The largest freshwater odontocete: A South Asian river dolphin relative from the proto-Amazonia.

Several dolphin lineages have independently invaded freshwater systems. Among these, the evolution of the South Asian river dolphin Platanista and its relatives (Platanistidae) remains virtually unknown as fossils are scarce. Here, we describe Pebanista yacuruna gen. et sp. nov., a dolphin from the Miocene proto-Amazonia of Peru, recovered in phylogenies as the closest relative of Platanista. Morphological characters such as an elongated rostrum and large supraorbital crests, along with ecological interpretations, indicate that this odontocete was fully adapted to fresh waters. Pebanista constitutes the largest freshwater odontocete known, with an estimated body length of 3 meters, highlighting the ample resource availability and biotic diversity in the region, during the Early to Middle Miocene. The finding of Pebanista in proto-Amazonian layers attests that platanistids ventured into freshwater ecosystems not only in South Asia but also in South America, before the modern Amazon River dolphin, during a crucial moment for the Amazonian evolution.

Factores asociados al miedo hacia el coronavirus en profesionales de la salud que laboran en el primer nivel de atención / Factors associated with fear of the coronavirus in health professionals who work at the first level of care

Introducción: El miedo es un trastorno emocional que puede manifestarse también en profesionales de la salud al enfrentarse a enfermedades infecciosas desconocidas. Esta emoción puede desencadenar síntomas depresivos, que van desde el desánimo, la fatiga y el desinterés hasta la falta de concentración. Objetivos: Determinar los factores asociados al miedo hacia el coronavirus en profesionales de la salud que laboran en el primer nivel de atención durante el año 2022. Materiales y métodos: El presente estudio es de tipo observacional, transversal-analítico. La población de estudio estuvo conformada por 200 profesionales de la salud que laboran en el primer nivel de atención. Se llevó a cabo un muestreo probabilístico de tipo aleatorio simple. Para determinar la prevalencia del miedo hacia el coronavirus se aplicó el instrumento "Escala de Miedo a COVID-19". Para identificar los factores asociados al miedo, se utilizó el instrumento de variables epidemiológicas y laborales. Los datos se procesaron utilizando el paquete estadístico SPSSv28. Resultados: Se encontró una prevalencia del miedo al coronavirus del 72%, relacionada con los factores epidemiológicos con el ser de sexo femenino (p-valor 0.021) y los factores laborales tales como el tiempo trabajado (p=0.015) y el acceso al equipo de protección individual (p-valor 0.003), todos con un valor estadísticamente significativo. Conclusión: Los factores asociados al miedo hacia el coronavirus en profesionales de la salud mostraron un impacto significativo en el sexo femenino, en el periodo laboral de 6 a 10 años y el acceso diario al equipo de protección individual.

Introduction: Fear is an emotional disorder that can also manifest itself in health professionals when faced with an unknown infectious disease. This emotion can trigger depressive symptoms, ranging from discouragement, fatigue, and lack of interest to a lack of concentration. Objectives: To determine the factors associated with fear of the coronavirus in health professionals who work at the first level of care during the year 2022. Materials and methods: This study is observational, cross-sectional, and analytical. The study population consisted of 200 health professionals who work at the first level of care. A simple random probabilistic sampling was carried out. To determine the prevalence of fear towards the coronavirus, the instrument "Scale of Fear of COVID-19" was applied. To identify the factors associated with fear, the instrument of epidemiological and occupational variables was used. The data was processed using the statistical package SPSSv28. Results: A prevalence of fear of coronavirus of 72% was found, related to epidemiological factors with being female (p-value 0,021) and labor factors such as time worked (p=0,015) and access to equipment of individual protection (p-value 0,003), all with a statistically significant value. Conclusion: The factors associated with fear of the coronavirus in health professionals showed a significant impact on the female sex, in the working period of 6 to 10 years and daily access to personal protective equipment.

Incidental finding of left-sided superior vena cava: A case report and comprehensive literature review.

INTRODUCTION AND IMPORTANCE: Persistent left superior vena cava (PLSVC) is a rare vascular anomaly that affects systemic venous circulation. PLSVC typically is asymptomatic as the return of venous blood to the right atrium occurs through the coronary sinus. It is important to possess a comprehensive understanding of drainage as it can present challenges in catheter placement on the right side of the heart, aiming to prevent potential complications. CASE PRESENTATION: A 59-year-old female patient presented at the medical service with abdominal distention. During the examination, the presence of ascites was observed. Subsequent studies revealed peritoneal carcinomatosis of unknown origin. The patient underwent staging laparoscopy with biopsy sampling. Consequently, the placement of a catheter for chemotherapy was performed. A portable chest X-ray was obtained revealing the catheter extending along the left subclavian vein and progressing through the left paramediastinal regionThe presence of persistent left superior vena cava was confirmed after reviewing prior studies. CLINICAL DISCUSSION: The most common abnormality in the venous drainage system is PLSVC. Approximately 40 % of PLSVC cases have associated significant cardiovascular anomalies, with septal defects being the most common. Recognizing anomalies and anatomical variants with the involvement of a multidisciplinary team is critical to prevent vascular complications during endovascular procedures and to tailor techniques for patients in need of cardiac endovascular procedures or cardiac devices. CONCLUSION: PLSVC is often asymptomatic and discovered incidentally, it is essential to have a comprehensive understanding of this anomaly and perform meticulous imaging workup to prevent potential complications.

Adherencia y barreras en el uso de anticonceptivos en mujeres adultas jóvenes atendidas en establecimientos de salud del primer nivel de atención, Perú

Introducción: En los países en vías de desarrollo, la existencia de barreras de acceso de las mujeres a la anticoncepción genera baja adherencia al uso de los diferentes métodos anticonceptivos. Objetivo: Describir la adherencia y barreras en el uso los métodos anticonceptivos en una población de mujeres adultas. Metodología: Estudio cuantitativo, observacional, descriptivo de corte trasversal, con una muestra no probabilística de mujeres mayores de 18 años atendidas en un centro de salud de primer nivel, a quienes se aplicó criterios de selección y se obtuvo consentimiento voluntario para su participación. El estudio siguió los principios de Helsinki y contó con la aprobación del Comité de Ética de la Sociedad Peruana de Obstetricia y Ginecología. El instrumento utilizado fue el IRB Study (Barriers to adolescent contraception adherence) con una consistencia Alfa de Cronbach de 0,79. Se usó estadística descriptiva y la prueba exacta de Fisher para el análisis bivariado. Resultados: Participaron 353 mujeres, la edad media fue 24,6 ± 4,2 años. El 65,7 % fueron solteras y 19,5 % convivientes; el 58,4 % refirió nivel de estudios universitarios; el 73,7 % son de religión católica frente al 26,3% de evangélicos. Los métodos más usados fueron el condón masculino con 37,2 % y las píldoras orales con 23%. Los principales obstáculos fueron el temor por los efectos colaterales de los anticonceptivos con 66,2% y el desplazamiento al centro de salud para su control con 23,5 %. Discusión: La edad y la práctica de actividad sexual son factores que estuvieron vinculados a la adherencia de los anticonceptivos. La preocupación por el aumento de peso, sangrado y riesgo para la salud fueron las principales barreras.

Introduction: In developing countries, the existence of barriers to women's access to contraception generates low adherence to the use of different contraceptive methods. Objective: To describe the adherence and barriers in the use of contraceptive methods in a population of adult women. Methods: Quantitative, observational, descriptive, cross-sectional study, with a non-probabilistic sample of women over 18 years of age attended at a first level health center, to whom selection criteria were applied and voluntary consent was obtained for their participation. The study followed the Helsinki principles and was approved by the Ethics Committee of the Peruvian Society of Obstetrics and Gynecology. The instrument used was the IRB Study (Barriers to adolescent contraception adherence) with a Cronbach Alpha consistency of 0.79. Descriptive statistics and Fisher's exact test were used for bivariate analysis. Results: A total of 353 women participated, the mean age was 24.6 ± 4.2 years; 65.7% were single and 19.5% were cohabiting; 58.4% reported university education; 73.7% were Catholic compared to 26.3% Evangelical. Male condoms (37.2%) and oral pills (23%) were the most commonly used methods. Fear of the side effects of contraceptives (66.2%) and travel to the health center for control (23.5%) were the main obstacles. Discussion: Age and sexual activity were factors associated with contraceptive adherence. Concern about weight gain, bleeding and health risk were the main barriers.

Epidemiological-clinical characteristics and results of appendiceal plastron management in adult patients from a reference hospital in Peru / Características epidemiológico-clínicas y resultados del manejo de plastrón apendicular en pacientes adultos de un hospital de referencia del Perú

Introduction: Appendicular plastron is considered a progressive form of acute appendicitis, with a national prevalence of 2-10%. Currently management is often controversial. It is that from this context, it seeks to promote studies that can elucidate the variables associated with the management of this condition. Objective: to determine the epidemiological-clinical characteristics associated with the results of the management of the appendiceal plastron in adult patients in a reference hospital in Peru. Methods: Non-experimental study, with a quantitative approach, observational, analytical and cross-sectional design, whose sample consisted of 100 patients with a diagnosis of appendicular plastron. The data collection sheet was applied as an instrument. Likewise, a Poisson regression model was used to respond to the objectives. Results: The multivariate analysis showed that alcohol consumption (p<0.05 RPa=1.12), nausea and vomiting (p<0.05, RPa=1.48), diarrhea (p<0.05; RPa=1.08), duration of symptoms before admission between 3 and 5 days (p<0.05; RPa=1.09), appendiceal mass (p<0.05, RPa=1.18) and bandemia (p<0.05, RPa=1.12) were significantly associated with unsuccessful management results of the appendiceal plastron. Conclusion: There are epidemiological and clinical characteristics associated with the results of the management of the appendicular plastron.

Introducción: El plastrón apendicular se considera una forma progresiva de apendicitis aguda, teniendo una prevalencia a nivel nacional de 2-10%. Actualmente el manejo suele ser controversial. Ante lo expuesto, se busca promover estudios que puedan dilucidar las variables asociadas al manejo de esta condición. Objetivo: determinar las características epidemiológico-clínicas asociadas a los resultados del manejo del plastrón apendicular en pacientes adultos en un hospital de referencia del Perú. Métodos: Estudio no experimental, de enfoque cuantitativo, diseño observacional, analítico y transversal, cuya muestra estuvo conformada por 100 pacientes con diagnóstico de plastrón apendicular. Se aplicó como instrumento la ficha de recolección de datos. Asimismo, se utilizo un modelo de regresión de Poisson para responder a los objetivos. Resultados: El análisis multivariado evidenció que el consumo de alcohol (p<0.05 RPa=1.12), las náuseas y vómitos (p<0.05, RPa=1.48), diarrea (p<0.05; RPa=1.08), duración de síntomas antes del ingreso entre 3 y 5 días (p<0.05; RPa=1.09), masa apendicular (p<0.05, RPa=1.18) y bandemia (p<0.05, RPa=1.12) se asociaron significativamente a resultados de manejo no exitosos de plastrón apendicular. Conclusión: Existe características epidemiológicas y clínicas asociadas a resultados del manejo de plastrón apendicular.

Carbon and nutrient burial within Peruvian coastal marsh driven by anthropogenic activities.

This research assessed carbon and nutrient burial during the past ~60 years within a Peruvian coastal marsh ecosystem affected by anthropogenic activities, by examining total organic carbon (TOC), total nitrogen (TN) and isotopes (δ13C and δ15N) tracers in two dated sediment cores. Significantly higher TOC and TN burial, up to 416.4 ± 65.0 and 0.7 ± 0.1 g m-2 year-1 respectively, were observed after an uncontrolled urban expansion starting in the early 1970's to the 1990's. The TOC and TN burial rates were up to twofold higher than those observed for preserved coastal marshes. Furthermore, the decreased δ13C values (-16.1 ± 0.6 ‰) and increasing δ15N values (+10.6 ± 2.6 ‰) indicate higher deposition of algal material and urban sewage during the same period. The higher burial rates during 1970's-1990's and reduced rates thereafter evidenced the role of coastal marsh ecosystems plays in sequestering carbon and nutrients.

Miocene fossils from the southeastern Pacific shed light on the last radiation of marine crocodylians.

The evolution of crocodylians as sea dwellers remains obscure because living representatives are basically freshwater inhabitants and fossil evidence lacks crucial aspects about crocodylian occupation of marine ecosystems. New fossils from marine deposits of Peru reveal that crocodylians were habitual coastal residents of the southeastern Pacific (SEP) for approximately 14 million years within the Miocene (ca 19 to 5 Ma), an epoch including the highest global peak of marine crocodylian diversity. The assemblage of the SEP comprised two long and slender-snouted (longirostrine) taxa of the Gavialidae: the giant Piscogavialis and a new early diverging species, Sacacosuchus cordovai. Although living gavialids (Gavialis and Tomistoma) are freshwater forms, this remarkable fossil record and a suite of evolutionary morphological analyses reveal that the whole evolution of marine crocodylians pertained to the gavialids and their stem relatives (Gavialoidea). This adaptive radiation produced two longirostrine ecomorphs with dissimilar trophic roles in seawaters and involved multiple transmarine dispersals to South America and most landmasses. Marine gavialoids were shallow sea dwellers, and their Cenozoic diversification was influenced by the availability of coastal habitats. Soon after the richness peak of the Miocene, gavialoid crocodylians disappeared from the sea, probably as part of the marine megafauna extinction of the Pliocene.

Correction to: Late Neogene evolution of the Peruvian margin and its ecosystems: a synthesis from the Sacaco record.

[This corrects the article DOI: 10.1007/s00531-021-02003-1.].

Early Holocene greening of the Sahara requires Mediterranean winter rainfall.

The greening of the Sahara, associated with the African Humid Period (AHP) between ca. 14,500 and 5,000 y ago, is arguably the largest climate-induced environmental change in the Holocene; it is usually explained by the strengthening and northward expansion of the African monsoon in response to orbital forcing. However, the strengthened monsoon in Early to Middle Holocene climate model simulations cannot sustain vegetation in the Sahara or account for the increased humidity in the Mediterranean region. Here, we present an 18,500-y pollen and leaf-wax δD record from Lake Tislit (32° N) in Morocco, which provides quantitative reconstruction of winter and summer precipitation in northern Africa. The record from Lake Tislit shows that the northern Sahara and the Mediterranean region were wetter in the AHP because of increased winter precipitation and were not influenced by the monsoon. The increased seasonal contrast of insolation led to an intensification and southward shift of the Mediterranean winter precipitation system in addition to the intensified summer monsoon. Therefore, a winter rainfall zone must have met and possibly overlapped the monsoonal zone in the Sahara. Using a mechanistic vegetation model in Early Holocene conditions, we show that this seasonal distribution of rainfall is more efficient than the increased monsoon alone in generating a green Sahara vegetation cover, in agreement with observed vegetation. This conceptual framework should be taken into consideration in Earth system paleoclimate simulations used to explore the mechanisms of African climatic and environmental sensitivity.

La utilidad del FilmArray como método diagnóstico de la meningitis en pediatría. Revisión Sistemática / The usefulness of FilmArray as a diagnostic method of meningitis in pediatrics. Systematic review

La meningitis es una patología prevalente en pediatría, tiene múltiples causales y alta morbimortalidad. Ante la sospecha se debe iniciar tratamiento empírico de amplio espectro, una rápida identificación del patógeno mejora el pronóstico y disminuye complicaciones. Esta revisión pretende evaluar la utilidad del FilmArray en el diagnóstico de meningitis en pediatría. Se realizó búsquedas en base de todos en Pubmed y Lilacs se encontraron 381, luego de excluir repetidos, por título y resumen; 8 artículos cumplieron los criterios de inclusión y exclusión. Con la estrategia PICO (P: niños entre 2 y 12 años, I: Método del FilmArray ME, C: Métodos cultivo, Gram y PCR específica, D: identificar el impacto sobre un uso racional de antibióticos, disminución del tiempo de hospitalización y otras comorbilidades asociadas). Evidenciando que el FilmArray ME es un examen con igual rendimiento diagnóstico que los métodos convencionales para el diagnóstico de meningitis en población infantil. No se logra evidenciar que mejore tiempo de hospitalización, uso de antibióticos o secuelas; hasta el momento ha igualado y en algunos casos superado el rendimiento del diagnóstico etiológico en la meningitis, aunque faltan estudios para ayudar a dilucidar su real valor en reducción de días de hospitalización y uso de antibióticos

Meningitis is a prevalent pathology in pediatrics, it has multiple causes and high morbidity and mortality. When suspected, empirical broad-spectrum treatment should be started, rapid identification of the pathogen improves the prognosis and reduces complications. This review aims to evaluate the usefulness of the FilmArray in the diagnosis of meningitis in pediatrics. Searches were carried out on the basis of all in Pubmed and Lilacs, 381 were found, after excluding repetitions, by title and abstract; 8 articles met the inclusion and exclusion criteria. With the PICO strategy (P: children between 2 and 12 years old, I: FilmArray ME method, C: Culture, Gram and specific PCR methods, D: identify the impact on a rational use of antibiotics, decrease in hospitalization time and other associated comorbidities). Evidence that the FilmArray ME is an exam with the same diagnostic performance as conventional methods for the diagnosis of meningitis in children. It is not possible to show that it improves hospitalization time, use of antibiotics or sequelae; Up to now, it has equaled and, in some cases, exceeded the performance of etiological diagnosis in meningitis, although studies are lacking to help elucidate its real value in reducing days of hospitalization and use of antibiotics

Her-2 positive mucinous carcinoma breast cancer, case report.

INTRODUCTION: Mucinous carcinoma is a variant of invasive breast carcinomas that accounts for 2% of them and has a better prognosis in contrast to the non-specific invasive carcinoma. They regularly are positive for estrogen and progesterone receptors and, generally, they do not overexpress HER2. When HER2 is positive, the first line treatment is trastuzumab; although the resistance is 52-89% for the non-specific carcinoma, it has been described just once in mucinous carcinoma. CASE SUMMARY: A 48-year-old female presented with a lump in her right breast and after a biopsy, it was diagnosed as mucinous carcinoma in the core biopsy and surgical resection, with positive hormone receptors and HER2 positive (3+) in 100% of the tumor cells. She was treated with neoadjuvant chemotherapy based on trastuzumab and pertuzumab with no pathological response. DISCUSSION: There are few pure mucinous carcinomas positive for HER2. Mucinous carcinomas are positive for HER2 account for less than 5% of invasive ductal carcinoma. Furthermore, our case was resistance to chemotherapy. Most mucinous carcinomas test negative for HER2, so they usually would not be treated with trastuzumab, in this case because the expression of HER2 in the biopsies we initiated it. CONCLUSION: It's important to know that cases of mucinous carcinoma positive for HER2 exist and to be aware of the clinical problems that they may present: resistance to trastuzumab. Also, we need to understand the responsible mechanisms of this resistance and use immunohistochemistry for MUC which may predict it.

Nutrition and physical activity transitions in the Ecuadorian Andes: Differences among urban and rural-dwelling women.

OBJECTIVES: The nutrition and physical activity transitions, characterized by increased consumption of high energy density foods and more sedentary lifestyles, are associated with increased obesity and hypertension in Ecuador. These transitions have been characterized primarily in urban areas, which may neglect variation in specific rural areas of Ecuador. Therefore we examined the extent of the differences in dietary and activity patterns, obesity prevalence, and blood pressure (BP) in urban and rural-dwelling women in the Ecuadorian central highlands. METHODS: Urban-dwelling women (UW, n = 198, mean age = 44 years) from three areas of a city of 250,000 residents and rural women (RW; n = 202, mean age = 47 years) from three remote communities in the same province (Chimborazo) were randomly selected and surveyed for dietary and activity practices, BP, and anthropometrics. RESULTS: Ninety percent of UW reported obtaining their food primarily from markets while 65% of RW women obtained their food primarily from their own cultivation. Cookies, cakes, candies, ice cream, and French fries were consumed more frequently by UW. RW reported lower consumption of beef, poultry, and chicken, as well as fruits, milk, and white rice. UW compared to RW women spent less time walking and in strenuous work activities. Obesity (BMI > 30 kg/m2 ) (UW = 18.7% vs RW = 9.2%) and hypertension (UW = 15.7%, RW= 3.0%) were more common in UW. Average systolic and diastolic BP was significantly higher in UW. CONCLUSIONS: The nutrition and physical activity transitions appear more evident in urban- compared to rural-dwelling women, and are associated with more obesity and higher BP.

Awareness, Comprehension, and Use of Newly-Mandated Nutrition Labels Among Mestiza and Indigenous Ecuadorian Women in the Central Andes Region of Ecuador.

BACKGROUND: In 2014, Ecuador became the first country in Latin America to adopt the nutritional traffic light labeling system as a public policy aimed at guiding informed food choices. OBJECTIVE: To describe the differences in comprehension and use of the new nutrition label in 2 different ethnic populations residing in a limited resource area of central Ecuador. METHODS: A total of 394 women (18-75 years, 54.8% indigenous and 45.2% mixed-race mestizas) were randomly selected in the Chimborazo Province and were requested by a questionnaire to provide information regarding their awareness and comprehension of the traffic light nutritional labeling system and personal use of the food label in food selection. RESULTS: Indigenous women had a high percentage who lacked any formal education (43.5%) and a greater proportion were not aware of the labeling system when compared with the mestizas (84.3% vs 46%; P = .001). In both groups, the main reason for not reading labels was lack of understanding of its meaning (50% indigenous vs 32.7% mestiza; P < .05). The reported use of the labeling system for food choices was low-on average, 32% of the mestizas and 5% of the indigenous women reported using nutrition label information to guide their purchase and consumption of packaged food items. CONCLUSION: The use of nutritional labeling is low in both mestiza and indigenous Ecuadorians, although higher among the mestizas. Among the indigenous women, mostly likely owing to less education, limited nutrition-related health knowledge, and higher risk for food insecurity, the utility of the new traffic light food label is limited.

Medellín, una ciudad de contrastes desde los ojos de sus jóvenes / Medellín, a city of contrasts from the eyes of their young

Este artículo pretende dar cuenta de las representaciones sociales que tienen los jóvenes, entre 16 y 20 años de edad y pertenecientes a diferentes sectores de la ciudad, sobre Medellín. La investigación asumió un diseño cualitativo hermenéutico y utilizó técnicas de recolección de información, como la cartografía social y la entrevista semiestructurada. Se establecieron categorías de análisis preliminares tales como: Representaciones Sociales, Jóvenes y Ciudad, las cuales derivaron categorías emergentes denominadas como: Medellín mi ciudad, Medellín polarizada, Medellín ciudad violenta y Medellín de cemento. En conjunto, se puede indicar que los jóvenes han construido representaciones sociales desde la pertenencia e identidad por la ciudad, desde las oportunidades que ésta les proporciona, desde los progresos adquiridos en términos de seguridad y desde la percepción que tienen de la influencia de los avances en infraestructura, en la buena imagen de Medellín. La discusión de estos resultados permite entrever que hay diversas formas de percibir la ciudad, que se ven influenciadas por la carga histórica (transmitida oralmente por los abuelos), la realidad actual, lo que se dice y se divulga acerca de la ciudad, donde aparecen elementos como la historia de narcotráfico, la prostitución, así como los premios y reconocimientos a su desarrollo. En definitiva, hay posiciones dicotómicas en cuanto a las percepciones de Medellín, reflejadas en el discurso de sus habitantes jóvenes.

The present article aspire to reveal the social representations that young people (between 16 and 20 years old, from different areas of the city) have about Medellín. The investigation assumed a qualitative hermeneutics design and it used some compilation techniques like social mapping and semistructured interview. We established preliminary analysis categories, such as: Social representations, Young people and the city; which generated results called as emerging categories: Medellín my city, Polarised Medellín, Medellín violent city, and Cement Medellín. As a whole, we can indicate that young people have built social representations from its belonging and identity for the city, from the opportunities that it gives to them, from the acquire progress (in terms of security) and from the perception that they have about the influence of the infrastructure advances, in the good picture of Medellín. The discussion of these results lets to make out that there are many ways to sense the city, and those ways are influenced by the historic charge, (orally transmitted by grand-fathers) the current reality, what is telling, and what is disclosing by the people about the city, where some elements appear like the history of drug trafficking, the prostitution just like the prizes and recognitions to its development. In short, there are dichotomous positions on Medellín, perceptions, reflected on the speech of its young inhabitants.

Importance of ancillary supplies for subcutaneous immunoglobulin infusion: management of the local infusion site.

A number of ancillary supplies are used in the process of administering subcutaneous immunoglobulin. The particular type of ancillary supplies used (needles, tubing, and tape) may contribute to the development of issues at the local infusion site. Patient case studies demonstrate that changes in the choice of ancillary supplies can often alleviate these issues. The use of alternative ancillary supplies should be considered prior to the possibility of changing immunoglobulin replacement products in patients experiencing local infusion-site issues in order to improve outcomes and increase compliance. A treatment progression algorithm of ancillary supply adjustments has been developed.

The road to real zero ischemia for partial nephrectomy.

PURPOSE: To evaluate our initial outcomes of retroperitoneal partial nephrectomy (RPN) performed by off-clamp excision. PATIENTS AND METHODS: Between January 2011 and October 2102, patients with T1 posterior renal masses or in the renal convexity were selected for RPN with the intent of performing the modified zero ischemia technique. Patient characteristics, operative details, complications, and long-term outcomes were analyzed. RESULTS: There were 19 patients included (mean age 60 years, range 37-81 years; body mass index 27.8 kg/m(2), range 25-34 kg/m(2)). Mean tumor size was 35 mm (20-50 mm), and preoperative aspects and dimensions used for an anatomical (PADUA) classification score was 9 (7-11). Surgical time was 182 minutes (110-255 min), and the series warm ischemia time was 4.9 minutes (0-28 min). The off-clamp procedure was performed in 15 (79%) patients. Mean estimated blood losses (EBL) were 414 mL (100-1600 mL). Transfusion was necessary in two cases, while one reoperation and one conversion to open surgery were needed. Mean hospital stay was 4.5 days (range 3-11). One (5.3%) case of positive margins was reported. Serum creatinine levels varied from 86 to 94 µmol/L (preoperative and 6-month follow-up). Considering the learning curve of the technique, separate analysis of the initial 9 and last 10 cases revealed that while tumor characteristics remained comparable (size 33 vs 37 mm; PADUA score 8.8 vs 9.2), no clamping was performed in the later cases with decreased EBL (544 vs 297 mL), surgical time (207 vs 159 min), and shorter hospital stay (5 vs 4 days). CONCLUSION: Our preliminary results on off-clamp RPN are promising and may pave the way for a real zero ischemia nephron-sparing surgery. Larger and randomized studies should follow in to confirm our initial results.

Effects of rapid global warming at the Paleocene-Eocene boundary on neotropical vegetation.

Temperatures in tropical regions are estimated to have increased by 3° to 5°C, compared with Late Paleocene values, during the Paleocene-Eocene Thermal Maximum (PETM, 56.3 million years ago) event. We investigated the tropical forest response to this rapid warming by evaluating the palynological record of three stratigraphic sections in eastern Colombia and western Venezuela. We observed a rapid and distinct increase in plant diversity and origination rates, with a set of new taxa, mostly angiosperms, added to the existing stock of low-diversity Paleocene flora. There is no evidence for enhanced aridity in the northern Neotropics. The tropical rainforest was able to persist under elevated temperatures and high levels of atmospheric carbon dioxide, in contrast to speculations that tropical ecosystems were severely compromised by heat stress.

Los perfiles cognitivos psicopatológicos en la formulación cognitiva de caso / Psychopathological cognitive profiles in the cognitive case formulation

Se resaltó la relevancia de incluir los perfiles cognitivos desarrollados de acuerdo con las categorías diagnósticas del DSM-IV TR para los trastornos de la personalidad en la formulación cognitiva de caso. Los contenidos informacionales deben dar cuenta del perfil cognitivo específico del paciente, con el fin de facilitar la planeación y el curso del tratamiento ajustado a sus necesidades, aunque no presente diagnóstico en el eje II. También se analizaron las implicaciones del uso inadecuado de las categorías diagnósticas en los trastornos de la personalidad; la necesidad de generar investigación en torno al soporte empírico y psicométrico derivado de la presente propuesta, y el entrenamiento de terapeutas cognitivos en formulación cognitiva de caso.

This paper emphasizes the relevance of including the cognitive profiles based on DSM-IV TR in the cognitive case formulation criteria for personality disorders. The informational contents must explain the specific cognitive profile of the patient, in order to facilitate the treatment planning and course, according to the patient´s needs, even if he does not show any diagnosis in the axis II. In addition, the consequences of an inadequate use of diagnosis categories were analyzed, as well as the need to promote and generate research about the empirical and psychometric support in this area derived from this proposal, as much as the need of a training for cognitive therapists in cognitive case formulation, including cognitive profiles.

Programa de ejercicio físico para los adultos mayores del club nueva vida de la ciudad de Tunja / Physical Exercise Program for Elderly Subjects in the “Club Nueva Vida”, in Tunja City

Este artículo se basa en un estudio descriptivo serie de casos con intervención, que tuvo como objetivo identificar, durante el segundo semestre de 2005, el cambio en las cualidades físicas, potencia aeróbica, flexibilidad, fuerza y composición corporal en veinte adultos mayores del Club Nueva Vida de la ciudad de Tunja, a quienes se les realizó, previo consentimiento, una evaluación pre y pos de sus cualidades físicas, después de un programa de ejercicio físico de dieciséis semanas. Los resultados evidencian que la fuerza muscular estática aumentó de una media inicial de 0,27 Newton a una final de 0,30 Newton, con disminución de la desviación estándar de 0,1. El 10% de la fuerza dinámica con la prueba de Push Up mejoró. El 35% de los adultos mayores mejoró su capacidad cardiovascular, hasta un nivel de 80%. El peso corporal antes y después de la aplicación del programa no presentó cambios significativos. La flexibilidad en la prueba Sit and Reach no tuvo cambios estadísticamente significativos; sin embargo, en las otras pruebas de flexibilidad pasó de rangos malos a regulares y buenos. Se obtuvo adherencia y mantenimiento de la población durante el desarrollo del programa de ejercicio. El estudio concluye que los adultos mayores adquieren cambios sobre sus cualidades físicas. Los programas de ejercicio físico del adulto mayor deben incluir actividades de fuerza para el tren superior, tronco y actividades de potencia aeróbica. Tener como referente el “modelo de creencias en salud” asegura el cumplimiento de las fases adherencia y mantenimiento al ejercicio físico.

A descriptive, case series intervention study was performed to identify changes in physical qualities, aerobic power, flexibility, strength and body composition amongst 20 elderly subjects belonging to the “Club Nueva Vida” in Tunja City, during the second period of 2005. A PRE and POST assessment of their physical qualities was applied after a 16 week physical exercise program. Results showed an increase in the average of the static muscle streneth from 0.27 to 0.30 Newtons . Standard deviation diminished in 0.1. The dynamic strength measure by the push up test improved in 10% a 35% improved in 10% a 35% improved their. Cardiovascular capability until to high levels of 80% there were not significant changes in the body weight between measures taken before and after the program application. The results obtained with the sit and reach test did not show statistically significant differences. Hower in other flexibility tests the results changed from bad ranges to middle and good ones. The enrolled population was stable during the development of the exercise program. This study concludes that elderly adults acquire changes in their physical quality features after exercise intervention. Physical exercise programs in elderly adults must involve strength activities for upper limbs, trunk and aerobic power activities. The “Beliefs Health Model” is a adherence to reach compliance and maintenance in physical exercise.

El modelo situacional en la interconsulta psiquiátrica / The situational model in the psychiatric interconsult

Por ser la interconsulta el quehacer fundamental de la Unidad de Psiquiatría del Hospital Miguel Pérez Carreño, dirigida a la atención del paciente hospitalizado, los autores presentan el siguiente trabajo destinado a investigar las características del abordaje de la interconsulta en dicho Hospital durante el período Enero-Diciembre de 1992, a partir de cuyos resultados proponen un modelo alternativo, el modelo situacional. Se basa la investigación en la realización de un estudio descriptivo-exploratorio a partir de un instrumento de recolección de la información (Hoja de Registro), a través de la cual se recabó lo siguiente: datos de identificación, motivo de consulta verbal y escrita, actitud del tratante ante el paciente, actitud del tratante ante la consulta, diagnóstico e intervención terapéutica. A los fines del análisis se categorizó la información en relación al motivo de consulta en tanto claro, confuso, contradictorio o discordante, en virtud de la receptividad o no del médico tratrante hacia la interconsulta y en cuanto a la posición del interconsultante de Psiquiatría atinente a la orientación de su intervención: hacia el paciente, el médico o la relación médico paciente. Se realizó así un diagnóstico transversal de lo ocurrido en la Interconsulta de Psiquiatría en el lapso señalado. Los resultados mostraron centramiento de la atención hacia la figura del paciente, dificultades en la relación médico tratante-interconsultante psiquiatra y visión parcial de la problemática planteada. Se discuten los resultados y se propone como modelo alternativo de intervención, el modelo situacional que permite ampliar la visualización del problema, estrechar las relaciones tratante-interconsultante, privilegiar el trabajo en equipo y que redunda en beneficio de una intervención terapéutica más pertinente y por tanto más eficaz