Performance of the 2019 American College of Rheumatology/European League Against Rheumatism Classification Criteria for IgG4-Related Disease in a Latin American Cohort.

BACKGROUND/OBJECTIVE: The 2019 American College of Rheumatology/European League Against Rheumatism Classification Criteria (2019 AECC) for IgG4-related disease (IgG4-RD) is considered a significant advancement in the study of this condition. Most studies evaluating their performance have focused on White and Asian patients, leaving a knowledge gap regarding Latin American populations. Therefore, this study aimed to assess the performance of the 2019 AECC for IgG4-RD in a cohort of Latin American patients. METHODS: A multicenter medical records review study was conducted, involving centers from Argentina, Chile, Mexico, Peru, and Uruguay. Data on IgG4-RD patients and mimicker conditions were collected through a standardized online form. The criterion standard for diagnosing IgG4-RD was based on the fulfillment of the Comprehensive Diagnostic Criteria for IgG4-RD and/or the Consensus Statement on Pathology. The 2019 AECC was retrospectively applied. RESULTS: We included 300 patients, with 180 (60%) having IgG4-RD and 120 (40%) having mimicker conditions. The 2019 AECC had a sensitivity of 66.7% and a specificity of 100%. Sensitivity increased to 73.3% when disease-specific autoantibody items were removed, without affecting specificity. The true-positive cases had more involved organs, a higher availability of biopsy results, and were more likely to belong to the Mikulicz/systemic and proliferative phenotypes. CONCLUSIONS: The use of the 2019 AECC for IgG4-RD in a Latin American population confirms its high specificity in excluding those without the disease. The presence of concomitant autoimmune diseases and clinically nonsignificant disease-specific autoantibodies excludes a significant number of patients from fulfilling the criteria.

Multimodal postoperative analgesia with transdermal buprenorphine is a safe option in arthroscopic rotator cuff repair.

BACKGROUND: Arthroscopic rotator cuff repairs are associated with moderate-to-severe pain. Opioids are not the first line for postsurgical pain control due to their potential misuse and side effects. Transdermal buprenorphine represents an alternative for multimodal postoperative pain control. METHODS: This was a single-centre, prospective longitudinal exploratory study of patients undergoing arthroscopic rotator cuff repairs managed with multimodal analgesia with transdermal buprenorphine. Patients were followed-up by telephone at eight time points, assessing pain levels, rescue analgesics requirement and side effects. FINDINGS: Twenty-five patients with an average age of 63.4 ± 8.2 were included. Fourteen patients were ⩾65 years. Pain levels were similar among age groups at all time points, with no pain or mild pain (visual analogue scale 1-4) in most patients. The most frequent side effects were dizziness and somnolence. CONCLUSION: Transdermal buprenorphine provided a sustained analgesic effect after an arthroscopic rotator cuff repair during the acute postsurgical period. It showed a similar safety profile among younger and older patients.

Diferencia en la expresión del ligando de receptor activador para el factor nuclear K B, en tejido tumoral frente a la infección por diferentes patógenos periodontales / Difference in receptor activator of nuclear factor K B expression in tumoral tissue by different periodontal pathogens

La enfermedad periodontal es una de las principales causas de pérdida dentaria. Clínicamente, esta patología, mediada por la desregulación del sistema inmune producto de una disbiosis ocurrida en el surco gingival, inicia con la inflamación de la encía y evoluciona con el daño irreversible de los tejidos que rodean el diente. El hueso alveolar es uno de los tejidos afectados esta patología, esto debido a la activación de osteoclastos por la sobreexpresión de la proteína RANKL en el huésped. El propósito de este trabajo es determinar el nivel de sobreexpresión de RANKL, en un modelo de células tumorales U2OS, frente a la infección con Porphyromonas gingivalis y Prevotella intermedia. Para identificar el nivel de RANKL, se definieron cuatro grupos: Un grupo control, no tratado; Grupo PG, tratado con P. gingivalis; Grupo PI, tratado con P. Intermedia; y un grupo PG+PI, tratado con ambas bacterias. El nivel relativo de la proteína RANKL fue determinado en el sobrenadante y en los extractos celulares de manera independiente, mediante la técnica Western blot. En sobrenadantes, el grupo PG mostró mayores niveles de RANKL comparados con PI (p < 0,05). En extractos celulares los niveles fueron mayores en el grupo PG+PI (p < 0,05). El grupo PI mostró los niveles más bajos de RANKL. La infección polimicrobiana resulta en una mayor expresión de RANKL en células tumorales U2OS, mientras que frente a la infección P. gingivalis, se observó mayor cantidad de RANKL soluble.

SUMMARY: Periodontal disease is one of the main causes of tooth loss. Clinically, this pathology, mediated by the deregulation of the immune system due to a dysbiosis occurred in the gingival sulcus, begins with the inflammation of the gum and evolves with the irreversible damage of the tissues that surround the tooth. Alveolar bone is one of the most affected tissues by this disease, due to the activation of osteoclasts by the upregulation of RANKL in the host. The aim of this study is to determine the increase of RANKL, in a U2OS tumor cells model, inoculated with Porphyromonas gingivalis and Prevotella intermedia. To identify the level of RANKL, four groups were defined: A control group, not treated; PG group, treated with P.gingivalis; PI group, treated with P. intermedia; and a PG+PI group, treated with both bacteria. The relative level of RANKL was determined in the supernatant and cell extracts independently, using the Western blot technique. In supernatants, the PG group showed higher RANKL levels compared to PI (p < 0.05). In cell extracts the levels were higher in the PG+PI group (p < 0.05.). The PI group showed the lowest levels of RANKL.Polymicrobial infection results in a greater expression of of soluble RANKL was observed.

Pancreatitis aguda: Puntos clave. Revisión argumentativa de la literatura / Acute pancreatitis: Key points. Argumentative review of the literature

Introducción. La pancreatitis aguda es una condición gastrointestinal común que se asocia a una importante morbimortalidad. Se estima que su incidencia es de 34 por cada 100.000 habitantes, afecta principalmente a adultos a partir de la sexta década de la vida y en nuestra región es debida en la mayoría de los casos a cálculos biliares. Métodos. Se hizo una revisión de los aspectos fundamentales de esta patología, común y potencialmente mortal. Resultados. El diagnóstico requiere del hallazgo de manifestaciones clínicas, aumento de las enzimas pancreáticas en suero y, en ocasiones, el uso de imágenes diagnósticas. Se puede clasificar en leve, moderada y severa, lo cual es fundamental para determinar la necesidad de tratamiento y vigilancia en una unidad de cuidados intensivos. Conclusión. En la actualidad los pilares de manejo de la pancreatitis aguda son la terapia temprana con líquidos, tratamiento del dolor, inicio precoz de la vía oral y resolución del factor etiológico desencadenante. En presencia de complicaciones o un curso severo de enfermedad, pueden requerirse manejo antibiótico e intervenciones invasivas

Introduction. Acute pancreatitis is a common gastrointestinal condition that is associated with significant morbidity and mortality. It is estimated that its incidence is 34 per 100,000 inhabitants, it mainly affects adults from the sixth decade of life, and in our region, most of the cases are secondary to gallbladder stones. Methods. We present a review of the fundamental aspects of this disease, common and potentially fatal. Results. Diagnosis requires finding clinical manifestations, increased serum pancreatic enzymes, and sometimes the use of diagnostic imaging. It can be classified as mild, moderate and severe, which is essential to determine the need for treatment and monitoring in an intensive care unit. Conclusion. Currently, the pillars of management of acute pancreatitis are early fluid therapy, pain management, early oral food intake, and resolution of the etiology. In the presence of complications or a severe course of the disease, antibiotic management and invasive interventions may be required

Epicardial adipose tissue thickness is related to early subclinical myocardial dysfunction, particularly in patients with type 2 diabetes mellitus: a case control study.

BACKGROUND: Cardiac myofibrillary dysfunction, which can be measure by echocardiographical strain value, represents an early subclinical manifestation of heart failure. Epicardial Adipose tissue (EAT) is related to low degree inflammation and oxidative damage in the adjacent tissue. AIM: To explore whether EAT affects early myocardial dysfunction, as assessed strain values. METHODS: Case-Control design. Patients lacking clinical significant heart failure, thyroid or renal disease or malignant abnormalities were included. Clinical-demographic and biochemical data were collected. EAT and myofibril deformation were measured by echocardiography. RESULTS: A total of 71 patients were analyzed, and further subdivided according to type 2 Diabetes Mellitus (t2DM). Higher strain value (higher than -22.4%cut-off value) was associated with male sex and higher anthropometric and metabolic risk measures; particularly those with t2DM. Higher EAT was also associated higher strain value (AUC = 0.92 ± 0.06, p = 0.004), and further correlation was evidenced (rho = 0.488, p < 0.001), with significant influence of t2DM. CONCLUSION: EAT was related to strain value, suggesting the influence of cardiac adipose tissue on the deformability of cardiac myofibril, with a more significant effect in the population with t2DM.

Sympatric cleptobiotic stingless bees have species-specific cuticular profiles that resemble their hosts.

Stingless bees are the largest group of eusocial pollinators with diverse natural histories, including obligate cleptobionts (genus Lestrimelitta) that completely abandoned flower visitation to rely on other stingless bees for food and nest materials. Species of Lestrimeliita are thought to specialize upon different host species, and deception through chemical similarity has been proposed as a mechanism to explain this phenomenon. In the Yucatan Peninsula of Mexico, Scaptotrigona pectoralis is a species chemically distinct from, and not preferred as a host by, locally widespread Lestrimeliita niitkib; witnessing attacks on S. pectoralis colonies offered the opportunity to test the sensory deception hypothesis to cletoparasitism. Analysis of cuticular profiles revealed that the Lestrimelitta attacking S. pectoralis differed significantly in odour bouquet to L. niitkib and, in contrast, it resembled that of S. pectoralis. Further analyses, including morphometrics, mtDNA barcoding, and the examination of taxonomic features, confirmed the existence of two sympatric Lestrimelitta species. The results give support to the hypothesis of chemical deception as a cleptobiotic strategy in Lestrimelitta sp. This is the first evidence that sympatric cleptobionts of the same genus select hosts in accordance with species-specific cuticular profiles, with possible consequences for ecological adaptation and the evolution of these remarkable organisms and the community of stingless bee hosts.

[Anatomy variant of the papillary muscles as a cause of mitral regurgitation. Case report of a parachute-like asymmetric mitral valve] / Variante de la anatomía de los músculos papilares como causa de insuficiencia mitral. Un caso de válvula mitral asimétrica en paracaídas-like.

Introducción: La válvula mitral en paracaídas-like es una anomalía congénita caracterizada por una disposición asimétrica de los músculos papilares, siendo las pruebas de imagen cardiaca son el procedimiento de elección tanto para el diagnóstico anatómico como para realizar la valoración funcional de este tipo de anomalía estructural. Caso Clínico: Paciente con cuadro de descompensación hemodinámica en el cual se diagnóstica de manera incidental de una valvulopatía mitral en forma de paracaídas-like. Los hallazgos de imagen por ecocardiografía transtorácica y resonancia magnética ponen de manifiesto la presencia de 2 músculos papilares, ambos con inserción en segmento lateral apical confirmando una válvula mitral asimétrica con similitud a su morfología en paracaídas. Discusión: La válvula mitral en paracaídas es una anomalía congénita poco común constituyente en la presencia de dos músculos papilares siendo uno de ellos más elongado y adherido al velo mitral de forma contigua, mostrándose en algunos casos pequeñas cuerdas tendinosas asociadas. Puede presentar una evolución benigna siendo un hallazgo casual o asociarse a repercusión hemodinámica valvular como el caso presentado. Conclusión: La válvula mitral en paracaídas-like es una anomalía congénita caracterizada por una disposición asimétrica de los músculos papilares, siendo su evolución muy variable, pudiendo pasar desapercibida o afectando de forma significativa a la mecánica valvular.

Introducción: La válvula mitral en paracaídas-like es una anomalía congénita caracterizada por una disposición asimétrica de los músculos papilares, siendo las pruebas de imagen cardiaca son el procedimiento de elección tanto para el diagnóstico anatómico como para realizar la valoración funcional de este tipo de anomalía estructural. Caso Clínico: Paciente con cuadro de descompensación hemodinámica en el cual se diagnóstica de manera incidental de una valvulopatía mitral en forma de paracaídas-like. Los hallazgos de imagen por ecocardiografía transtorácica y resonancia magnética ponen de manifiesto la presencia de 2 músculos papilares, ambos con inserción en segmento lateral apical confirmando una válvula mitral asimétrica con similitud a su morfología en paracaídas. Discusión: La válvula mitral en paracaídas es una anomalía congénita poco común constituyente en la presencia de dos músculos papilares siendo uno de ellos más elongado y adherido al velo mitral de forma contigua, mostrándose en algunos casos pequeñas cuerdas tendinosas asociadas. Puede presentar una evolución benigna siendo un hallazgo casual o asociarse a repercusión hemodinámica valvular como el caso presentado. Conclusión: La válvula mitral en paracaídas-like es una anomalía congénita caracterizada por una disposición asimétrica de los músculos papilares, siendo su evolución muy variable, pudiendo pasar desapercibida o afectando de forma significativa a la mecánica valvular.

Divergent Expression of SPARC, SPARC-L, and SCPP Genes During Jawed Vertebrate Cartilage Mineralization.

While cartilage is an ancient tissue found both in protostomes and deuterostomes, its mineralization evolved more recently, within the vertebrate lineage. SPARC, SPARC-L, and the SCPP members (Secretory Calcium-binding PhosphoProtein genes which evolved from SPARC-L) are major players of dentine and bone mineralization, but their involvement in the emergence of the vertebrate mineralized cartilage remains unclear. We performed in situ hybridization on mineralizing cartilaginous skeletal elements of the frog Xenopus tropicalis (Xt) and the shark Scyliorhinus canicula (Sc) to examine the expression of SPARC (present in both species), SPARC-L (present in Sc only) and the SCPP members (present in Xt only). We show that while mineralizing cartilage expresses SPARC (but not SPARC-L) in Sc, it expresses the SCPP genes (but not SPARC) in Xt, and propose two possible evolutionary scenarios to explain these opposite expression patterns. In spite of these genetic divergences, our data draw the attention on an overlooked and evolutionarily conserved peripheral cartilage subdomain expressing SPARC or the SCPP genes and exhibiting a high propensity to mineralize.

Complicaciones relacionadas con el cateterismo cardíaco pediátrico y cardiopatías congénitas. / Complications associated to pediatric cardiac catheterization and congenital heart diseases

INTRODUCTION: Congenital heart diseases are the most common congenital abnormalities in newborns with a prevalence of 1%. Therapeutic and diagnostic cardiac catheterization has revolutionized the treatment of these diseases; however, it can be associated with complications. OBJECTIVE: To describe the incidence and type of complications associated with pediatric cardiac catheterization in a reference center for congenital heart defects. METHODOLOGY: Retrospective observational study, with analytical intention based on records of cardiac catheterization performed on patients with congenital and acquired heart disease. RESULTS: 2,688 records were included for nine consecutive years. 53.9% were men, 21.3% with ages between 2 and 5 years and 20.3% between 6 months and 2 years. 63.5% of the procedures were elective. The prevalence of complications in the first 24 hours after catheterization was 6.7% (4.2% minor and 2.4% major). Early death occurred in 0.8% of the procedures. Factors associated with complications were age at catheterization <28 days (OR 2.18, 95% CI [1.28-3.70]), precatheter oxygen saturation <79% (OR 2.15, 95% CI [1.02-4.53]), use of pre-catheter inotropics (OR 3.00, 95% CI [1.68-5.33]). The variables included in the model explain 38% of the variance of post-cardiac catheterization complications in patients younger than 18 years. DISCUSSION: Cardiac catheterization is associated with major and minor complications including death. The associated factors were less than 28 days, lower oxygen saturation and use of pre-catheter inotropics.

INTRODUCCIÓN: Las cardiopatías congénitas son las anomalías congénitas más comunes en recién nacidos con una prevalencia de 1%. El cateterismo cardíaco diagnóstico y terapéutico ha revolucionado el tratamiento de estas enfermedades, aunque puede acompañarse de complicaciones. OBJETIVO: Describir la incidencia y el tipo de complicaciones vinculadas con el cateterismo cardíaco pediátrico en un centro de referencia para cardiopatías congénitas. MÉTODO: Estudio observacional retrospectivo, con intención analítica a partir de registros de cateterismos cardíacos realizados a pacientes con cardiopatías congénitas y adquiridas. RESULTADOS: Se incluyeron 2,688 registros durante nueve años consecutivos. El 53.9% correspondió a hombres, 21.3% con edades de dos a cinco años y 20.3% de seis meses a dos años. El 63.5% de los procedimientos fue electivo. La prevalencia de complicaciones en las primeras 24 horas posteriores al cateterismo fue de 6.7% (4.2% menores y 2.4% mayores). En el 0.8% de los procedimientos sobrevino la muerte temprana. Los factores relacionados con las complicaciones fueron: edad al momento del cateterismo <28 días (OR, 2.18; IC 95%, 1.28-3.70), saturación de oxígeno antes del cateterismo <79% (OR, 2.15; IC 95%, 1.02-4.53), uso de inotrópicos antes del cateterismo (OR, 3.00; IC 95%, 1.68-5.33). Las variables incluidas en el modelo explican el 38% de la varianza de las complicaciones posteriores al cateterismo cardíaco en pacientes menores de 18 años. CONCLUSIONES: En este estudio, el cateterismo cardíaco se vinculó con complicaciones mayores y menores, incluida la muerte. Los factores adjuntos fueron edad menor de 28 días, menor saturación de oxígeno y uso de inotrópicos antes del cateterismo.

Factores predisponentes para paludismo complicado en el departamento del Cauca, Colombia

RESUMEN Introducción: El paludismo es una parasitosis producida por protozoos del género Plasmodium que puede causar disfunción orgánica. A pesar del control y prevención, es un problema de salud pública que contribuye a la morbilidad y mortalidad, especialmente en países tropicales. Objetivo: Identificar factores predisponentes para la complicación del paludismo en el departamento del Cauca, Colombia. Métodos: Se desarrolló un estudio observacional tipo casos y controles no pareados en el departamento del Cauca durante 2016-2019 con pacientes notificados al Sistema Nacional de Vigilancia en Salud Pública. Se recolectaron 445 pacientes con paludismo, aquellos con alguna complicación fueron definidos como casos (n= 89) y a cada uno se asignaron 4 controles (n= 356). La información de los complicados se contrastó con la historia clínica. Resultados: De la población estudiada (n= 445), 281 fueron hombres (63,1%), la edad media fue 28,34 años y 397 eran originarios del departamento del Cauca (89,2%). Noveta y nueve requirieron hospitalización (22,2 %) y tres fallecieron (0,7 %). Sesenta y uno complicados fueron por P. falciparum (68,5%). Los casos importados (p= 0,000), etnia negra (p=0,000), tratamiento después de 3 días (p= 0,000), procedencia urbana (p= 0,025), régimen contributivo (p=0,026), P. vivax (p= 0,000) y presencia de gametocitos (p=0,000) se asociaron con complicaciones. Conclusiones: La ubicación geográfica, redes hospitalarias ineficientes, desconocimiento de la enfermedad, entre otros factores deben intervenirse. La falta de estudios sobre paludismo y sus complicaciones limitan tomar decisiones.

ABSTRACT Introduction: Malaria is a parasitic infection caused by protozoa of the genus Plasmodium. This condition may lead to organ dysfunction. Despite the actions implemented to control and prevent malaria, it continues to be a public health problem contributing to morbidity and mortality, mainly in tropical countries. Objective: Identify the predisposing factors for complicated malaria in Cauca Department, Colombia. Methods: An observational non-paired case-control study was conducted in Cauca Department in the period 2016-2019. The study sample was 445 patients notified to the National Public Health Surveillance System. Patients with complications were defined as cases (n= 89). Each case was assigned four controls (n= 356). Information about complicated cases was contrasted with the medical records. Results: Of the total population studied (n= 445), 281 were men (63.1%) and 397 were from Cauca Department (89.2%). Mean age was 28.34 years. Ninety-nine patients required hospitalization (22.2%) and three died (0.7%). Sixty-one of the complicated patients were infected by P. falciparum (68.5%). The following factors were associated to complications: imported cases (p= 0.000), black ethnic group (p=0.000), treatment after three days (p= 0.000), urban area of residence (p= 0.025), contributory regime (p=0.026), P. vivax (p= 0.000) and presence of gametocytes (p=0.000). Conclusions: Actions should be implemented concerning geographic location, inefficient hospital networks and insufficient knowledge about the disease, among other factors. Lack of studies about malaria and its complications limit decision making.

Viral Infection Drives the Regulation of Feeding Behavior Related Genes in Salmo salar.

The feeding behavior in fish is a complex activity that relies on the ability of the brain to integrate multiple signals to produce appropriate responses in terms of food intake, energy expenditure, and metabolic activity. Upon stress cues including viral infection or mediators such as the proinflammatory cytokines, prostaglandins, and cortisol, both Pomc and Npy/Agrp neurons from the hypothalamus are stimulated, thus triggering a response that controls both energy storage and expenditure. However, how appetite modulators or neuro-immune cues link pathogenesis and energy homeostasis in fish remains poorly understood. Here, we provide the first evidence of a molecular linkage between inflammation and food intake in Salmon salar. We show that in vivo viral challenge with infectious pancreatic necrosis virus (IPNV) impacts food consumption by activating anorexic genes such as mc4r, crf, and pomcb and 5-HT in the brain of S. salar. At the molecular level, viral infection induces an overall reduction in lipid content in the liver, favoring the production of AA and EPA associated with the increment of elovl2 gene. In addition, infection upregulates leptin signaling and inhibits insulin signaling. These changes are accompanied by a robust inflammatory response represented by the increment of Il-1b, Il-6, Tnfa, and Pge2 as well as an increased cortisol level in vivo. Thus, we propose a model in which hypothalamic neurons respond to inflammatory cytokines and stress-related molecules and interact with appetite induction/inhibition. These findings provide evidence of crosstalk between pathogenesis-driven inflammation and hypothalamic-pituitary-adrenocortical axes in stress-induced food intake behavior in fish.

Behavioural Fever Promotes an Inflammatory Reflex Circuit in Ectotherms.

BACKGROUND: The communication between the brain and the immune system is a cornerstone in animal physiology. This interaction is mediated by immune factors acting in both health and pathogenesis, but it is unclear how these systems molecularly and mechanistically communicate under changing environmental conditions. Behavioural fever is a well-conserved immune response that promotes dramatic changes in gene expression patterns during ectotherms' thermoregulatory adaptation, including those orchestrating inflammation. However, the molecular regulators activating the inflammatory reflex in ectotherms remain unidentified. METHODS: We revisited behavioural fever by providing groups of fish a thermal gradient environment during infection. Our novel experimental setup created temperature ranges in which fish freely moved between different thermal gradients: (1) wide thermoregulatory range; T° = 6.4 °C; and (2) restricted thermoregulatory range; T° = 1.4 °C. The fish behaviour was investigated during 5-days post-viral infection. Blood, spleen, and brain samples were collected to determine plasmatic pro- and anti-inflammatory cytokine levels. To characterize genes' functioning during behavioural fever, we performed a transcriptomic profiling of the fish spleen. We also measured the activity of neurotransmitters such as norepinephrine and acetylcholine in brain and peripheral tissues. RESULTS: We describe the first set of the neural components that control inflammatory modulation during behavioural fever. We identified a neuro-immune crosstalk as a potential mechanism promoting the fine regulation of inflammation. The development of behavioural fever upon viral infection triggers a robust inflammatory response in vivo, establishing an activation threshold after infection in several organs, including the brain. Thus, temperature shifts strongly impact on neural tissue, specifically on the inflammatory reflex network activation. At the molecular level, behavioural fever causes a significant increase in cholinergic neurotransmitters and their receptors' activity and key anti-inflammatory factors such as cytokine Il10 and Tgfß in target tissues. CONCLUSION: These results reveal a cholinergic neuronal-based mechanism underlying anti-inflammatory responses under induced fever. We performed the first molecular characterization of the behavioural fever response and inflammatory reflex activation in mobile ectotherms, identifying the role of key regulators of these processes. These findings provide genetic entry points for functional studies of the neural-immune adaptation to infection and its protective relevance in ectotherm organisms.

Territorial development and mining. Insights and challenges from the Chilean case.

As mining activity generally occurs far away from metropolitan areas, governments tend to forget the problems that communities in mining regions face. Centralized government systems and, more importantly, a lack of a robust understanding of the effects of mining impacts on communities and regions, explain in part the lag of development in mining regions and countries. This paper discusses these aspects and introduces eight different papers (comprising the Special Issue: Territorial development and mining in Chile) discussing the impacts that mining activity brings to local economic activity and societal outcomes using the case of Chile, one of the most important mining countries in the world. We conclude this invitation to a territorial turn in the study of mining-based economic development with a set of key research topics we believe would benefit from further research to improve our understanding of the temporal and spatial dynamics between mining activity and development across territories.

Delay in hip fracture surgery and its outcomes. A reflection / Retraso en cirugía de fractura de cadera y sus desenlaces. Una reflexión

Abstract Hip fracture is one of the major public healthcare problems in elderly patients around the world, mainly because of the risk of falls and osteoporosis which are typical during this stage of life, and may be the cause for up to 36% of deaths among those affected. Its management in principle is surgical and the best results are achieved with patients undergoing surgery during the first 24 to 72 hours after the fracture. Any delays in surgery are mostly associated with decompensated personal pathological factors, delays in perioperative assessment, or in presurgical complementary tests; sometimes, the delays are the result of administrative formalities of the healthcare providers. These determining factors may affect both morbidity and mortality, and contribute to functional decline, disability, and reduced quality of life of these patients. A third party intervention is then necessary to improve the preventable factors that delay the osteosynthesis in these types of fractures, in addition to ensuring education, infrastructure, inputs, skilled human resources, and prompt referral of patients from the first level of care. Investigating this scenario and assessing the quality of life impact on these patients should be a priority.

Resumen La fractura de cadera representa uno de los problemas de salud pública más grandes en los pacientes ancianos en todo el mundo, principalmente, por el riesgo de caídas y la osteoporosis típicos en esta etapa de la vida, que puede causar la muerte de hasta el 36 % de los afectados; su manejo es en principio quirúrgico y los mejores resultados se presentan cuando se interviene en las primeras 24 a 72 horas después de la fractura. El retraso en la corrección quirúrgica está asociado principalmente a factores patológicos personales no compensados, demora en la valoración perioperatoria o en los estudios complementarios prequirúrgicos, o por trámites administrativos de las empresas prestadoras de servicios de salud. Estos determinantes pueden afectar la morbimortalidad y contribuir a un deterioro funcional, incapacidad y pérdida de la calidad de vida de estos pacientes. Se hace necesaria una intervención por parte de terceros para mejorar los factores prevenibles que retrasan la osteosíntesis de este tipo de fracturas; además, asegurar educación, infraestructura, insumos, talento humano capacitado y remisión rápida de pacientes desde el primer nivel de atención. Investigar en este escenario y evaluar los efectos en la calidad de vida de estos pacientes debería ser una prioridad.