentina. This work aimed to determine if water salinity affects the expression of genes involved in somatic growth (gh; ghr-I; ghr-II; igf-I), lipid metabolism (Δ6-desaturase) and food intake (nucb2/nesfatin-1). First, we identified the full-length cDNA sequences of Δ6-desaturase (involved in lipid metabolism) and nesfatin-1 (an anorexigen). Then, pejerrey juveniles were reared during 8weeks in three different water salinity conditions: 2.5g/L (S2.5), 15g/L (S15) and 30g/L (S30) of NaCl. Brain, pituitary, liver and muscle samples were collected in order to analyze mRNA expression. The expression of gh and ghr-II mRNAs increased in the pituitary of fish reared at S2.5 and S30 compared with the S15 group. The expression of ghr-I was higher in the liver of S30 group compared to S2.5 and S15. Igf-I mRNA expression in liver increased with the increment of water salinity, while it decreased in the muscle of S15 and S30 groups. Δ6-desaturase expression increased in S2.5 group compared to S15 in both liver and muscle. S30 caused a decrease in the Δ6-desaturase expression in liver compared to S15. The S30 treatment produced an increase in nucb2/nesfatin-1 mRNA expression in the brain and liver compared to S2.5 and S15. The changes in gene expression observed could help pejerrey perform better during salinity challenges. The S30 condition would likely promote pejerrey somatic growth in the long term.

Localized holes and delocalized electrons in photoexcited inorganic perovskites: Watching each atomic actor by picosecond X-ray absorption spectroscopy.

We report on an element-selective study of the fate of charge carriers in photoexcited inorganic CsPbBr3 and CsPb(ClBr)3 perovskite nanocrystals in toluene solutions using time-resolved X-ray absorption spectroscopy with 80 ps time resolution. Probing the Br K-edge, the Pb L3-edge, and the Cs L2-edge, we find that holes in the valence band are localized at Br atoms, forming small polarons, while electrons appear as delocalized in the conduction band. No signature of either electronic or structural changes is observed at the Cs L2-edge. The results at the Br and Pb edges suggest the existence of a weakly localized exciton, while the absence of signatures at the Cs edge indicates that the Cs+ cation plays no role in the charge transport, at least beyond 80 ps. This first, time-resolved element-specific study of perovskites helps understand the rather modest charge carrier mobilities in these materials.

Topological and histological description of preoptic area and hypothalamus in cardinal tetra Paracheirodon axelrodi (Characiformes: Characidae)

Topological and histological descriptions of the preoptic area and hypothalamus of the cardinal tetra Paracheirodon axelrodi were performed. Standard histological paraffin sections were used and stained with Nissl technique, and plastic sections for high-resolution optic microscopy (HROM). The preoptic area showed some differences related to the location of the magnocellular preoptic nucleus (PM) and the size of the neurons in this region, as they were the biggest in all the preoptic area. Additionally, within the preoptic area, the different structures that comprise the organum vasculosum of the lamina terminalis (OVLT) were identified and characterized. The hypothalamus could be subdivided in three regions - the ventral, the dorsal and the caudal hypothalamic regions - neuron morphology, size and staining pattern were similar in all of them.(AU)

ESUMEN Se realizó la descripción topológica e histológica del área preóptica e hipotálamo en el Neón cardenal Paracheirodon axelrodi. Se usaron cortes obtenidos con tecnicas histológicas estándar, coloreados con técnica de Nissl y secciones en resina con microscopía óptica de alta resolución (MOAR). El área preóptica muestra algunas diferencias relacionadas con la localización del núcleo preóptico magnocelular (PM) y el tamaño de algunas neuronas en esta región, puesto que estas eran las más grandes de toda el área preoptica. Adicionalmente, dentro del área preóptica, fue posible identificar y caracterizar las diferentes estructuras que componen el órgano vasculoso de la lámina media (OVLM). El hipotálamo puede sudividirse en tres zonas: la zona hipotalámica ventral, la zona hipotalámica dorsal y la zona hipotalámica caudal. La morfología de las neuronas de los núcleos que comprenden las diferentes zonas del hipotálamo tiene tamaño, forma y coloración similar.(AU)

Colestasis intrahepática benigna recurrente, un reto diagnóstico / Recurrent Benign Intrahepatic Cholestasis is a Diagnostic Challenge

La colestasis hepática incluye una gran variedad de desórdenes que pueden comprometer la vía intra o extrahepática, requiriendo para su diagnóstico una asociación de hallazgos clínicos, bioquímicos, imagenológicos y en algunos casos, patológicos. Se describe el caso de un paciente que presenta episodios intermitentes y autoresolutivos de ictericia recurrente asociados con dolor abdominal y prurito intenso, en quien se encuentra durante los episodios de agudización un patrón colestásico intrahepático que se resuelve completamente durante los episodios de remisión.

Hepatic cholestasis includes a large variety of disorders which can compromise the intrahepatic and extrahepatic pathways. Diagnosis requires a combination of clinical, biochemical, imaging, and sometimes pathological, findings. We describe the case of a patient with intermittent episodes of jaundice which resolved by themselves but which were and decisive associated with abdominal pain and severe itching. These episodes occurred during exacerbation of the intrahepatic cholestatic pattern but completely resolved during episodes of remission.