Short bowel syndrome related intestinal failure outcomes in Latin America: Insights from the RESTORE Registry.

BACKGROUND: Short bowel syndrome is considered a low prevalence disease. The scant information available about intestinal failure in Latin America was the driving force to expand this registry. METHODS: A prospective, multicenter observational registry was created for patients with chronic intestinal failure short bowel at specialized centers in Latin America. Demographics, clinical characteristics, nutrition assessment, parenteral nutrition management, intestinal rehabilitation, related complications, clinical outcome, and survival were analyzed. RESULTS: From May 2020 to July 2023, 167 patients (115 adults, 52 children) from 20 centers were enrolled. For the adults, the mean age was 37.2 ± 18 years, 48% were female, and the mean follow-up was 22.6 ± 18.3 months. The main etiology was surgical resections (postsurgical complications: 37%; ischemia: 25%); the mean intestinal length was 73 ± 55 cm. The complications were as follows: infections: 0.4/1000 catheter-days; thrombosis: 0.24/1000 catheter-days; liver disease: 2.6%. The outcomes were as follows: 28% were rehabilitated, 15% died, 9.6% were lost to follow-up, 0.9% underwent transplant, and 45.6% continued follow-up. For the children, the mean age 48 ± 52 months, 48% were female, 52% were premature. The mean follow-up was 17.2 ± 5.6 months; the mean remaining intestinal length was 38 ± 45 cm. The leading etiologies were atresia (25%), NEC (23%), and gastroschisis (21%). The complication were as follows: infections: 2/1000 catheter-days; thrombosis: 2.22/1000 catheter-day; 25% developed liver disease. The outcomes were as follows: 7.7% died, 3.8% were rehabilitated, and 88.5% continued follow-up. CONCLUSION: The RESTORE amendment served as a registry and educational tool for the participating teams. The aspiration is to objectively show current aspects of intestinal failure in the region and carry them to international standards. Including all Latin American countries and etiologies of chronic intestinal failure besides short gut would serve to complete this registry.

Proposal of a Knowledge Management Model for Complex Systems: Case of the Supervision and Control Subsystem of the Colombian Health System.

BACKGROUND: Considering regulatory, supervision, and control health policy, an innovative knowledge management model is proposed for the Colombian health system, which is recognized as a complex system. METHODS: A model is constructed through a comparative analysis of various theoretical and conceptual frameworks, and an original methodology is proposed based on an analysis of the macroprocesses of the Supervision and Control System (SSC) of the Colombian General Social Security System in Health (SGSSS). After formulating hypotheses and conceptual references, information errors are determined within the different macroprocesses of the SGSSS, including those of governance and the SSC. RESULTS: The risks of generating duplicate, wrong, hidden, or non-existent information arise when the associated regulations need more specificity to be applied in all cases, thus leading to the risk of different interpretations by some actors. In this way, it is possible to hinder the generation of unified information, as there is no clarity as to who is responsible for the generation or creation of certain data. CONCLUSIONS: The proposed model is characterized by its flexibility and adaptability, integrating several processes that can be executed simultaneously or cyclically (depending on the system's needs) and allowing for the generation and feedback of knowledge at different stages, with some processes simultaneously executed to complement each other.

Effects of a concurrent training protocol on body composition and phase angle in physically inactive young women: a quasi-experimental intervention study / Efectos de un protocolo de entrenamiento concurrente sobre la composición corporal y el ángulo de fase en mujeres jóvenes físicamente inactivas: un estudio de intervención cuasi-experimental

SUMMARY: To determine the effect of a concurrent training program on body composition and phase angle in young women. 38 women (19.26 ± 1.86 years) participated in the study, and were assigned according to convenience sampling into two groups: 11 into the control group (CG) and 27 into the intervention group (IG). The IG performed a 12-weeks concurrent training protocol. The frequency was five days a week, and the intensity was established in 40-60 % of a repetition maximum to strength exercise, and 40-65 % heart rate reserve to endurance exercise. Body composition and phase angle were evaluated by bioelectrical impedance before and after the intervention. The IG had a decrease in fat mass (pre = 24.66 ± 5.65 kg; post = 20.38 ± 4.20 kg; Cohen's d = .80; p< 0,001 [CI 95 % = 3.34,5.22]), and an increase in muscle mass (pre = 22.75 ± 3.23 kg; post: 23.50 ± 3.41 kg; Cohen's d = -0.86; p= <0,001[CI 95 % = -1.09,- 0.40]) and total phase angle (pre = 5.72º ±0.39; post: 6.24º ± 0.51; Cohen's d = -1.32; p=<0,001 [CI 95 % = -0.67,-0.36]), whereas the CG had not show significant variations in variables of body composition or total phase angle. The results suggest that a 12-weeks concurrent training program could modify positively the young women's body composition and phase angle. Hence, it is recommended using similar protocols to change variables related to young women's health.

RESUMEN: El objetivo fue determinar el efecto de un programa de entrenamiento concurrente sobre la composición corporal y el ángulo de fase en mujeres jóvenes. 38 mujeres (19.26 ± 1.86 años) participaron en el estudio, y fueron asignadas de acuerdo a un muestreo de conveniencia en dos grupos: 11 en el grupo control (CG) y 27 en el grupo de intervención (GI). El IG realizó un protocolo de entrenamiento concurrente de 12 semanas. La frecuencia fue de cinco días a la semana y la intensidad se estableció en 40-60 % una repetición máxima para el ejercicio de fuerza y 40-65 % de frecuencia cardíaca de reserva para ejercicio de resistencia. La composición corporal y el ángulo de fase se evaluaron mediante impedancia bioeléctrica antes y después de la intervención. El IG tuvo una disminución en la masa grasa (pre = 24.66 ± 5.65 kg; post = 20.38 ± 4.20 kg; d de Cohen = .80; p <0,001 [IC 95 % = 3.34,5.22]), y un aumento en la masa muscular (pre = 22,75 ± 3,23 kg; post: 23,50 ± 3,41 kg; d de Cohen = -0,86; p = <0,001 [IC 95 % = -1,09, -0,40]) y ángulo de fase total (pre = 5,72º ± 0,39; post: 6,24 º ± 0,51; d de Cohen = -1,32; p = <0,001 [IC 95 % = -0,67, -0,36]), mientras que el GC no mostró variaciones significativas en las variables de composición corporal o ángulo de fase total. Los resultados sugieren que un programa de entrenamiento concurrente de 12 semanas podría modificar positivamente la composición corporal y el ángulo de fase de mujeres jóvenes. Por lo tanto, se recomienda utilizar protocolos similares para mofificar variables relacionadas con la salud de mujeres jóvenes.

[Cartagena Declaration. The International Declaration on the Right to Nutritional Care and the Fight against Malnutrition]. / Declaración de Cartagena. Declaración Internacional sobre el Derecho al Cuidado Nutricional y la Lucha contra la Malnutrición.

INTRODUCTION: The need to promote the right to nutritional care, to fight against malnutrition and to advance in education and research in clinical nutrition has led all the FELANPE's societies to sign on May 3rd, during the 33rd Congress of the Colombian Clinical Nutrition Association (ACNC) in the city of Cartagena, the International Declaration on the Right to Nutritional Care and the Fight against Malnutrition, "Declaration of Cartagena". The Declaration provides a coherent framework of 13 principles which can serve as a guide for societies, schools and associations affiliated to FELANPE in the development of action plans. In addition, it will serve as an instrument to promote, through governments, the formulation of policies and legislation in the field of clinical nutrition. We believe that the general framework of principles proposed by the Declaration can contribute to raise awareness about the magnitude of this problem and to promote cooperation networks among Latin-American countries. Although this Declaration does not have a binding legal effect, it has an undeniable moral strength and it can provide practical guidance to States. An implementation program will allow developing a toolkit to transform principles into actions.

INTRODUCCIÓN: Frente a la necesidad de promover el derecho al cuidado nutricional, de luchar contra la malnutrición y de avanzar en temas de educación e investigación en nutrición clínica, las sociedades que constituyen la FELANPE firmaron la Declaración Internacional sobre el Derecho al Cuidado Nutricional y la Lucha contra la Malnutrición, "Declaración de Cartagena", el 3 de mayo del presente año en la ciudad de Cartagena, en el marco del 33º Congreso de la Asociación Colombiana de Nutrición Clínica. La Declaración proporciona un marco coherente de 13 principios, los cuales podrán servir de guía a las sociedades afiliadas a la FELANPE en el desarrollo de los planes de acción. Además, servirá como un instrumento para que promuevan, a través de los gobiernos, la formulación de políticas y legislaciones en el campo de la nutrición clínica. Consideramos que el marco general de principios propuesto por la Declaración puede contribuir a crear conciencia acerca de la magnitud de este problema y a forjar redes de cooperación entre los países de la región. Aunque esta Declaración no tiene un efecto jurídico vinculante (obligatorio), tiene una fuerza moral innegable y puede proporcionar orientación práctica a los estados. Un plan de implementación permitirá desarrollar la caja de herramientas necesaria para transformar los principios en acciones.

Method for the technical, financial, economic and environmental pre-feasibility study of geothermal power plants by RETScreen - Ecuador's case study.

RETScreen presents a proven focused methodology on pre-feasibility studies. Although this tool has been used to carry out a number of pre-feasibility studies of solar, wind, and hydropower projects; that is not the case for geothermal developments. This method paper proposes a systematic methodology to cover all the necessary inputs of the RETScreen-International Geothermal Project Model. As case study, geothermal power plant developments in the Ecuadorian context were analysed by RETScreen-International Geothermal Project Model. Three different scenarios were considered for analyses. Scenario I and II considered incentives of 132.1 USD/MWh for electricity generation and grants of 3 million USD. Scenario III considered the geothermal project with an electricity export price of 49.3 USD/MWh. Scenario III was further divided into IIIA and IIIB case studies. Scenario IIIA considered a 3 million USD grant while Scenario IIIB considered an income of 8.9 USD/MWh for selling heat in direct applications. Modelling results showed that binary power cycle was the most suitable geothermal technology to produce electricity along with aquaculture and greenhouse heating for direct use applications in all scenarios. Financial analyses showed that the debt payment would be 5.36 million USD/year under in Scenario I and III. The correspindig values for Scenario II was 7.06 million USD/year. Net Present Value was positive for all studied scenarios except for Scenario IIIA. Overall, Scenario II was identified as the most feasible project due to positive NPV with short payback period. Scenario IIIB could become financially attractive by selling heat for direct applications. The total initial investment for a 22 MW geothermal power plant was 114.3 million USD (at 2017 costs). Economic analysis showed an annual savings of 24.3 million USD by avoiding fossil fuel electricity generation. More than 184,000 tCO2 eq. could be avoided annually.

Differential tissue distribution of Trypanosoma cruzi during acute experimental infection: Further evidence using natural isolates.

In the present work, we evaluated the effect of mixed Trypanosoma cruzi infections, studying the biological distribution of the different parasites in blood, heart and skeletal muscle during the acute phase. Albino Swiss mice were infected with different parasite strain/isolates or with a combination of them. The parasites in the different tissues were typified through specific PCR, population variability was analyzed through RFLP studies and parasitological and histopathological parameters were evaluated. We found a predominance of TcII and TcVI in all tissues samples respect to TcV and different parasite populations were found in circulation and in the tissues from the same host. These results verify the distribution of parasites in host tissues from early stages of infection and show biological interactions among different genotypes and populations of T. cruzi.

Quality control in gastrointestinal surgery.

We analyzed the Mexican legal framework, identifying the vectors that characterize quality and control in gastrointestinal surgery. Quality is contemplated in the health protection rights determined according to the Mexican Constitution, established in the general health law and included as a specific goal in the actual National Development Plan and Health Sector Plan. Quality control implies planning, verification and application of corrective measures. Mexico has implemented several quality strategies such as certification of hospitals and regulatory agreements by the General Salubrity Council, creation of the National Health Quality Committee, generation of Clinical Practice Guidelines and the Certification of Medical Specialties, among others. Quality control in gastrointestinal surgery must begin at the time of medical education and continue during professional activities of surgeons, encouraging multidisciplinary teamwork, knowledge, abilities, attitudes, values and skills that promote homogeneous, safe and quality health services for the Mexican population.