First national mapping of cadmium in cacao beans in Colombia.

Cacao crops in Colombia play a fundamental role in its economy. Cacao bean exports have a rising tendency due to increased area and production. However, cadmium (Cd) in cacao beans has affected market in Colombia. The aim of this study is to assess Cd distribution hotspots for cacao beans, Cd in beans and soil relationships, geological ages and soil chemical parameters, overall Cd dynamics, soil-to-plant translocation, and EU regulation impacts on Cd presence in Colombian cacao production. A hot and cold spot analysis combined with a cluster and outlier analysis was used to build the geographic Cd distribution in cacao beans in Colombia. Cadmium in the subsurface and the relationship with Cd in the soil surface of cacao farms were analysed using the geoaccumulation index (Igeo). The bioconcentration factor (BCF) and soil chemical features in cacao beans were quantified. Positive correlations were observed within all the studied variables except for Mn and Fe. The highest correlation was observed within Ca, pH, and Cd in soil. The Valanginian-Albian and Albian-Maastrichtian geological ages are directly related to Cd in beans, Zn, P, soil Cd, and Fe. Regions with the highest cacao productivity and export registered an average Cd concentration in beans of 2.39_ ± _2.82 mg kg-1. Two municipalities in Santander were 'partially contaminated' according to Igeo. The BCF was not directly proportional to soil and bean Cd level and did not fully coincide with hot spots. This evidence reinforces the idea that even areas with apparently low Cd levels may register a latent problem associated with genetic/ontogenetic, climatic, or management factors. This first distribution map of Cd in cacao beans constitutes a tool to implement actions to minimize risks and face challenges posed by the imposed regulations that may limit raw cacao bean exports in Colombia.

Estimación de la calidad de vida relacionada con la salud y medidas de utilidad en una población de pacientes colombianos con lupus eritematoso sistémico / Estimated quality of life and health related utility measurements in a population of Colombian patients with systemic lupus erythematosus

Resumen Introducción: La posibilidad de daño orgánico irreversible secundario a la actividad del lupus eritematoso sistémico o por su tratamiento afectan, indefectiblemente, la calidad de vida relacionada con la salud de estos pacientes; éste es un concepto en el cual influyen factores: sociales, familiares y culturales, y es un desenlace primordial en el pronóstico de las enfermedades crónicas. Objetivo: Determinar la calidad de vida relacionada con la salud y los valores de utilidad, en una muestra de pacientes con diagnóstico de lupus eritematoso sistémico y su correlación con actividad y cronicidad. Materiales y métodos: Estudio observacional, descriptivo, de corte transversal. Se incluyeron sujetos con lupus eritematoso sistémico según los criterios del Colegio Americano de Reumatología,ACR (por sus siglas en inglés) de 1997. Se hizo la evaluación de calidad de vida relacionada con la salud mediante SF-36; valores de utilidad, parámetros psicológicos y sociales relacionados con el impacto de la enfermedad con la escala HAD, el cuestionario Duke UNK y su asociación con la actividad lúpica a través de SELENA/SLEDAI y con daño orgánico a través de SLICC-ACR. Resultados: Se incluyeron 152 pacientes. 90.1% mujeres. Los valores promedio de los dominios de calidad de vida relacionada con la salud oscilaron desde 52.9 para el desempeño físico hasta 67.3 para función social. En cuanto a las asociaciones evaluadas éstas fueron débiles, pero estadísticamente significativas, excepto para la variable DUKE-UNK. Conclusiones: La mayoría de los pacientes con lupus eritematoso sistémico tuvo una calidad de vida, relacionada con la salud, ubicada por encima del percentil 50. Las dimensiones más comprometidas fueron las relacionadas con salud física.

Abstract Background: The possibility of irreversible organ damage secondary to systemic lupus erythematosus activity or treatment, inevitably affects the health-related quality of life of these patients. This is a concept which is affected by social, cultural and familial factors, and is a primary outcome in the prognosis of chronic diseases. Objective: To determine the health-related quality of life and utility values in a sample of patients with a diagnosis of systemic lupus erythematosus, and its correlation with activity and chronicity. Materials and methods: Observational, descriptive, cross-sectional study in subjects with systemic lupus erythematosus according to 1997 ACR criteria. Outcomes: Evaluation of health-related quality of life using the SF-36 questionnaire; values of utility, social and psychological parameters related to the impact of the disease with HAD scale, the Duke UNK questionnaire, and its association with lupus activity with SELENA/SLEDAI, and organic damage through the SLICC/ACR. Results: A total of 152 patients were included, of whom 90.1% were women.The mean values of the health-related quality of life domains ranged from 52.9 in the physical performance to 67.3 in the social function. As regards the evaluated associations, these were weak, but statistically significant, except for the DUKE-UNK variable. Conclusions: The majority of patients with systemic lupus erythematosus had a healthrelated quality of life located above the 50th percentile.The most compromised dimensions were those related to physical health.

Renal transplantation in high cardiovascular risk patients.

Current transplant success allows recipients with previous contraindications to transplant to have access to this procedure with more frequency and safety. The concept of high-risk patient has changed since the first stages of transplantation. In the first studies, the high-risk concept was based on probability of early graft failure or on a patient's clinical condition to cope with high perioperatory morbimortality. Later on, this concept implied immunological factors that were crucial to ensure transplant success because hypersensitized or polytransfused patients experienced a higher risk of acute rejection and subsequent graft loss. Afterward, the presence of various comorbidities would redefine the high-risk concept for renal transplant mainly considering recipient's clinical aspects. Currently, the change in epidemiological characteristics of patients starting dialysis causes that we now deal with a greater increase of elderly patients, diabetic patients, and patients with history of cardiovascular disease. Today, high-risk patients are those with clinical features that predict an increase in the risk of perioperative morbimortality or death with functioning graft. In this review, we will attempted to analyze currents results of renal transplant outcomes in terms of patients and graft survival in elderly patients, diabetic patients, and patients with previous cardiovascular disease from the most recent experiences in the literature and from experiences in our center. In any of the groups previously analyzed, survival offered by renal transplant is significantly higher compared to dialysis. Besides, these patients are the recipient group that benefit the most with the transplant because their mortality while remaining on dialysis is extremely high. Hence, renal transplantation should be offered more frequently to older patients, diabetic patients, and patients with pretransplant cardiac and peripheral vascular disease. A positive attitude toward renal transplantation is needed by physicians taking care of these patients from predialysis stages of chronic renal failure.

Características clínicas y epidemiológicas de pacientes trasplantados renales con larga sobrevida del injerto / Clinical and epidemiological characteristics of renal transplant patients with long graft survival

La sobrevida del trasplante renal a largo plazo ha cambiado ligeramente con respecto a la sobrevida al año. Existe un interés en conocer que factores condicionan un éxito prolongado, clínico y funcional, luego del trasplante. Objetivos: conocer la incidencia de sobrevida renal >/ a 8 años (prolongada). Analizar los factores (inmunológicos y no inmunológicos) asociados a una sobrevida >/ a 8 años del injerto. Analizar la influencia del tipo de trasplante en la serie general y en los pacientes con >/ a 8 años de sobrevida. Determinar la sobrevida del injerto renal del total de la población trasplantada. Determinar las causas de falla del injerto y de mortalidad de los pacientes en ambos grupos. Material y métodos: Hipótesis: Algunos de los factores inmunológicos y no inmunológicos que han sido citados como fuentes determinantes de la sobrevida del injerto renal a corto plazo podrían serlo también a largo plazo, y además podría haber otras características biológicas del donante y/o receptor

Características clínicas y epidemiológicas de pacientes trasplantados renales con larga sobrevida del injerto / Clinical and epidemiological characteristics of renal transplant patients with long graft survival

La sobrevida del trasplante renal a largo plazo ha cambiado ligeramente con respecto a la sobrevida al año. Existe un interés en conocer que factores condicionan un éxito prolongado, clínico y funcional, luego del trasplante. Objetivos: conocer la incidencia de sobrevida renal >/ a 8 años (prolongada). Analizar los factores (inmunológicos y no inmunológicos) asociados a una sobrevida >/ a 8 años del injerto. Analizar la influencia del tipo de trasplante en la serie general y en los pacientes con >/ a 8 años de sobrevida. Determinar la sobrevida del injerto renal del total de la población trasplantada. Determinar las causas de falla del injerto y de mortalidad de los pacientes en ambos grupos. Material y métodos: Hipótesis: Algunos de los factores inmunológicos y no inmunológicos que han sido citados como fuentes determinantes de la sobrevida del injerto renal a corto plazo podrían serlo también a largo plazo, y además podría haber otras características biológicas del donante y/o receptor