3D printing: a useful tool for safe clinical practice in children with complex vasculature.

BACKGROUND: 3D printing has been used in different medical contexts, although it is underutilised in paediatrics. We present the first use of 3D printing in the management of three paediatric patients with complex renovascular disease. METHODS: Patient-specific 3D models were produced from conventional 2D imaging and manufactured using 3D polyjet printing technology. All three patients had different underlying pathologies, but all underwent multiple endovascular interventions (renal artery balloon angioplasty) prior to 3D printing and subsequent vascular surgery. The models were verified by an expert radiologist and then presented to the multidisciplinary team to aid with surgical planning. RESULTS: Following evaluation of the 3D-printed models, all patients underwent successful uni/bilateral renal auto-transplants and aortic bypass surgery. The 3D models allowed more detailed preoperative discussions and more focused planning of surgical approach, therefore enhancing safer surgical planning. It influenced clinical decision-making and shortened general anaesthetic time. The families and the patients reported that they had a significantly improved understanding of the patient's condition and had more confidence in understanding proposed surgical intervention, thereby contributing to obtaining good-quality informed consent. CONCLUSION: 3D printing has a great potential to improve both surgical safety and decision-making as well as patient understanding in the field of paediatrics and may be considered in wider surgical areas.

Pediatric renal transplantation-A UNOS database analysis of donor-recipient size mismatch.

BACKGROUND: We used the BSAi (Donor BSA/Recipient BSA) to assess whether transplanting a small or large kidney into a pediatric recipient relative to his/her size influences renal transplant outcomes. METHODS: We included 14 322 single-kidney transplants in pediatric recipients (0-17 years old) (01/2000-02/2020) from the United Network for Organ Sharing database. We divided cases into four BSAi groups (BSAi ≤ 1, 1 < BSAi ≤ 2, 2 < BSAi ≤ 3, BSAi > 3). RESULTS: There were no differences concerning delayed graft function (DGF) or primary non-function (PNF) rates, whether the grafts were from living or brain-dead donors. In both transplants coming from living donors and brain-dead donors, cases with BSAi > 3 and cases with 2 < BSAi ≤ 3 had similar graft survival (p = .13 for transplants from living donors, p = .413 for transplants from brain-dead donors), and both groups had longer graft survival than cases with 1 < BSAi ≤ 2 and cases with BSAi ≤ 1 (p < .001). The difference in 10-year graft survival rates between cases with BSAi > 3 and cases with BSAi ≤ 1 reached around 25% in both donor types. The better graft survival in transplants with BSAi > 2 was confirmed in multivariable analysis. CONCLUSIONS: There is no significant impact of donor-recipient size mismatch on DGF and PNF rates in pediatric renal transplants. However, graft survival is significantly improved when the donor's size is more than twice the pediatric recipient's size.

Utilizing 3D printing to facilitate surgical in-situ paediatric renal artery aneurysm repair for refractory hypertension.

Renal artery aneurysmal (RAA) disease is a rare, but potentially life-threatening cause of renovascular disease presenting with hypertension. Conventional management involves aneurysmal excision followed by renal auto-transplantation. We present the management of a 13-year-old girl with complex multiple saccular aneurysmal disease of the left renal artery with hilar extension and symptomatic hypertension. We used 3D printing to print a patient-specific model that was not implanted in the patient but was used for surgical planning and discussion with the patient and their family. Endovascular options were precluded due to anatomical complexities. Following multi-disciplinary review and patient-specific 3D printing, she underwent successful in-situ RAA repair with intraoperative cooling, without the need for auto-transplantation. 3D printing enabled appreciation of aneurysmal spatial configuration and dimensions that also helped plan the interposition graft length needed following aneurysmal excision. The models provided informed multidisciplinary communications and proved valuable during the consent process with the family for this high-risk procedure. To our knowledge, this is the first reported case utilizing 3D printing to facilitate in-situ complex repair of RAA with intra-hilar extension for paediatric renovascular disease.

A Review of the Presence of SARS-CoV-2 in Wastewater: Transmission Risks in Mexico.

The appearance of SARS-CoV-2 represented a new health threat to humanity and affected millions of people; the transmission of this virus occurs through different routes, and one of them recently under debate in the international community is its possible incorporation and spread by sewage. Therefore, the present work's research objectives are to review the presence of SARS-CoV-2 in wastewater throughout the world and to analyze the coverage of wastewater treatment in Mexico to determine if there is a correlation between the positive cases of COVID-19 and the percentages of treated wastewater in Mexico as well as to investigate the evidence of possible transmission by aerosol sand untreated wastewater. Methodologically, a quick search of scientific literature was performed to identify evidence the presence of SARS-CoV-2 RNA (ribonucleic acid) in wastewater in four international databases. The statistical information of the positive cases of COVID-19 was obtained from data from the Health Secretary of the Mexican Government and the Johns Hopkins Coronavirus Resource Center. The information from the wastewater treatment plants in Mexico was obtained from official information of the National Water Commission of Mexico. The results showed sufficient evidence that SARS-CoV-2 remains alive in municipal wastewater in Mexico. Our analysis indicates that there is a low but significant correlation between the percentage of treated water and positive cases of coronavirus r = -0.385, with IC (95%) = (-0.647, -0.042) and p = 0.030; this result should be taken with caution because wastewater is not a transmission mechanism, but this finding is useful to highlight the need to increase the percentage of treated wastewater and to do it efficiently. In conclusions, the virus is present in untreated wastewater, and the early detection of SAR-CoV-2 could serve as a bioindicator method of the presence of the virus. This could be of great help to establish surveillance measures by zones to take preventive actions, which to date have not been considered by the Mexican health authorities. Unfortunately, wastewater treatment systems in Mexico are very fragile, and coverage is limited to urban areas and non-existent in rural areas. Furthermore, although the probability of contagion is relatively low, it can be a risk for wastewater treatment plant workers and people who are close to them.

Carbon Pool in Mexican Wetland Soils: Importance of the Environmental Service.

Mexican wetlands are not included in Earth system models around the world, despite being an important carbon store in the wetland soils in the tropics. In this review, five different types of wetlands were observed (marshes, swamps, flooded grasslands, flooded palms and mangroves) in which their carbon pool/carbon sequestrations in Mexican zones were studied. In addition, it was shown that swamps (forested freshwater wetlands) sequestered more carbon in the soil (86.17 ± 35.9 Kg C m−2) than other types of wetlands (p = 0.011); however, these ecosystems are not taken into consideration by the Mexican laws on protection compared with mangroves (34.1 ± 5.2 Kg C m−2). The carbon pool detected for mangrove was statistically similar (p > 0.05) to data of carbon observed in marshes (34.1 ± 5.2 Kg C m−2) and flooded grassland (28.57 ± 1.04 Kg C m−2) ecosystems. The value of carbon in flooded palms (8.0 ± 4.2 Kg C m−2) was lower compared to the other wetland types, but no significant differences were found compared with flooded grasslands (p = 0.99). Thus, the carbon deposits detected in the different wetland types should be taken into account by policy makers and agents of change when making laws for environmental protection, as systematic data on carbon dynamics in tropical wetlands is needed in order to allow their incorporation into global carbon budgets.

Estado de la política pública para personas con discapacidad en materia de empleo, seguridad social y educación en Tunja (Colombia) / State of Public Policy for People with Disabilities in Employment, Social Security, and Education in Tunja, Colombia

Resumen Con el producto se pretende exponer cuál es el estado actual de la política pública para población con discapacidad en la ciudad de Tunja, a partir de los derechos constitucionales fundamentales al empleo, la seguridad social y la educación. Para ello, se realizó un estudio normativo de cada uno de estos aspectos, yendo de lo general a lo particular, para culminar en la política pública que desarrolla los lineamientos en materia de población con discapacidad en Tunja: el Acuerdo Municipal No. 0026 de 2011.

Abstract The product is intended to expose the current state of public policy for the population with disabilities in the city of Tunja, based on the fundamental constitutional rights to employment, social security, and education. For this purpose, a normative study of each of these aspects was carried out, going from the general to the particular, to culminate in the public policy that develops the guidelines for the population with disabilities in Tunja: Municipal Agreement No. 0026 of 2011.

Carbon Fluxes and Stocks by Mexican Tropical Forested Wetland Soils: A Critical Review of Its Role for Climate Change Mitigation.

Wetland soils are important stores of soil carbon (C) in the biosphere, and play an important role in global carbon cycles in the response strategy to climate change. However, there areknowledge gaps in our understanding of the quantity and distribution in tropical regions. Specifically, Mexican wetlands have not been considered in global carbon budgets or carbon balances for a number of reasons, such as: (1) the lack of data, (2) Spanish publications have not been selected, or (3) because such balances are mainly made in the English language. This study analyzes the literature regarding carbon stocks, sequestration and fluxes in Mexican forested wetlands (Forest-W). Soil carbon stocks of 8, 24.5 and 40.1 kg cm-2 were detected for flooded palms, mangroves, and freshwater or swamps (FW) wetland soils, respectively, indicating that FW soils are the Forest-W with more potential for carbon sinks (p = 0.023), compared to mangroves and flooded palm soils. While these assessments of carbon sequestration were ranged from 36 to 920 g-C m-2 year-1, C emitted as methane was also tabulated (0.6-196 g-C m-2 year-1). Subtracting the C emitted of the C sequestered, 318.2 g-C m-2 year-1 were obtained. Such data revealed that Forest-W function is mainly as carbon sink, and not C source. This review can help to inform practitioners in future decisions regarding sustainable projects, restoration, conservation or creation of wetlands. Finally, it is concluded that Forest-W could be key ecosystems in strategies addressing the mitigation of climate change through carbon storage. However, new studies in this research line and public policies that protect these essential carbon sinks are necessary in order to, hopefully, elaborate global models to make more accurate predictions about future climate.

Elimination of fungicides in biopurification systems: Effect of fungal bioaugmentation on removal performance and microbial community structure.

Bioaugmentation with ligninolytic fungi represents a potential way to improve the performance of biomixtures used in biopurification systems for the treatment of pesticide-containing agricultural wastewater. The fungus Trametes versicolor was employed in the bioaugmentation of a biomixture to be used in the simultaneous removal of seven fungicides. Liquid cultures of the fungus were able to remove tebuconazole, while no evidence of carbendazim, metalaxyl and triadimenol depletion was found. When applied in the biomixture, the bioaugmented matrix failed to remove all the triazole fungicides (including tebuconazole) under the assayed conditions, but was efficient to eliminate carbendazim, edifenphos and metalaxyl (the latter only after a second pesticide application). The re-addition of pesticides markedly increased the elimination of carbendazim and metalaxyl; nonetheless, no clear enhancement of the biomixture performance could be ascribed to fungal bioaugmentation, not even after the re-inoculation of fungal biomass. Detoxification efficiently took place in the biomixture (9 d after pesticide applications) according to acute tests on Daphnia magna. DGGE-analysis revealed only moderate time-divergence in bacterial and fungal communities, and a weak establishment of T. versicolor in the matrix. Data suggest that the non-bioaugmented biomixture is useful for the treatment of fungicides other than triazoles.

Tracheostomy tube in place at intensive care unit discharge is associated with increased ward mortality.

OBJECTIVE: To determine the relationship between tracheostomy tube in place after intensive-care-unit (ICU) discharge and hospital mortality. METHODS: We conducted a prospective observational cohort study in a medical-surgical ICU in a tertiary-care hospital that does not have a step-down unit. We recorded clinical and epidemiologic variables, indication and timing of tracheostomy, time to decannulation, characteristics of respiratory secretions, need for suctioning, and Glasgow coma score at ICU discharge. We excluded patients who had do-not-resuscitate orders, tracheostomy for long-term airway control, neuromuscular disease, or neurological damage. RESULTS: A total of 118 patients were tracheostomized in the ICU, and 73 were discharged to the ward without neurological damage. Of these, 35 had been decannulated. Ward mortality was 19% overall, 11% in decannulated patients, and 26% in patients with the tracheostomy tube in place; that difference was not statistically significant in the univariate analysis (P = .10). However, the multivariate analysis, which adjusted for lack of decannulation, age, sex, body mass index, severity of illness, diagnosis at ICU admission, duration of mechanical ventilation, Glasgow coma score, characteristics of respiratory secretions, and need for suctioning at ICU discharge, found 3 factors associated with ward mortality: lack of decannulation at ICU discharge (odds ratio 6.76, 95% confidence interval 1.21-38.46, P = .03), body mass index > 30 kg/m(2) (odds ratio 5.81, 95% confidence interval 1.24-27.24, P = .03), and tenacious sputum at ICU discharge (odds ratio 7.27, 95% confidence interval 1-55.46, P = .05). CONCLUSIONS: In our critical-care setting, lack of decannulation of conscious tracheostomized patients before ICU discharge to the general ward was associated with higher mortality.

Neurobiología de las emociones / Neurobiology of emotions

Las emociones son respuestas químicas y neuronales complejas, cuya función fundamental es adaptativa. Ellas organizan tanto el pensamiento como la acción con el fin de evolucionar en vida de la manera más adecuada y óptima. Las emociones se clasifican en primarias y secundarias, siendo las primeras originadas en la amígdala y la corteza singular anterior, las que se dividen en 6 tipos universales, explicando así la similitud de la expresión emocional en todos los individuos y culturas. Las segundas se originan de preferencia en la corteza prefrontal y requieren de la cognición para desarrollarse, dándole un sello social a nuestra personalidad. El sentimiento supone un darse cuenta de las sensaciones básicas de la emoción a través de la interpretación de los cambios en el estado corporal, proceso que se realiza gracias a la integración realizada por la conciencia. En la presente revisión se detallan los mecanismos neurobiológicos y fisiológicos que determinan las diversas emociones humanas, así como las diversas estructuras cerebrales que participan en su configuración, haciendo un recorrido que abarca el binomio tálamo-amigdaliano, corteza prefrontal y hemisferios cerebrales en su rol regulatorio.

Conocimientos y actitudes de la sexualidad en profesores de la provincia de Chañaral / knowledge and attitudes about sexuality among teachers of Chañaral province

Los autores, médicos de dos hospitales de la III Región (Norte de Chile), estudian en profesores de enseñanza básica y media (144), de ambos sexos, de las localidades donde trabajan, el nivel de conocimientos sobre sexualidad humana. Se pretende con ello determinar el grado de adecuación de las actitudes en torno a la sexualidad de sus alumnos, la existencia de creencias erróneas y la opinión sobre fuentes de información y educación sexual. Los 144 profesores representan el 80% de los existentes. El 20% restante se encontraba ausente. 59% son de sexo masculino y 41% femenino, los que se agrupan en 70.1% entre 20 y 35 años, 27,7 entre 36 y 50 y 4,2% entre 50 y más años, con una dispersión entre 24 y 51 años. El cuestionario contempla conceptos de sexualidad, conocimientos de anatomía y fisiología sexual, de aspectos psico-sexuales y de métodos anticonceptivos. En cada uno de los ítems sobre sexualidad, alrededor del 25% de los profesores se abstiene de contestar, situación que llega al 43,7% frente a la definición de líbido. La proporción de respuestas inadecuadas supera el 50% para definir sexualidad, pubertad y adolescencia. Sumadas las abstenciones y las respuestas erróneas, en todos los ítems se supera el 80%, exceptuando el orgasmo que tiene un 50% de respuestas correctas. En conocimiento de anatomía de los órganos genitales, llama la atención que resulte mucho más conocido el aparato reproductor femenino que el masculino (62,9% vs. 37,1%) y el-aparato genital externo del hombre que el de la mujer. En, conocimientos de fisiología, el 33% responde en forma errada y el 67% se abstiene. En cuanto a las etapas del desarrollo psicosexual, el 98% no responde o lo hace mal y sólo el 2% lo hace adecuadamente...