Phylogenetic and paleobotanical evidence for late Miocene diversification of the Tertiary subtropical lineage of ivies (Hedera L., Araliaceae).

BACKGROUND: Hedera (ivies) is one of the few temperate genera of the primarily tropical Asian Palmate group of the Araliaceae, which extends its range out of Asia to Europe and the Mediterranean basin. Phylogenetic and phylogeographic results suggested Asia as the center of origin and the western Mediterranean region as one of the secondary centers of diversification. The bird-dispersed fleshy fruits of ivies suggest frequent dispersal over long distances (e.g. Macaronesian archipelagos), although reducing the impact of geographic barriers to gene flow in mainland species. Genetic isolation associated with geographic barriers and independent polyploidization events have been postulated as the main driving forces of diversification. In this study we aim to evaluate past and present diversification patterns in Hedera within a geographic and temporal framework to clarify the biogeographic history of the genus. RESULTS: Phylogenetic (biogeographic, time divergence and diversification) and phylogeographic (coalescence) analyses using four DNA regions (nrITS, trnH-psbA, trnT-trnL, rpl32) revealed a complex spatial pattern of lineage divergence. Scarce geographic limitation to gene flow and limited diversification are observed during the early-mid Miocene, followed by a diversification rate increase related to geographic divergence from the Tortonian/Messinian. Genetic and palaeobotanical evidence points the origin of the Hedera clade in Asia, followed by a gradual E-W Asian extinction and the progressive E-W Mediterranean colonization. The temporal framework for the E Asia - W Mediterranean westward colonization herein reported is congruent with the fossil record. Subsequent range expansion in Europe and back colonization to Asia is also inferred. Uneven diversification among geographic areas occurred from the Tortonian/Messinian onwards with limited diversification in the newly colonized European and Asian regions. Eastern and western Mediterranean regions acted as refugia for Miocene and post-Miocene lineages, with a similar role as consecutive centers of centrifugal dispersal (including islands) and speciation. CONCLUSIONS: The Miocene Asian extinction and European survival of Hedera question the general pattern of Tertiary regional extinction of temperate angiosperms in Europe while they survived in Asia. The Tortonian/Messinian diversification increase of ivies in the Mediterranean challenges the idea that this aridity period was responsible for the extinction of the Mediterranean subtropical Tertiary flora. Differential responses of Hedera to geographic barriers throughout its evolutionary history, linked to spatial isolation related to historical geologic and climatic constraints may have shaped diversification of ivies in concert with recurrent polyploidy.

Burden of serious fungal infections in Guatemala.

Guatemala is a developing country in Central America with a high burden of HIV and endemic fungal infections; we attempted to estimate the burden of serious fungal infections for the country. A full literature search was done to identify epidemiology papers reporting fungal infections from Guatemala. We used specific populations at risk and fungal infection frequencies in the population to estimate national rates. The population of Guatemala in 2013 was 15.4 million; 40% were younger than 15 and 6.2% older than 60. There are an estimated 53,000 adults with HIV infection, in 2015, most presenting late. The estimated cases of opportunistic fungal infections were: 705 cases of disseminated histoplasmosis, 408 cases of cryptococcal meningitis, 816 cases of Pneumocystis pneumonia, 16,695 cases of oral candidiasis, and 4,505 cases of esophageal candidiasis. In the general population, an estimated 5,568 adult asthmatics have allergic bronchopulmonary aspergillosis (ABPA) based on a 2.42% prevalence of asthma and a 2.5% ABPA proportion. Amongst 2,452 pulmonary tuberculosis patients, we estimated a prevalence of 495 for chronic pulmonary aspergillosis in this group, and 1,484 for all conditions. An estimated 232,357 cases of recurrent vulvovaginal candidiasis is likely. Overall, 1.7% of the population are affected by these conditions. The true fungal infection burden in Guatemala is unknown. Tools and training for improved diagnosis are needed. Additional research on prevalence is needed to employ public health measures towards treatment and improving the reported data of fungal diseases.

Consensus document for multimodal intraoperatory neurophisiological monitoring in neurosurgical procedures. Basic fundamentals. / Documento de consenso para la monitorización neurofisiológica intraoperatoria multimodal en procedimientos neuroquirúrgicos. Fundamentos básicos.

The present work aims to establish a guide to action, agreed by anaesthesiologists and neurophysiologists alike, to perform effective intraoperative neurophysiological monitoring for procedures presenting a risk of functional neurological injury, and neurosurgical procedures. The first section discusses the main techniques currently used for intraoperative neurophysiological monitoring. The second exposes the anaesthetic and non-anaesthetic factors that are likely to affect the electrical records of the nervous system structures. This section is followed by an analysis detailing the adverse effects associated with the most common techniques and their use. Finally, the last section describes a series of guidelines to be followed upon the various intraoperative clinical events.

Updating the evidence for an association between anxiety and risk of Alzheimer's disease: A meta-analysis of prospective cohort studies.

OBJECTIVES: Anxiety is postulated to be a modifiable risk factor for Alzheimer's disease (AD). Our primary aim was to conduct a meta-analysis of prospective cohort studies investigating the association between anxiety and AD risk. DESIGN: We searched multiple scientific databases to identify relevant papers published up to March 2019. Inclusion criteria were: prospective cohort studies with a minimum follow-up period of 1 year, baseline anxiety assessment, absence of dementia at baseline, investigated the association between anxiety and AD incidence, and reporting Relative Risks (RRs), or equivalents (HRs and SHRs), for the association between anxiety and AD risk. We excluded studies that: focused on subjective memory or mild cognitive impairment samples, review and meta-analyses, not reporting original, published peer-reviewed results. We used a random-effects model that accommodated the differences in association statistics. RESULTS: 7 prospective cohorts (reported in 6 studies), with a total of 24,528 participants, were included in our meta-analysis. A marginally significant association between anxiety and AD risk was found, with a pooled RR of 1.45 (95% CI: 1.00-2.12), and a population attributable fraction for AD of 2.8% (95% CI: 1.2%-4.3%). LIMITATIONS: There was a high level of heterogeneity across the studies, which may be associated with differences in the covariates adjusted for. Studies also differed considerably in how they measured anxiety. CONCLUSION: Anxiety is marginally associated with an increased risk of AD in this meta-analysis. Future research is needed to determine the extent to which anxiety might be a cause of AD rather than a prodrome or marker.

Methyl-parathion decreases sperm function and fertilization capacity after targeting spermatocytes and maturing spermatozoa.

Paternal germline exposure to organophosphorous pesticides (OP) has been associated with reproductive failures and adverse effects in the offspring. Methyl-parathion (Me-Pa), a worldwide-used OP, has reproductive adverse effects and is genotoxic to sperm, possibly via oxidative damage. This study investigated the stages of spermatogenesis susceptible to be targeted by Me-Pa exposure that impact on spermatozoa function and their ability to fertilize. Male mice were exposed to Me-Pa (20 mg/kg bw, i.p.) and spermatozoa from epididymis-vas deferens were collected at 7 or 28 days post-treatment (dpt) to assess the effects on maturing spermatozoa and spermatocytes, respectively. Spermatozoa were examined for DNA damage by nick translation (NT-positive cells) and SCSA (%DFI), lipoperoxidation (LPO) by malondialdehyde production, sperm function by spontaneous- and induced-acrosome reactions (AR), mitochondrial membrane potential (MMP) by using the JC-1 fluorochrome, and fertilization ability by an in vitro assay and in vivo mating. Alterations on DNA integrity (%DFI and NT-positive cells) in spermatozoa collected at 7 and 28 dpt, and decreases in sperm quality and induced-AR were observed; reduced MMP and LPO were observed at 7 dpt only. Negative correlations between LPO and sperm alterations were found. Altered sperm functional parameters evaluated either in vitro or in vivo were associated with reduced fertilization rates at both times. These results show that Me-Pa exposure of maturing spermatozoa and spermatocytes affects many sperm functional parameters that result in a decreased fertilizing capacity. Oxidative stress seems to be a likely mechanism of the detrimental effects of Me-Pa exposure in male germ cells.

Enhancing biohydrogen production from Agave tequilana bagasse: Detoxified vs. Undetoxified acid hydrolysates.

The aim of this work was to compare the biohydrogen production potential of undetoxified and detoxified acid hydrolysates from A. tequilana bagasse. Detoxification was carried out with activated carbon at different concentrations and pH values. Results indicated that pH was not a significant variable, while the lowest evaluated concentration of activated carbon (1% p/v) significantly promoted the highest removal of acetic acid (89%) with minimal losses of fermentable sugars. Regarding dark fermentation experiments, central composite designs were used to optimize COD and pH variables for both substrates, undetoxified and detoxified hydrolysates (activated carbon 1% p/v and pH 0.6). At optimal conditions, the detoxified hydrolysate produced 33% more biohydrogen than the undetoxified one. Hydrogen molar yields were 1.71 and 1.23 mol H2/molsugar, respectively. This improvement was correlated to changes in metabolic byproducts, since the detoxified hydrolysate produced only acetic and butyric acids, while lactic acid was detected in the undetoxified hydrolysate.

Is floral morphology a good predictor of floral visitors to Antirrhineae (snapdragons and relatives)?

The association between plants and flower visitors has been historically proposed as a main factor driving the evolutionary change of both flower and pollinator phenotypes. The considerable diversity in floral morphology within the tribe Antirrhineae has been traditionally related to pollinator types. We used empirical data on the flower visitors from 59 Antirrhineae taxa from the literature and our own field surveys, which provide an opportunity to test whether flower phenotypes are reliable predictors of visitors and pollinator niches. The degree of adjustment between eight key floral traits and actual visitors was explored by testing the predictive value of inferred pollinator syndromes (i.e. suites of floral traits that characterise groups of plant species related to pollination). Actual visitors and inferred pollinator niches (categorisation of visitors' association using a modularity algorithm) were also explored using Linear Discriminant Analysis (LDA). The bee pollinator niche is correctly classified for flowers with dull corolla colour, without nectar guides, as the most important predictor. Both predictive value and statistical classification prove useful in classifying Antirrhineae taxa and the bee pollinator niche, mostly as a consequence of the high proportion of genera and taxa with occluded corollas primarily visited by bees. Our predictive approach rendered a high Positive Predictive Value (PPV) of floral traits in the diagnosis of visitors/pollinator niches. In particular, a high PPV was found for bees as both visitors and forming pollinator niches. In addition, LDA showed that four pollinator niches are well defined based on floral traits. The large number of species visited by bees irrespective of pollinator syndromes leads us to hypothesise their generalist pollinator role, despite the phenotypically specialised flowers of Antirrhineae.

Phylogeny determines flower size-dependent sex allocation at flowering in a hermaphroditic family.

In animal-pollinated hermaphroditic plants, optimal floral allocation determines relative investment into sexes, which is ultimately dependent on flower size. Larger flowers disproportionally increase maleness whereas smaller and less rewarding flowers favour female function. Although floral traits are considered strongly conserved, phylogenetic relationships in the interspecific patterns of resource allocation to floral sex remain overlooked. We investigated these patterns in Cistaceae, a hermaphroditic family. We reconstructed phylogenetic relationships among Cistaceae species and quantified phylogenetic signal for flower size, dry mass and nutrient allocation to floral structures in 23 Mediterranean species using Blomberg's K-statistic. Lastly, phylogenetically-controlled correlational and regression analyses were applied to examine flower size-based allometry in resource allocation to floral structures. Sepals received the highest dry mass allocation, followed by petals, whereas sexual structures increased nutrient allocation. Flower size and resource allocation to floral structures, except for carpels, showed a strong phylogenetic signal. Larger-flowered species allometrically allocated more resources to maleness, by increasing allocation to corollas and stamens. Our results suggest a major role of phylogeny in determining interspecific changes in flower size and subsequent floral sex allocation. This implies that flower size balances the male-female function over the evolutionary history of Cistaceae. While allometric resource investment in maleness is inherited across species diversification, allocation to the female function seems a labile trait that varies among closely related species that have diversified into different ecological niches.

Lesiones de vía biliar poscolecistectomía: conducta terapéutica actual / Post Cholecystectomy Bile Duct Injuries: Current Therapeutic Option

Resumen La colecistolitiasis es una condición común en Chile. La complicación más frecuente de esta condición es la colecistitis aguda. Aproximadamente 60.000 colecistectomías son realizadas anualmente en nuestro país, convirtiéndola en una de las patologías digestivas más frecuentes. El tratamiento de la colelitiasis ha evolucionado las últimas dos décadas. Con el desarrollo de la laparoscopía a final de 1980, la colecistectomía abierta fue definitivamente sustituida en los 90 por la vía laparoscópica. Desafortunadamente, la generalización de este procedimiento produjo un aumento en la incidencia de lesiones de vía biliar, aumentando desde una 0,1-0,2% hasta un 0,5-0,7%. Si bien, con el progresivo entrenamiento de los cirujanos en la cirugía mínimamente invasiva esta cifra ha disminuido nuevamente, la LVB aún constituye una de las complicaciones más graves en cirugía, generando gran impacto en la calidad de vida del paciente, e incluso costos en salud que pueden llegar a ser devastadores. El manejo de una lesión de vía biliar es, para muchos cirujanos, un desafío quirúrgico, que para su resolución requiere de las habilidades y experiencia de un cirujano hepatobiliar y derivación a centros de salud especializados. Sin duda, la acción más importante es extremar de manera rutinaria las medidas de prevención. Sin embargo, una vez que la lesión se ha producido, el futuro del paciente depende, directamente, del buen criterio del cirujano, tanto para realizar un diagnóstico temprano, como del enfrentamiento terapéutico que realice. El objetivo de este trabajo es dar a conocer diferentes conductas preventivas y terapéuticas cuando esta complicación se presenta.

Calculous biliary disease is a common condition in Chile. Over 60.000 cholecystectomies are performed annually, making gallstone disease one of the most common digestive health problems. The treatment of calculous biliary disease has evolved over the last 2 decades. With the development of laparoscopic technology in the late 1980s, new techniques for cholecystectomy were introduced. By the early 1990s, laparoscopic cholecystectomy had replaced open cholecystectomy in the operative management of gallbladder stone disease. Unfortunately, the widespread application of laparoscopic cholecystectomy has led to a concurrent rise in the incidence of major bile duct injuries. Reports have estimated the incidence has risen from 0.1-0.2 to 0.5-0.7%. Although, exponential training of surgeons in minimally invasive surgery has led to decrease this numbers again, bile duct injuries still constitute one of the most serious complications in surgery, generating a great impact on the patient's quality of life, and even health costs that can be devastating. The management of patients following major bile duct injurie is a surgical challenge, often requiring the skills of experienced hepatobiliary surgeons at tertiary referral centers. In this setting, the most important action is to routinely maximize prevention measures. However, once injury has occurred, patient's future depends directly on the correct judgment of the surgeon, both to make an early diagnosis and to choose the best therapeutic confrontation. The objective of this article is to present the different preventive and therapeutic options available when this complication occurs.

Desarrollo y estudio psicométrico de la Escala de Susceptibilidad al Castigo Anticipado (ESCA) / Development and psychometric study of the Susceptibility to Early Punishment Scale (SEPS)

INTRODUCCIÓN: Tomando en consideración el concepto de Susceptibilidad al Castigo de la teoría de Sensibilidad al Refuerzo de Gray y la actividad lingüística-verbal interna propia del ser humano, se propone el concepto Susceptibilidad al Castigo Anticipado (SCA) debido a que no existe ningún instrumento para evaluarlo. El Objetivo: es diseñar y estudiar la bondad de los ítems, la estructura interna y la confiabilidad la Escala de Susceptibilidad al Castigo Anticipado (ESCA). Además, se presentan datos descriptivos de la ESCA. MÉTODO: Primero se elaboraron los ítems en función de la definición del concepto, después fueron valorados por expertos. En la fase piloto se administró la versión inicial de la ESCA a 240 personas adultas con las que se realizó la depuración y primer estudio de la consistencia a partir de un Análisis Factorial Exploratorio. Posteriormente, se realizó un Análisis Factorial Confirmatorio con la versión final en una muestra de 960 estudiantes universitarios, se corroboró la bondad de los ítems y se estudió la confiabilidad de la ESCA. RESULTADOS: Todos los ítems de la versión final resultaron adecuados. Se observó y corroboró en la fase final una estructura interna de tres factores (y uno de segundo orden). Los factores y la escala total mostraron adecuados valores de consistencia interna. CONCLUSIONES: La ESCA, a pesar de las limitaciones derivadas en gran parte al tratarse de un nuevo constructo, es un instrumento adecuado para evaluar la susceptibilidad al castigo anticipado en población universitaria de Michoacán (México).

INTRODUCTION: Taking into consideration the concept of Susceptibility to Punishment of Gray's Reinforcement Sensitivity theory and the internal linguistic-verbal activity of the human being, the concept of Susceptibility to Early Punishment (SEP) is proposed, because there is no instrument to evaluate it. The Objective: To Design and study the goodness of the items, the internal structure and the reliability of the Susceptibility to Early Punishment Scale (SEPS). In addition, descriptive data from SEPS are presented. METHOD: The items were first elaborated based on the definition of the concept, and were valued by experts. In the pilot phase, the initial version of the SEPS was administered to 240 adult people where information was filtered and the first study of consistency was done based on an Exploratory Factor Analysis. Subsequently, a Confirmatory Factor Analysis was performed with the final versión of the scale, in a sample of 960 university students. The goodness of the items was corroborated, and the reliability of the SEPS was studied. RESULTS: All the items of the final version were adequate; an internal structure of three factors (and one of the second order) was observed and corroborated in the final phase. The factors and the full scale revealed adequate internal consistency values. CONCLUSIONS: The SEPS, despite the limitations derived largely from being a new construct, is an adequate instrument to assess the susceptibility to early punishment in the university population of Michoacan (Mexico).

Effects of antiepileptic drugs on reaction time, attention, and impulsivity in children.

Simple, choice, and complex reaction times, attention (variability of responses and omission errors), and impulsivity (commission and wrong-hand errors on choice and complex reaction time) were repeatedly measured in 111 epileptic children, aged 5 to 13 years, tested a total of 232 times. Antiepileptic drugs (AEDs) were started, stopped, and adjusted throughout the study period, for a variety of clinical indications, and AED serum levels were monitored. The relationship of performance to AED serum level was examined. Overall the nonspecific effect of AEDs was minimal: higher total serum levels of AEDs correlated with more impulsive errors on complex reaction time testing only. In contrast, in 54 children receiving carbamazepine monotherapy, we found a dose-related beneficial effect upon reaction time, with higher serum levels associated with faster responses and fewer omission errors, particularly on complex reaction time. Phenobarbital caused minimal dose-related effects: only variability and impulsive errors increased with increasing serum levels, and only on one segment of the test (73 subjects).

Radiopharmacokinetics, renal clearance and dosimetry of 99mTc-MAG3.

BACKGROUND: Technetium-99m-mercaptoacetyltriglycine (99mTc-MAG3) is a radiopharmaceutical for tubular function and can be prepared with 99m-technetium and the ligand Bz-MAG3 (Instituto Nacional de Investigaciones Nucleares, Mexico City). No radiopharmacokinetic parameters have been found for the healthy adult Mexican population with 99mTc-MAG3, prepared with the nationally produced or imported Bz-MAG3 kit. METHODS: The radiopharmacokinetic parameters and the clearance of 99mTc-MAG3 in seven healthy Mexican volunteers were determined by the single- and multi-sample methods. Computer programs were used for the calculations. RESULTS: Using several plasma samples from 0-43 min and the BIEXP program, it was shown that 99mTc-MAG3 follows a two-compartment model of distribution, with an apparent volume in the central compartment Vdcc = 3.8 + 0.7 l, a volume of distribution at steady state Vdss = 6.7 + 1.0 l, T1/2 alpha = 0.07 + 0.02 h-1, T1/2 beta = 0.49 + 0.15 h-1, mean residence time MRT = 0.60 + 0.17 h and clearance = 208 + 57 (ml/min)/1.73 m2. In comparison, the clearance value with a single sample drawn 43 min post-injection and calculated with Tauxe's formula was 193 +/- 59 (ml/min)/m2. CONCLUSIONS: The 15 ml difference between the two methods is neither statistically different (p = 0.11) nor important for routine clinical studies. The single-sample method is recommended because it is reliable and can be done at the same time that the dynamic renal scan is acquired. Estimated absorbed radiation dose was calculated for several organs.

Academic underachievement in children with epilepsy.

Academic achievement was studied in 78 children with epilepsy, ages 5 to 13 years, to determine how seizures, treatment of seizures, and sociocultural factors influence academic achievement. Cognitive abilities were assessed with either the McCarthy Scales of Children's Abilities or the Wechsler Intelligence Scale for Children--Revised. Achievement was measured with the Peabody Individual Achievement Tests. Achievement scores were corrected for cognitive ability (IQ), and underachievement was defined as achievement score 1/2 standard deviation or more below IQ. Information regarding seizure history (severity, duration) and treatment with anticonvulsant drugs was obtained. In addition, the family was extensively interviewed regarding the child's environment, behavior, and demographic background. The Home Observation for Measurement of the Environment (HOME) scale was completed on a home visit. Underachievement was frequent, ranging from 16% (Reading Recognition) to 50% (General Knowledge), but there was no relationship between severity or duration of seizure disorder or total exposure to anticonvulsant medications and achievement. Major determinants of achievement included subscales of the HOME scale, age (older children more likely to be underachieving), and parental education. An equal proportion of newly diagnosed and/or untreated subjects were underachieving compared to those with longstanding epilepsy and anticonvulsant drug treatment.

Reaction time, impulsivity, and attention in hyperactive children and controls: a video game technique.

Maturation of sustained attention was studied in a group of 52 hyperactive elementary school children and 152 controls using a microcomputer-based test formatted to resemble a video game. In nonhyperactive children, both simple and complex reaction time decreased with age, as did variability of response time. Omission errors were extremely infrequent on simple reaction time and decreased with age on the more complex tasks. Commission errors had an inconsistent relationship with age. Hyperactive children were slower, more variable, and made more errors on all segments of the game than did controls. Both motor speed and calculated mental speed were slower in hyperactive children, with greater discrepancy for responses directed to the nondominant hand, suggesting that a selective right hemisphere deficit may be present in hyperactives. A summary score (number of individual game scores above the 95th percentile) of 4 or more detected 60% of hyperactive subjects with a false positive rate of 5%. Agreement with the Matching Familiar Figures Test was 75% in the hyperactive group.

Reaction time, attention, and impulsivity in epilepsy.

Reaction time, attention, and impulsivity were studied in 112 children with epilepsy (4.5-13 years) using a computerized test. We measured simple reaction time (response with each hand separately to a single stimulus), forced choice reaction time (two stimuli presented in random order, one designated for each hand), and choice reaction time with distraction (two response stimuli, one for each hand, with two additional distracting stimuli randomly inserted). We also measured variability of speed of response and errors of omission and commission. Controls were unaffected children of similar age, ethnic, and socioeconomic backgrounds. Children with epilepsy were significantly slower, more variable, and made more omission errors than control children, even when analysis was limited to epileptic patients with IQ greater than 90, but they did not make more commission (i.e., impulsive) errors. Reaction times were related to IQ, but in general were not related to seizure severity, duration of seizure disorder, or duration of medication use. Untreated patients (N = 13) did not differ from those with antiepileptic drug levels in the therapeutic range on the day of testing (N = 52), but differed significantly from normal patients. Epileptic patients demonstrated significant slowing of reaction time and inattention, but not significant impulsivity, compared to normal children; however, these deficits do not appear to be related specifically to seizure history or treatment.

Pressure-removing strategies in neuropathic ulcer therapy. An alternative to total contact casting.

Technical considerations, advantages, and disadvantages of felt and foam contact pads have been presented. Anecdotally, it appears the technique provides a more dynamic, safe, and practical method of ulcer decompression compared with total contact casting. In light of the apparent advantages of felt and foam contact padding, a randomized prospective study would be worthwhile to determine the effectiveness of this modality as compared with total contact casting.

Vigilancia de la calidad del agua para consumo humano en Colombia: desafíos para la salud ambiental / Surveillance of drinking water quality in Colombia: challenges for environmental health / Vigilância da qualidade da água para consumo humano na Colômbia: desafios para a saúde ambiental

Objetivo: analizar las experiencias de las autoridades de salud en el ejercicio de la vigilancia del agua de consumo en Colombia, para comprender sus fortalezas y dificultades. Metodología: La investigación se realizó a través de un estudio cualitativo de los componentes de estructura, procesos y resultados del programa de vigilancia. Se construyó un cuestionario mediante la metodología Delphi, aplicado a los coordinadores de la vigilancia en 12 municipios y 27 departamentos. Resultados: se obtuvieron mediante la metodología de análisis de contenido, identificando 3 temáticas relevantes que influyen en la implementación de la vigilancia, entre ellos la descentralización, limitaciones en el recurso humano y la aplicación de las herramientas de evaluación del riesgo. Discusión: el programa de vigilancia en Colombia requiere el fortalecimiento de la rectoría, la capacidad de gestión de los territorios, el establecimiento de una efectiva descentralización y fortalecimiento de la gobernanza, además de instaurar mecanismos que regulen la problemática de recurso humano y evalúen las herramientas de análisis de riesgo y sus resultados.

Objective: to analyze the experiences of health authorities in the exercise of surveillance of drinking water quality in Colombia, with the aim of understanding the strengths and difficulties of its implementation. Methodology: the research was conducted through a qualitative study of the components of structure, processes and results of the surveillance program. A questionnaire was built using the Delphi methodology and applied to surveillance coordinators in 12 municipalities and 27 departments. Results: The results were obtained through the content analysis methodology, and three relevant issues affecting the implementation of surveillance were identified, namely: decentralization, limitations in human resources and the application of risk assessment tools. Discussion: the surveillance program in Colombia requires stronger stewardship, management capacity in the territories, the establishment of effective decentralization measures and the strengthening of governance in addition to establishing mechanisms to regulate the problem of human resources and to assess risk analysis tools and their results.

Objetivo: analisar as experiências das autoridades da saúde na aplicação da vigilância da água para consumo na Colômbia, visando compreender assuas fortalezas e dificuldades. Metodologia: A pesquisa se realizou através de um estudo qualitativo dos componentes da estrutura, dos processos e dos resultados da vigilância. Construiu-se um questionário com metodologia Delphi, aplicado aos coordenadores da vigilância em 12 municípios e em 27 departamentos. Resultados: foram obtidos por meio da metodologia de análise de conteúdo, identificando 3 temáticas relevantes na realização da vigilância: a descentralização, as limitações de recursos humanos e as aplicações das ferramentas de avalição do risco. Discussão: No programa de vigilância na Colômbia precisase o fortalecimento da reitoria, da capacidade de gestão dos territórios, o estabelecimento de uma descentralização efetiva e o fortalecimento da governança. Além disso, precisa mecanismos para regulamentar os problemas de recursos humanos e para avaliar as ferramentas de análise de riscos e seus resultados.

Documento de consenso para la monitorización neurofisiológica intraoperatoria multimodal en procedimientos neuroquirúrgicos. Fundamentos básicos / Consensus document for multimodal intraoperatory neurophisiological monitoring in neurosurgical procedures. Basic fundamentals

El presente trabajo pretende establecer una guía de actuación consensuada entre anestesiólogos y neurofisiólogos para realizar una monitorización neurofisiológica intraoperatoria efectiva en procedimientos tanto neuroquirúrgicos, como en aquellos en los que existe un riesgo de lesión neurológica funcional. En la primera parte, se describen las principales técnicas utilizadas en la actualidad para la monitorización neurofisiológica intraoperatoria. En segundo lugar, se describen los factores anestésicos y no anestésicos que pueden afectar al registro eléctrico de las estructuras del sistema nervioso. Posteriormente, se analizan los efectos adversos de las técnicas más comunes derivados de su utilización. Y, por último, se describen las diferentes pautas a seguir tras la aparición de los diferentes eventos clínicos intraoperatorios.(AU)

The present work aims to establish a guide to action, agreed by anaesthesiologists and neurophysiologists alike, to perform effective intraoperative neurophysiological monitoring for procedures presenting a risk of functional neurological injury, and neurosurgical procedures. The first section discusses the main techniques currently used for intraoperative neurophysiological monitoring. The second exposes the anaesthetic and non-anaesthetic factors that are likely to affect the electrical records of the nervous system structures. This section is followed by an analysis detailing the adverse effects associated with the most common techniques and their use. Finally, the last section describes a series of guidelines to be followed upon the various intraoperative clinical events.(AU)