Patrones de actividad de mamíferos alrededor de la línea transportadora de gas natural de Camisea en la Reserva Comunal Machiguenga, Cusco, Perú

En el presente trabajo se estudia la actividad horaria de los mamíferos que habitan el área circundante a la línea transportadora de gas de Camisea que atraviesa la Reserva Comunal Machiguenga. Desde febrero del 2020 hasta enero del 2021, se realizó un registro fotográfico mediante cámaras trampa dispuestas a lo largo de la tubería de gas. Los patrones de actividad se estimaron mediante la función de densidad de Kernel. Durante el periodo de estudio, se registraron 25 especies de mamíferos. Se encontró que Dasyprocta kalinowskii y Eira barbara presentan un patrón de actividad diurno; mientras que Cuniculus paca, Tapirus terrestris, Dasypus spp. y Mazama spp. presentan un patrón predominantemente nocturno. Se sugiere que los patrones de actividad observados estarían influenciados por varios factores como la exclusión competitiva entre D. kalinowskii y C. paca, disponibilidad estacional del alimento para T. terrestris, variación de temperatura y precipitación para Dasypus spp., restricciones filogenéticas en Mazama spp., y segregación temporal con otros carnívoros para E. barbara. Se destaca la importancia de la colaboración entre las empresas del rubro energético, las comunidades nativas y las organizaciones gubernamentales.

The present study investigates the hourly activity patterns of mammals inhabiting the area surrounding the Camisea gas pipeline that crosses the Machiguenga Communal Reserve. From February 2020 to January 2021, a photographic record was conducted using camera traps placed along the gas pipeline. Activity patterns were estimated using Kernel density functions. During the study period, 25 mammal species were recorded. It was found that Dasyprocta kalinowskii and Eira barbara exhibit a diurnal activity pattern, whereas Cuniculus paca, Tapirus terrestris, Dasypus spp., and Mazama spp. display predominantly nocturnal behavior. It is suggested that observed activity patterns could be influenced by various factors such as competitive exclusion between D. kalinowskii and C. paca, seasonal food availability for T. terrestris, temperature and precipitation variations for Dasypus spp., phylogenetic constraints in Mazama spp., and temporal segregation with other carnivores for E. barbara. The significance of collaboration between energy industry companies, native communities, and governmental organizations is emphasized.

Assessment of sexual dysfunction in patients with multiple sclerosis: a perspective from neurologist.

BACKGROUND: Sexual dysfunction (SD) is a common comorbidity in people with multiple sclerosis (pwMS). It affects the quality of life and remains an overlooked condition. The objective of this study was to describe how Colombian neurologists assess and treat SD and explore the barriers during sexual function evaluation. METHODS: In this observational cross-sectional study we developed a questionnaire for neurologists with 4 sections (demographic data, evaluation and treatment of SD, and possible reasons for not discussing sexual dysfunction.) It was sent via email to 326 Colombian neurologists. We grouped the answers according to the type of consultation (neurologists from a MS program or no MS program). We described through absolute frequencies and proportions. RESULTS: Fifty neurologists answered the survey. 64% stated that they usually study sexual dysfunction in neurological disorders. The main methods employed were private reading (86%) and attending conferences (14%). 5/50 participants have never attend pwMS; the Sect. 2-4 was not answered by them. 29% work in a MS program, all of them asked their patients about sexual function, but 18.75% of physicians working outside an MS program have never asked about it. Main reasons for not talking about sexual dysfunction were lack of knowledge (65.1%), presence of a companion (65.1%) and lack of time (55.8%). 91% of the neurologists reported that their patients usually and frequently ask about sexual function. Neurologists use informal questions to assess sexual function (80%), although 64.4% said that they are aware of SD questionnaires. When sexual dysfunction is detected, 91% of neurologists refer patients to another specialist and 87% do not start any treatment. CONCLUSIONS: Colombian neurologists are concerned with sexual function in pwMS, however it remains an underdiagnosed an undertreated condition. It is necessary to strengthen knowledge about the diagnosis and treatment of sexual dysfunction in pwMS, for neurologists and patients. It is also imperative to eliminate barriers around the topic and include sexual function evaluation and treatment as the routine care of pwMS.

Polycystic ovary syndrome and the new antiepileptic drugs: A systematic review.

OBJECTIVE: To evaluate the presence of polycystic ovary syndrome (PCOS) in women of reproductive age with the use of antiepileptic drugs. METHODS: A systematic literature review of observational analytical studies (cohort, cross-sectional and case-control), from January 1966 to January 2021 on PCOS in women of reproductive age with the use of the antiepileptics. The search covered the Cochrane, MEDLINE, Embase and LILACS databases. INCLUSION CRITERIA: Studies reporting the frequency of PCOS with the antiepileptic drugs in women of reproductive age. EXCLUSION CRITERIA: studies that did not have categorically relevant measurements, those published as abstracts only, and studies of investigational treatment. Data extraction was performed based on the PECOT strategy, considering the method of intervention, methodological quality, and presence of PCOS with the antiepileptic drugs. RESULTS: A total of 2043 references were obtained from which 22 articles were selected by title and abstract. Four articles met the inclusion criteria. No articles were found describing the risk of PCOS upon exposure to levetiracetam, felbamate, gabapentin, lacosamide, pregabalin, rufinamide, tiagabine, topiramate, vigabatrin, or zonisamide. Only articles related to oxcarbazepine and lamotrigine were found, in which the frequency of PCOS was like that found in women without epilepsy. CONCLUSIONS: The anticonvulsants are probably safer, but the risk of developing PCOS associated with the antiepileptics cannot be established, since there are insufficient studies.

[Personal and familial features associated with organ donation in Chilean adults]. / Características sociales y familiares asociadas a la decisión de ser donante de órganos y tejidos en población adulta, Coquimbo, Chile 2019.

BACKGROUND: The rates of organ donation are alarmingly low in Chile. AIM: To determine the relationship between social and family characteristics that influence the decision to donate organs and tissues among adults. MATERIAL AND METHODS: The questionnaire developed in Spain by the international collaborative project on organ transplantation and donation, developed and validated in Chile was applied to 383 adults aged 40 ± 17 years (mostly women), living in Coquimbo, Chile. RESULTS: Seventy seven percent of respondents would agree to be a donor. The main features of eventual donors are: being young adult in 62% of respondents, single in 48%, with complete secondary education in 29%, non-practicing Catholic in 37% and being informed on television about transplantation in 66%. In a logistic regression model, the features significantly associated with being an eventual donor were the decision of donating organs of relatives (Odds Ratio [OR] 9.1 95% confidence intervals [CI] 4.8-17-2), commenting and knowing the opinion of relatives (OR 2.3 95%CI 1.2-4.1), especially parents and partner, and a lower age (OR 0.98 95% CI 0.96-0.99). CONCLUSIONS: The decision to donate organs is influenced by commenting and knowing the opinion of relatives, especially parents and partners. Also, a lower age is associated with a better attitude towards donation.

Características sociales y familiares asociadas a la decisión de ser donante de órganos y tejidos en población adulta, Coquimbo, Chile 2019 / Personal and familial features associated with organ donation in Chilean adults

Background: The rates of organ donation are alarmingly low in Chile. Aim: To determine the relationship between social and family characteristics that influence the decision to donate organs and tissues among adults. Material and Methods: The questionnaire developed in Spain by the international collaborative project on organ transplantation and donation, developed and validated in Chile was applied to 383 adults aged 40 ± 17 years (mostly women), living in Coquimbo, Chile. Results: Seventy seven percent of respondents would agree to be a donor. The main features of eventual donors are: being young adult in 62% of respondents, single in 48%, with complete secondary education in 29%, non-practicing Catholic in 37% and being informed on television about transplantation in 66%. In a logistic regression model, the features significantly associated with being an eventual donor were the decision of donating organs of relatives (Odds Ratio [OR] 9.1 95% confidence intervals [CI] 4.8-17-2), commenting and knowing the opinion of relatives (OR 2.3 95%CI 1.2-4.1), especially parents and partner, and a lower age (OR 0.98 95% CI 0.96-0.99). Conclusions: The decision to donate organs is influenced by commenting and knowing the opinion of relatives, especially parents and partners. Also, a lower age is associated with a better attitude towards donation.

¿Cuál es su diagnóstico? / What is your diagnosis?

No disponible

Safety liver profile of teriflunomide versus interferon ß in multiple sclerosis: Systematic review and indirect comparison meta-analysis.

OBJECTIVES: To compare the liver safety profile of interferon ß (IFN ß) and teriflunomide in patients with multiple sclerosis. METHODS: A network meta-analysis was carried out following the Cochrane Collaboration methodology. All trials comparing all types of IFN ß with teriflunomide, or disease-modifying drugs, or placebo in RRMS were included. An indirect comparison network meta-analysis within a Bayesian framework with STATA (version 13.0) was done for this study. RESULTS: The database searches yielded 284 titles, with 15 records as duplicates. One study was identified by manually searching. Thirteen articles were included in the systematic review. Twelve studies compared IFN ß (4203 patients) vs another DMT. Four studies evaluated the effectiveness and safety of teriflunomide (906 patients) vs another DMT. Six studies reported drug-induced liver injury as per the Hy's Law. However, only one study had a direct comparison and reported no cases of liver toxicity in either group, so it was not possible to estimate the OR. The indirect comparisons metanalysis shows that there was no statistically-significant difference between teriflunomide and IFN ß (OR 1.09, 95% CI 0.02-2.16). CONCLUSIONS: There were no significant difference when comparing IFN ß and teriflunomide in terms of liver failure or elevation of transaminases.

¿Cuál es su diagóstico? / What would your diagnosis be?

No disponible

Sarcoidosis con hipertrofia bilateral parotídea como primer síntoma / Sarcoidosis with bilateral parotid hypertrophy as the first symptom

No disponible

Human Immunoglobulin Versus Plasmapheresis in Guillain-Barre Syndrome and Myasthenia Gravis: A Meta-Analysis.

OBJECTIVES: To evaluate the efficacy and safety over a short time period of human intravenous immunoglobulin versus plasma exchange (PE) in the management of some autoimmune neurologic diseases. In addition, length of hospital stay and duration of ventilator support were compared. METHODS: Randomized controlled trials and analytical observational studies of more than 10 cases were reviewed. Cochrane Neuromuscular Disease Group trials, MEDLINE, EMBASE, HINARI, and Ovid, were searched as data source. Reference lists were examined for further relevant articles. A random-effect model was used to derive a pooled risk ratio. RESULTS: A total of 552 articles were found and 24 met the criteria for a studied population of 4657 cases: 14 articles were about Guillain-Barré syndrome and 10 of myasthenia gravis. No evidence was found to suggest that PE or intravenous immunoglobulin differed in terms of efficacy or safety to treat any of the 2 diseases. Hospital stay length and ventilatory support time are different in each illness; however, we found no statistical difference in either of the 2 treatments. CONCLUSIONS: There is no evidence for superiority in the efficacy or safety of immunoglobulin or plasmapheresis in the management of Guillain-Barré syndrome and myasthenia gravis. However, caution should be exercised in the interpretation of these results given the limitations in the quality of the evidence and the heterogeneity of the studies.

Síndrome de alertamiento capsular asociado con el síndrome antifosfolípidos: reporte de un caso / Capsular Warning Syndrome Associated with Antiphospholipid Syndrome: Case Report / Síndrome de advertência capsular associado à síndrome antifosfolípide: reporte de um caso

El síndrome de alertamiento es definido como ataques isquémicos transitorios esterotipados y recurrentes, los cuales se manifiestan con síntomas motores y/o sensitivos de un hemicuerpo. Las lesiones, generalmente, son de pequeño vaso de la cápsula interna. Entre un 40% y 60% de los casos terminan con infarto del territorio sintomático. El proceso fisiopatológico exacto aún se desconoce y, a pesar de algunos casos exitosos, no existe consenso sobre el manejo óptimo de este síndrome. Se presenta un caso de síndrome de alertamiento capsular de un en paciente con historia de síndrome antifosfolípidos, a la fecha no hay casos publicados que describan la correlación de estas dos condiciones clínicas.

The capsular warning syndrome is defined as recurrent and stereotyped transient ischemic attacks that manifest themselves with motor and/or sensory symptoms. Generally, injuries take place in the small vessel of the internal capsule. Between 40 and 60% of cases will have a stroke.The pathophysiological process is still unknown, and despite some success cases, there is no consensus for the optimal management of the condition.This case of the capsular warning syndrome is presented in a patient with a history of antiphospholipid syndrome. To date, there are no published cases describing the correlation between these two conditions.

A síndrome de advertência é definida como ataques isquêmicos transitórios estereotipados e recorrentes, os quais manifestam-se com sintomas motores e/ou sensitivos de um hemicorpo. As lesões são geralmente de pequeno vaso da capsula interna.Entre um 40% e 60% dos casos terminam com infarto do território sintomático. O processo fisiopatológico exato ainda desconhece-se e apesar de alguns casos de sucesso não existe consenso sobre o manejo óptimo desta síndrome.Apresenta-se um caso de síndrome de advertência capsular de um paciente com história de síndrome antifosfolípide; até esta data não há casos publicados que descrevam a correlação destas duas condições clínicas.

Meningoencefalitis por Nocardia spp: Reporte de un caso y revisión de la literatura / Nocardia spp meningoencephalitis: A case report and literature review

Resumen La nocardiosis es una rara infección oportunista que afecta principalmente a pacientes con alteración de la inmunidad celular, como pacientes con síndrome de inmunodeficiencia adquirida o postrasplantes. El compromiso del sistema nervioso central es generalmente como absceso y menos frecuentemente como meningitis primaria. El presente artículo hace el reporte de un caso de meningitis primaria por Nocardia en paciente inmunocompetente y revisión de la literatura.

Nocardiosis is a rare opportunistic disease that affects mainly patients with deficient cell-mediated immunity, such as those with acquired immunodeficiency syndrome (AIDS) or transplant recipients. The central nervous system presentation is as cerebral abscesses and less frequently, as primary meningitis. Here, a case of primary nocardia meningitis is described in a patient without a predisposing condition, along with a literature review.

Caracterización de pacientes adultos mayores con epilepsia en dos hospitales de Bogotá (Colombia) / Characterizing older adult patients suffering from epilepsy in two hospitals in Bogotá (Colombia) / Caracterização de pacientes adultos mais velhos com epilepsia em dois hospitais de Bogotá (Colômbia)

La prevalencia global de la epilepsia en Colombia es del 1,13% y en pacientes mayores de 65 años puede estar cercana al 1,5%. El objetivo de este trabajo ha sido el de describir las características demográficas y clínicas de la población mayor de 65 años que presenta epilepsia. Materiales y métodos: estudio descriptivo, de corte transversal en dos hospitales en Bogotá (Colombia), durante los años 2005-2008. Se revisaron las bases de datos y se seleccionaron las historias clínicas de los pacientes mayores de 65 años con epilepsia. Resultados: se revisaron 211 historias clínicas y se seleccionaron 179. La edad media fue de 75 años (65-98) y el inicio de la epilepsia fue a los 67,5 (7-93); el 64,4% inició la enfermedad después de los 65 años. El 84% de las crisis fueron clasificadas como focales. El diagnóstico más frecuente fue epilepsia focal sintomática (94,4%). 61 pacientes tuvieron como etiología una enfermedad cerebro-vascular. Los antiepilépticos de primera generación, especialmente fenitoína, fueron los más utilizados (99%), aunque 81 de 104 pacientes tratados no estaban libres de crisis. Conclusiones: la mayoría de las crisis son resultado de una epilepsia focal sintomática como consecuencia de una lesión vascular, por lo que se debe considerar el tratamiento farmacológico desde la primera crisis. Es recomendable iniciar el tratamiento con antiepilépticos de segunda generación como lamotrigina, gabapentin, levetiracetam, para minimizar efectos secundarios, y mantener el principio de inicio con dosis bajas y mantenimiento con dosis bajas. Si las condiciones económicas no lo permiten, se puede usar fenitoína o carbamacepina con precaución.

Epilepsy's overall prevalence in Colombia is 1.13%. Its prevalence in patients aged over 65 could be around 1.5%. Objective: describe demographic and clinical characteristics of patients older than 65 years of age with epilepsy. Materials and methods: A cross-sectional descriptive study was carried out in two high complexity hospitals in Bogotá, Colombia during 2005-2008. Demographic data were compiled and patients characterized regarding the type, frequency and diagnosis of seizures (based on ILAE classification), probable etiology, having a family background of epilepsy, and current pharmacological management. Results: 211 clinical histories were reviewed and 179 of them selected. Mean patient age was 75 (65-98) and average age at onset of epilepsy was 67.5 (7-93). 84% of the seizures were classified as being focal. The most frequently occurring diagnosis was symptomatic focal epilepsy (94.4%). 74 cases (41.3%) had an etiological diagnosis. The most important cause was cerebrovascular disease (61 patients). First generation anti-epileptic drugs were the most used ones (99%). 81/104 patients were found not to be free from epileptic episodes. Conclusions: Most seizures have a partial beginning, resulting from symptomatic partial epilepsy as a consequence of a vascular lesion. Pharmacological treatment must be considered following the first seizure. Treatment with second generation anti-epileptic drugs such as Lamotrigine, Gabapentin, Levetiracetam and Topiramate must be begun for minimizing secondary effects and low doses must be maintained from the start of treatment. Costs may limit the use of the above antiepileptic drugs, in such cases Phenytoin and Carbamazepine may be used with extreme caution.

A prevalência global da epilepsia na Colômbia é 1,13% e em pacientes maiores de 65 anos pode estar próxima a 1,5%. O objetivo deste trabalho tem sido descrever as características demográficas e clínicas da população maior de 65 anos que apresenta epilepsia. Materiais e métodos: estudo descritivo, de corte transversal em dois hospitais em Bogotá, Colômbia, durante os anos 2005-2008. Revisaram-se as bases de dados e se selecionaram as histórias clínicas dos pacientes maiores de 65 anos com epilepsia. Resultados: Se revisaram 211 histórias clínicas e se selecionaram 179. A idade média foi de 75 anos (65-98) e o inicio da epilepsia foi aos 67,5 (7-93); 64,4% iniciaram a doença depois dos 65 anos. 84% das crises foram classificadas como focais. O diagnóstico mais freqüente foi epilepsia focal sintomática (94.4%). 61 pacientes tiveram como etiologia uma doença cardiovascular. Os antiepilépticos de primeira geração, especialmente Fenitoína, foram os mais utilizados (99%) ainda que 81 de 104 pacientes tratados não estivessem livres de crises. Conclusões: a maioria das crises é resultado de uma epilepsia focal sintomática como conseqüência de uma lesão vascular pelo que se deve considerar o tratamento farmacológico desde a primeira crise. É recomndável iniciar o tratamento com antiepilépticos de segunda geração como Lamotrigina, Gabapentin, Levetiracetam para minimizar os efeitos secundários e, manter no princípio o início com doses baixas e conservação com doses baixas. Se as condições econômicas não o permitem, pode-se usar Fenitoína ou Carbamacepina com precaução.

[Assessment of cervical cancer screening in the Health Service of Valdivia, Chile]. / Pesquisa y control del cáncer cérvico-uterino en el Servicio de Salud de Valdivia (1993-2003).

BACKGROUND: One of the best Public Health achievements in Chile has been the coverage of the program for detection and treatment or cervical cancer. AIM: To evaluate the results of the Cervical Cancer Screening Program in Valdivia Health Service (Southern Chile) between 1993 and 2003. MATERIAL AND METHODS: Retrospective review of the number of women in whom a Papanicolau smear was obtained in the last three years. The incidence of the disease was calculated using pathological diagnoses of precursor or invasive lesions. Mortality for cervical cancer was calculated using data from death certificates. RESULTS: During 2003, 79% of women age 25 to 64 years, and 77% of women aged 35 to 63 years (considered the highest risk group) were screened. We confirmed that the number of precursor lesions detected were increased along with the increasing screening coverage. The diagnosis of carcinoma in situ increased almost three times when compared with 1990 figures. Likewise, the diagnosis of early invasive cervical cancer behaved similarly. Mortality by cervical cancer also experienced a decrease, reaching 4.6 per 100.000 women over 15 years old in the Health Service of Valdivia. CONCLUSIONS: The sustained increase in cervical cancer screening coverage has had a favorable impact in the morbidity and mortality caused by the disease.

Estrategias efectivas para aumentar la cobertura del Papanicolaou en el programa de detección del cáncer cervicouterino / Effective strategies to increase the papanicolau coverage in the cervicouterine cancer detection program

El aumento de las coberturas del Papanicolaou depende de múltiples factores donde se destaca la motivación de los equipos de salud, en especial de la profesional matrona, así como de una red de apoyo interdisciplinario y comunitaria destinada a captar mujeres, y el concepto de auto-cuidado que tenga internalizado cada mujer. El objetivo de este trabajo es dar a conocer estrategias de salud pública que permitieron aumentar la cobertura del Papanicolaou (Pap) vigente en mujeres beneficiarias en un 12 y 8% en los Servicios de Salud Valdivia y Metropolitano Norte. Las estrategias de salud pública probadas en este estudio como efectivas fueron: a)fomento de la informática con: la instalación del cito-expert en la atención primaria, planilla de cálculo de coberturas y estadística mensual, planilla de contra-referencia de pacientes atendidas en la UPC y envío vía e-mail cada tres días; b) Captación de monitoras de Pap en la comunidad;c) Investigación operativa y capacitación permanente a matronas, médicos y monitoras de Pap.d) Implementación de un banco de proyectos de promoción. Esto traducido en el efecto en la salud de la mujer ha significado diagnosticar NIE III cuatro veces más que en 1993, detectar el cáncer invasor en etapas iniciales (etapas I y II), y descender consecuentemente la mortalidad por esta enfermedad, alcanzando actualmente a una tasa de 4,6 por 100.000 mujeres mayores de 15 años en el Servicio de Salud de Valdivia.

The increase in Papanicolau coverage depends on multiple factors, in which the motivation of health teams stands out, specially that of the professional midwife, aided by an interdisciplinaryand community support network destined to attract women, and the concept of self care that each woman has internalized. The objective of this work is that of making available public health strategies allowing to bring about an increase in Papanicolau (PAP) coverage in beneficiary women by a 12 percent and 8% in the Valdivia and North Metropolitan Health Services respectively. The public health strategies proved as effective in this study were: a) promotion of the informative aspect, with installation of the cito-expert in primary attention, statements of coverage calculations and monthly statistics, counter-reference statement of patients attended at the Cervical Pathology Unit (UPC) and e-mail dispatch every three days; b) winning over of Pap monitors in the community; c) operative research and permanent training of midwives, physicians and Pap monitors; d) implementation of a promotion projects bank. This, translated into the effect on women’s health, has implied diagnosing intraepithelial neoplasia III (NIE III) four times as much as in 1993 and invasive cancer in its initial stages (stages I and II) and, consequently, decreasing mortality from this disease which, at present, reaches a rate of 4.6 per 100.000 women over 15 years of age in the Valdivia Health Service.