Multisystemic Inflammatory Syndrome in Children From the South of Colombia: One Year of Experience.

Background: Multisystemic inflammatory syndrome in children (MIS-C) is one of the most severe presentations of COVID-19 infection in pediatrics. Currently, we have few studies that describe the characteristics of this condition in Colombian children. Objective: To describe the clinical and epidemiological characteristics of children hospitalized with MIS-C in Neiva, Colombia. Methods: Observational follow-up study of a cohort of children with MIS-C for 12 months (May 15, 2020, to May 30, 2021) in two hospitals in the city of Neiva. Epidemiological data, clinical characteristics, laboratory characteristics, cardiological evaluation, treatment, and clinical outcomes were analyzed. Results: We included 34 patients who met the diagnosis of MIS-C. The median age was 68 months. Some type of nutritional issue was observed by 43.75% of those under 5 years of age and by 27.78% of those over 5 years of age. Gastrointestinal symptoms were the most frequent, with vomiting, diarrhea, and abdominal pain being the most frequent by 79, 70, and 67%, respectively. By 77% of the patients, a history of SARS-COV-2 infection was documented through IgG. In the echocardiogram, 35.4% of the patients had systolic dysfunction, followed by coronary involvement by 35%. Conclusion: This study describes a series of cases of children with MIS-C in Colombia. Gastrointestinal manifestations were predominant. Mortality was high in comparison to other countries but similar to that reported in Colombia. This fact was associated with relevant pathological background. More training is required for physicians in order to have a better understanding of the disease so as to have an early diagnosis and timely treatment.

Abdominal manifestation of multisystemic inflammatory syndrome in children.

SUMMARY: Multisystemic inflammatory syndrome (MIS-C) can develop as a complication of SARS CoV-2 infection, involving the gastrointestinal system mainly by vasoconstriction, edema, glandular hyperplasia, and a procoagulant state leading to direct tissue injury. METHOD: ology: a series of cases including 8 patients with MIS-C treated in two highly complex institutions is presented. These patients, had abdominal symptoms of surgical management. RESULTS: The average age was 9.5 years and the most frequent symptoms were fever, abdominal pain, diarrhea (100%); in addition, 87.5% presented shock. The diagnosis of SARS CoV-2 was confirmed by RT-PCR test in 37.5%, antigen 12.5% and the rest of the patients showed IgM and IgG antibodies. In laboratories, the increase in acute phase reactants, Erythrocyte Sedimentation Rate (ESR), C-reactive protein, procalcitonin, as well as troponin, D dimer and proBNP, is highlighted. The surgical outcome documented 2 patients with a normal appendix, 3 patients with edematous appendicitis, and 3 patients with complicated appendicitis. CONCLUSIONS: patients with MIS-C display abdominal symptoms similar to those present in surgical emergencies and a non-negligible number of cases require surgical exploration. This condition poses a new differential diagnosis to the surgical abdomen in pediatric patients.

Factors associated with dental fluorosis in children and teenagers from the city of Montería, Colombia / Factores asociados a la fluorosis dental en niños y jóvenes de la ciudad de Montería, Colombia

Abstract Introduction: dental fluorosis is the hypomineralization of enamel produced as a result of fluoride intake for a prolonged period during enamel formation. The aim of the present study was to identify the factors associated with dental fluorosis in children and teenagers from the city of Montería, Colombia. Methods: a quantitative, descriptive and retrospective study was conducted in a sample of 136 dental fluorosis cases in schoolchildren aged 6, 12, 15 and 18 years reported to the Surveillance and Control System from January to December 2016. Results: there was fluoride exposure in 81.6% of schoolchildren covered by the subsidized health system-the mechanism by which the poorest population, with not enough resources to pay, can access health services through a subsidy offered by the state in Colombia-. 89% were from the municipal center, defined by Colombia's National Administrative Department of Statistics (Departamento Administrativo Nacional de Estadística, DANE) as the geographical area bounded by an urban perimeter, where the administrative headquarters of a municipality are located. 47% of patients had cavities. Tooth brushing in a frequency higher than three times a day was predominant with 48.5%, and the use of toothpaste on more than 3/4 of the brush with 52%. 71.3% of patients said they did not swallow toothpaste, and 93.4% did not swallow mouthwash. 82.4% of patients did not receive topical fluoride in the last year. Conclusions: several factors are more highly associated with dental fluorosis, such as the amount of toothpaste during brushing, the habit of brushing three or more times a day, consumption of diet salt, and unintentional intake of toothpaste at an early age. Most schoolchildren had a moderate degree of dental fluorosis.

Resumen Introducción: la fluorosis dental es una hipomineralización del esmalte, producida como respuesta a la ingesta de flúor por un periodo prolongado de tiempo durante la formación del esmalte. El objetivo del presente studio consistió en determinar los factores asociados a la fluorosis dental en niños y jóvenes de la ciudad de Montería. Métodos: se realizó una investigación descriptiva retrospectiva cuantitativa, con una muestra conformada por 136 casos de fluorosis dental en escolares de 6, 12, 15 y 18 años notificados al sistema de vigilancia y control, en el periodo de enero a diciembre de 2016. Resultados: se presentaron 81,6% casos de escolares con exposición a flúor pertenecientes al régimen subsidiado, que es el mecanismo mediante el cual la población más pobre, sin capacidad de pago, tiene acceso a los servicios de salud mediante un subsidio ofrecido por el Estado colombiano; el 89% eran procedentes de la cabecera municipal, definida por el Departamento Administrativo Nacional de Estadísticas (DANE) en Colombia como el área geográfica delimitada por un perímetro urbano, donde se ubica la sede administrativa de un municipio. El 47% de los pacientes presentaron caries. La frecuencia de cepillado mayor a tres veces al día fue predominante en 48,5% y el uso de crema dental en más de 3/4 del cepillo en el 52%. El 71,3% de los pacientes manifestaron que no ingerían crema dental, ni enjuague bucal en un 93,4%. Un 82,4% de los pacientes no recibieron topificación de flúor en el último año. Conclusiones: existen factores con mayor fuerza de asociación con fluorosis dental, como la cantidad de dentífrico en el cepillado, frecuencia del cepillado entre tres o más veces al día, consumo de sal en dieta e ingesta accidental de dentífrico a temprana edad. La mayoría de los escolares presentó grado moderado de severidad de fluorosis dental.

Inmunodeficiencia combinada severa (SCID) en Neiva, Colombia. Reporte de caso / Severe combined immunodeficiency (SCID) in Neiva, Colombia: Case Report

Resumen Introducción. Las inmunodeficiencias primarias son enfermedades genéticas del sistema inmune que incrementan la susceptibilidad a infecciones. Una de las formas más graves en niños es la inmunodeficiencia combinada severa. Presentación del caso. Se presenta el caso de un niño que fue diagnosticado con inmunodeficiencia combinada severa; este era un paciente masculino de ocho meses que presentó cuadro clínico consistente en múltiples hospitalizaciones debido a infección por citomegalovirus, endocarditis por Candida albicans e infección recurrente de las vías urinarias por Pseudomonas aeruginosa. El perfil inmunológico mostró disminución del número absoluto de células CD3+ y CD19+, lo que permitió realizar el diagnóstico de inmunodeficiencia combinada severa instaurándose manejo; sin embargo, el niño no se recuperó y falleció. Conclusiones. Las inmunodeficiencias primarias son patologías que requieren una intervención oportuna que permita brindar un mejor pronóstico a los pacientes.

Abstract Introduction: Primary immunodeficiencies are genetic disorders of the immune system that increase susceptibility to infections. One of the most serious forms in children is severe combined immunodeficiency. Case presentation: This is the report of the case of an 8-monthold male patient who was diagnosed with severe combined immunodeficiency. The child presented a clinical profile consisting of multiple hospitalizations due to cytomegalovirus infection, endocarditis by Candida albicans and recurrent urinary tract infection by Pseudomonas aeruginosa. The immune profile showed a decrease in the absolute number of CD3+ and CD19+ cells, which led to the diagnosis of severe combined immunodeficiency. Even though management was established, the child did not recover and died. Conclusions: The primary immunodeficiencies are disorders that require timely intervention to provide a better prognosis to patients.

Effects of a co-culture of marine algae and shrimp (Litopenaeus vannamei) on the growth, survival and immune response of shrimp infected with Vibrio parahaemolyticus and white spot virus (WSSV).

In aquaculture, fighting infectious diseases is a necessity. This study measured the immuno-stimulating effect of live macroalgae consumption on Litopenaeus vannamei against Vibrio parahaemolyticus and WSSV infection in two independent bioassays. Shrimps and macroalgae were cultivated in a co-culture with two species of macroalgae separately (Gracilaria vermiculophylla and Dictyota dichotoma), and later, shrimp were infected with V. parahaemolyticus. In another bioassay, shrimp and macroalgae (G. vermiculophylla, D. dichotoma and Ulva lactuca) were grown and subsequently infected with WSSV. For both bioassays, survival after 120 h was determined, the total hemocyte count (TCH) was measured and the activity of superoxide dismutase (SOD) and catalase (CAT) in tissue were measured. The results indicate that the use of macroalgae in co-culture with L. vannamei provides a nutritional benefit that achieves higher growth than the control organisms, as well as improvements of the ammonium concentration and immune response after infection with V. parahaemolyticus and WSSV. A better immune response was obtained in organisms cultured with macroalgae in both bioassays at a ratio of 1.6-1.9 for organisms infected with bacteria and 1.4 to 1.6 times for organisms infected with the virus. In turn, the enzymatic activity of SOD and CAT were higher in the treated organisms relative to the controls in both experiments.

Humanización un desafío en instituciones públicas del departamento de Córdoba, Colombia / Humanization in health care: a challenge in health Public Institutions in Córdoba, Colombia

Objetivo. Evaluar la atención humanizada en instituciones prestadoras de servicios de salud públicas de cinco (5) mu-nicipios del departamento de Córdoba (Montería, Sahagún, Lorica, Planeta Rica y Montelíbano) en el año 2016. Materia-les y métodos. Investigación descriptiva, transversal de tipo mixto; para el desarrollo de este estudio se emplearon dos téc-nicas de recolección de datos; primero la aplicación del ins-trumento creado por Willmer Emilio Mojica Gutiérrez en su tesis de grado: "La Gerencia social en la humanización de la atención en salud" el cual es gratuito y de libre acceso. Como segunda herramienta la observación. Resultados. El mayor porcentaje de cumplimiento se obtuvo para la variable trato humanizado a discapacitados y enfermos mentales (81%); se-guida de servicios generales (68%); destacando el 100% en el cumplimiento de la variable seguimiento en todos los presta-dores evaluados. Conclusión. La humanización debe ser un compromiso institucional liderado desde la alta gerencia, que promueva la transformación cultural en los colaboradores; además requiere de la asignación de recursos financieros para la adecuación de infraestructura, la inclusión de elementos de humanización en el ambiente físico, la planificación de cro-nogramas de capacitación y aplicación de estrategias de sen-sibilización que garanticen el fomento del trato humanizado.

Objective. To evaluate the humanized care service in public health providers in five (5) municipalities of the department of Córdoba (Montería, Sahagún, Lorica, Planeta Rica and Montelíbano) in 2016. Materials and methods. Descriptive, cross-sectional mixed type research; to carry out this study, two data collection techniques were used; first the application of the instrument created by Willmer Emilio Mojica Gutiérrez in his thesis: "Social management in the humanization of health care" which is for free and can be downloaded, and the observation. Results. The highest percentage of compliance was obtained to the humanized treatment variable for disabled and mentally ill people (81%); followed by general services attention (68%); highlighting 100% of compliance with the follow-up variable in all health providers evaluated. Conclusion. Humanization must be an institutional commitment led by high management chiefs, who should promote cultural transformation in employees; it also requires the allocation of financial resources for the adaptation of adequate infrastructure, the inclusion of humanization elements in physical environments, in planning schedules of training and application of awareness strategies that guarantee the promotion of a more human treatment.

Morbimortalidad de recién nacidos prematuros extremos atendidos en el hospital de los valles desde enero 2014 a diciembre 2018 / Morbimortality of extreme premature newborns treated in the valleys hospital from January 2014 to December 2018

Introducción. La neonatología del Hospital de los Valles (HDLV) es un centro de referencia de cuarto nivel con atención de pacientes prematuros que presentan un mayor riesgo de morbimortalidad y en quienes aún hay debate sobre la edad gestacional aceptable para aunar esfuerzos en tratamiento y sobrevida. En los Estados Unidos, la tasa de nacimientos prematuros, que había aumentado constantemente durante la década de 1990 y principios de 2000, ha disminuido anualmente durante 7 años y ahora es aproximadamente del 11,39%. La viabilidad humana, definida como la edad gestacional en la que la posibilidad de supervivencia es del 50%, actualmente es de aproximadamente 23 a 24 semanas en los países desarrollados, con una supervivencia de prematuros de 25 semanas superior al 60%. Materiales y Métodos. Es un estudio descriptivo transversal de tipo retrospectivo, en el que se tomó como población a todos los niños nacidos antes de las 28 semanas de gestación atendidos en el Hospital de los Valles desde enero del 2014 a diciembre del 2018, se obtuvieron los datos de la base de datos EpicLatino y de las historias clínicas de los pacientes, Los datos obtenidos fueron ingresados en el programa Excel para su tabulación y análisis. Resultados. Entre enero del 2014 a diciembre del 2018 se registraron 1710 pacientes de los cuales 479 son prematuros y de estos 29 son prematuros extremos. Se registraron 8 fallecimientos 5 de los cuales nacieron fuera de la institución, la edad gestacional más temprana con sobrevida es de 24.5 semanas y el menor peso registrado es de 575 gramos, la morbilidad más comúnmente asociada a la prematurez extrema en orden descendente es enfermedad de membrana hialina, anemia, sepsis y broncodisplasia pulmonar, no hay registro de retinopatía y se reportaron 6 casos de hemorragia intraventricular. El peso promedio de alta es de 2045 gramos, con 16 pacientes enviados a casa con oxigeno domiciliario. Conclusión. La neonatología del HDLV presta atención de cuarto nivel con una sobrevida en pacientes menores de 28 semanas de edad gestacional comparable con otras instituciones a nivel mundial, con una mejor respuesta en pacientes nacidos dentro de la propia institución, es importante que los pacientes que tengan riesgo de nacer a edades gestacionales muy cortas sean derivados oportunamente a instituciones con mayor capacidad resolutiva en bien del paciente y su familia.

is an increased risk of morbidity and mortality and in whom there is still debate about the acceptable gestational age to combine efforts in treatment and survival. In the United States, the rate of premature births, which had steadily increased during the 1990s and early 2000s, has decreased annually for 7 years and now is approximately 11.39%. Human viability, defined as gestational age in which the possibility of survival is 50%, currently is approximately 23 to 24 weeks in developed countries, with a survival of preterm infants of 25 weeks greater than 60% . Materials and methods. This is a cross-sectional, retrospective descriptive study, in which all children born before the 28 weeks of gestation attended at the Hospital de los Valles from January 2014 to December 2018 were taken as a population. EpicLatino database and the patient's medical records. The data obtained were entered into the Excel program for tabulation and analysis. Results Between January 2014 and December 2018, 1710 patients were registered, of whom 479 are premature and of these 29 are premature preterm infants. There were 8 deaths 5 of which were born out of the institution, the earliest gestational age with survival is 24.5 weeks and the lowest recorded weight is 575 grams, the morbidity most commonly associated with extreme prematurity in descending order is disease. hyaline membrane, anemia, sepsis and pulmonary bronchodysplasia, there is no record of retinopathy and 6 cases of intraventricular hemorrhage were reported. The average dischange weight is 2045 grams, with 16 patients sent home with home oxygen. Conclusion. HDLV neonatology provides fourth level care with a survival in patients younger than 28 weeks gestational age comparable with other institutions worldwide, with a better response in patients born within the institution itself, it is important that patients at risk of being born at very short gestational ages are opportunely referred to institutions with greater resolutive capacity for the good of the patient and his family.

Aporte nutricional en pacientes prematuros extremos en la neonatología del hospital de los valles y su relación con el peso y perímetro cefálico a los 28 días de vida y a las 36 semanas de edad gestacional / Aporte nutricional en pacientes prematuros extremos en la neonatología del hospital de los valles y su relación con el peso y el perímetro cefálico a los 28 días de la vida y las 36 semanas de edad gestacional

Antecedentes: El peso al nacimiento es un factor importante y predictor de la morbimortalidad del neonato prematuro más aun en neonatos prematuros extremos y de peso bajo, sin embargo, las diferentes maneras de sustentar la alimentación enteral o parenteral nos permiten mejorar las la sobrevida y la calidad de vida. Los neonatos de muy bajo peso al nacer (menos de 1.500 g) tienen 200 veces más riesgo de morir, si sumamos esto a la edad gestacional la expectativa de vida es más complicada sobre todo en países en vías de desarrollo. Mantener guías de alimentación enteral y parenteral de manera precoz y sustentada evitan la desnutrición y proveen una mejor condición clínica para que el prematuro extremo pueda enfrentar esta primera etapa de la manera más satisfactoria. Varios son los nutrientes que tienen que ver en le crecimiento y desarrollo no solo de masa sino de funcionalidad y calidad sobre todo a nivel neurológico. Materiales y métodos: Es un estudio de tipo retrospectivo de cohorte descriptivo analizando la base de datos de EPIQ latino y las historias clínicas de los pacientes prematuros extremos, las variables a analizar son edad gestacional, peso, perímetro cefálico, tipo de alimentación enteral y parenteral al nacimiento, a los 28 dias de vida y a las 36 semanas de edad gestacional. Objetivo: Determinar el aporte nutricional en los pacientes prematuros extremos de la neonatología del Hospital de los Valles desde enero de 2015 hasta diciembre del 2018 Resultados: La mayoría de pacientes de la unidad de estudio reciben alimentación enteral dentro de las primeras 24 hs de vida, al igual modo el apoyo nutricional inmediato o casi inmediato protege de la desnutrición, la ganancia ponderal aumento de perímetro cefálico está garantizada con un adecuado aporte nutricional enteral o parenteral Recomendaciones: ampliar el estudio a todos los pacientes prematuros y correlaciona con la valoración sanguínea de los micronutrientes requeridos para el normal desempeño de las múltiples funciones del prematuro sobretodo neurológicas.

Background: Birth weight is an important factor and predictor of morbidity and mortality in premature neonates even in extreme premature and low birth weight neonates, however the different ways of sustaining enteral or parenteral feeding allow us to improve survival and quality of life, Very low birth weight infants (less than 1,500 g) have a 200 times higher risk of dying, if you add this to gestational age life expectancy is more complicated especially in developing countries. Keeping enteral and parenteral feeding guides early and sustained prevent malnutrition and provide a better clinical condition for the extreme premature to face this first stage in the most satisfactory way, several are the nutrients that have to do with growth and development not only mass but functionality and quality especially at the neurological level. Materials and methods: This is a retrospective study of a descriptive cohort analyzing the Latin EPIQ database and the clinical histories of the extreme premature patients, the variables to be analyzed are gestational age, weight, cephalic perimeter, type of enteral and parenteral feeding. at birth, at 28 days of age and at 36 weeks of gestational age. Objective: To determine the nutritional contribution in the extreme premature patients of the neonatology of the Hospital de los Valles from January 2015 to December 2018. Results: Most patients in the study unit receive enteral nutrition within the first 24 hours of life, as well as immediate or almost immediate nutritional support protects against malnutrition, weight gain and head circumference is guaranteed with an adequate contribution enteral or parenteral nutrition Recommendations: extend the study to all premature patients and correlate with the blood evaluation of the micronutrients required for the normal performance of the multiple functions of the premature, especially neurological.

Análisis descriptivo del compromiso de órganos en niños con dengue grave en Neiva, Colombia / Descriptive analysis of organ involvement in children with severe dengue in Neiva, Colombia

Resumen Introducción. La infección por dengue puede comprometer órganos como el miocardio y el hígado. Tal hecho puede agravar la evolución clínica, por ello estos órganos han sido considerados en la clasificación revisada de la Organización Mundial de la Salud (OMS) para esta enfermedad. Objetivo. Describir la presencia de afectación por dengue en órganos como miocardio, hígado y sistema nervioso central (SNC) en niños de Neiva, Colombia Materiales y métodos. Este estudio analizó 930 niños con diagnóstico de dengue confirmado que ingresaron al Hospital Universitario Hernando Moncaleano Perdomo de Neiva entre enero de 2009 y diciembre de 2010. Para el diagnóstico y estratificación clínica se usó la clasificación revisada de la OMS. La infección por dengue se confirmó por detección plasmática de NS1 o IgM específica. Se realizó seguimiento clínico y paraclínico diario durante toda la hospitalización. Resultados. De los 930 niños, 105 fueron clasificados como dengue grave (DG) y, de estos, 19 presentaron órganos afectados. El miocardio fue el más comprometido (14 casos), seguido por el hígado (4 casos) y el SNC (1 caso). Conclusión. El compromiso clínico del miocardio, el hígado o el SNC se observó en el 18% de los casos de niños con DG. Es necesario un diagnóstico y tratamiento oportuno de esta patología en niños.

Abstract Introduction: Dengue can compromise organs such as the myocardium and the liver. Clinical evolution may be aggravated by this fact, and for that reason, these organs have been considered in the revised classification of the World Health Organization (WHO) for this disease. Objective: To describe the affectation caused by dengue in organs such as the myocardium, the liver and the central nervous system (CNS) in children from Neiva, Colombia. Materials and methods: This study analyzed 930 children diagnosed with confirmed dengue and admitted to the Hernando Moncaleano Perdomo University Hospital of Neiva between January 2009 and December 2010. Diagnosis and clinical stratification were obtained based on the revised WHO classification. Dengue infection was confirmed by NS1 or specific IgM plasma detection. Daily clinical and paraclinical follow-up was performed during the full length of hospital stay. Results: Out of 930 children, 105 were classified as severe dengue (SD) and, of these, 19 had affected organs. The myocardium was the most compromised organ (14 cases), followed by the liver (4 cases) and the CNS (1 case). Conclusion: Clinical involvement of the myocardium, liver or CNS was observed in 18% of the cases of children with SD. A timely diagnosis and treatment of this pathology in children is necessary.

Effects of methanolic macroalgae extracts from Caulerpa sertularioides and Ulva lactuca on Litopenaeus vannamei survival in the presence of Vibrio bacteria.

Macroalgae are potentially excellent sources of highly bioactive secondary metabolites that are useful for the development of new functional ingredients. This study was conducted to determine whether methanolic extracts from Caulerpa sertularioides and Ulva lactuca macroalgae might be possible alternatives for the prevention of shrimp vibriosis, which is caused by Vibrio parahaemolyticus and Vibrio alginolyticus. Macroalgae extracts prepared with methanol as the solvent were evaluated for antibacterial activity with the microplate method. The extracts' effects on the mortality of juvenile Litopenaeus vannamei were evaluated at doses of 150 and 300 mg L(-1). Two independent assays for V. parahaemolyticus and V. alginolyticus were performed. The methanolic extract of C. sertularioides exhibited activity against V. parahaemolyticus and V. alginolyticus, and it had minimal inhibitory concentrations of <1000 and < 1500 µg mL(-1), respectively. L. vannamei mortality in the presence of both The methanolic extract of C. sertularioides exhibited activity against V. parahaemolyticus and V. alginolyticus, and it had minimal inhibitory concentrations of <1000 and <1500 µg mL(-1), respectively. and V. alginolyticus bacteria significantly decreased after treatment with 300 mg L(-1) C. sertularioides methanolic extract.

Geospatial mapping to estimate timely access to surgical care in nine low-income and middle-income countries.

BACKGROUND: The Lancet Commission on Global Surgery calls for universal access to safe, affordable, and timely surgical care. Two requisite components of timely access are (1) the ability to reach a surgical provider in a given timeframe, and (2) the ability to receive appropriately prompt care from that provider. We chose a threshold of 2 h in view of its relevance in time-to-death in post-partum haemorrhage. Here, we use geospatial mapping to enumerate the percentage of a nation's population living within 2 h of a surgeon and the surgeon-to-population ratio for each provider. METHODS: Geospatial mapping was used to identify the population living within a 2-h driving distance (access zone) of a health-care facility staffed by a surgeon. Surgeon locations were extracted from Ministries of Health, professional society databases, and published literature for countries which had available data. Data were reviewed by individuals knowledgeable of in-country distribution. Spatial distribution of providers was mapped with Google Maps engine. Access zones were constructed around every provider through estimation of driving times in Google Maps. The number of people living within zones was estimated with the Socioeconomic Data and Applications Center Population Estimation Service. Surgeon-to-population ratios were constructed for every individual access zone and averaged to report a single ratio. FINDINGS: Results (% country's population living within an access zone; average surgeon:population ratio within all access zones) are reported for nine countries with available data: Somaliland (16·9%; 1:118 306), Botswana (31·0%; 1:64 635), Ethiopia (39·6%; 1:229 696), Rwanda (41·3%; 1:158 484), Namibia (43·4%; 1:69 385), Zimbabwe (54%; 1:148 292), Mongolia (55·5%; 1:10 500), Sierra Leone (70·3%; 1:106 742), and Pakistan (84·4%, 1:139 299). Surgeon-to-population ratios vary substantially even within countries; in Sierra Leone, urban access zones have a ratio of 1:45 058 and rural access zones have a ratio of 1:467 929. INTERPRETATION: Surgical access is poor in many low-income and middle-income countries, even when using a narrow definition of surgical access consisting only of timeliness. Living outside of an access zone makes timely access to surgical care highly unlikely, and in view of low surgeon-to-population ratios and poor prehospital transport, even living within a 2-h access zone might not confer 2-h access. Investments in infrastructure and training must be prioritised to address widespread disparity in access to timely surgery. FUNDING: None.

Protocolo para el manejo de nutrición parenteral periférica lista para usar en paciente quirúrgico / Protocol for peripheral parenteral nutrition management ready to use in surgical patients

Introducción: Los pacientes sometidos a cirugía electiva, requieren de un tratamiento clínico integral que propenda por mantener o evitar el deterioro del estado nutricional y favorecer los resultados clínicos, y a su vez mejorar la seguridad de la terapia nutricional parenteral mediante la optimización de la tecnología, como una opción enfocada a la minimización de riesgo y la disminución de los costos operativos en las instituciones de prestación de servicios de salud. Objetivo: Realizar una revisión de la literatura con el fin de estudiar las indicaciones y recomendaciones del soporte nutricional parenteral periférico y/o complementario listo para usar en personas sometidas a una intervención quirúrgica. Métodos: Síntesis de datos tras la revisión de la bibliografía pertinente, que permitiera el diseño del protocolo. Se realizó la búsqueda en las siguientes bases de datos: PubMed, Medline, ScienceDirect y Embase. Conclusiones: La nutrición parenteral periférica lista para usar es una alternativa de soporte nutricional, que permite mejorar el aporte Proteico-Energético así como demostrar mejoras en la seguridad del paciente, disminución de los costos y aumentar la satisfacción del paciente (AU)

Introduction: Patients undergoing elective surgery, require a comprehensive clinical treatment that tends to maintain or prevent deterioration of nutritional status and promote clinical outcomes, and in turn improve the safety of parenteral nutrition therapy through optimization of technology, as a option aimed at minimizing risk and lower operating costs in institutions providing health services. Aim: To review the literature in order to study the requirements and recommendations of peripheral parenteral nutritional support and / or complementary ready to use in people undergoing surgery. Methods: Data synthesis after reviewing the relevant literature, to allow the protocol design. The search was conducted in the following databases: PubMed, Medline, Embase and ScienceDirect. Conclusions: Peripheral parenteral nutrition is a ready to use alternative nutritional support that improves the contribution Protein-Energy and demonstrate improvements in patient safety, decrease costs and increase patient satisfaction (AU)

Evaluation of the productive and physiological responses of Litopenaeus vannamei infected with WSSV and fed diets enriched with Dunaliella sp.

An experimental investigation was performed to evaluate the productive and physiological responses of Litopenaeus vannamei that were infected with WSSV and fed diets enriched with Dunaliella sp., which had a high ß-carotene content induced by nitrogen reduction in the culture medium. A basal diet containing 35% crude protein and experimental diets T1 and T2, which included 1% and 2% microalgae meal, respectively, were evaluated. Positive (infected juveniles) and negative (non-infected) controls were also evaluated. Survival was significantly higher (80%) in the two treatment groups compared to the positive control group (56%). In the negative control group, survival was 100%. Some variation was recorded for hemolymph metabolites among treatments and at distinct times post-infection; although the tendencies were not clear, some metabolites (glucose and triglycerides) appeared to decrease on the last days of the trial, probably due to their use as energy for the shrimp to thrive despite the infection. The results of the study suggest a positive effect of the dietary inclusion of Dunaliella meal on shrimp survival and an unclear effect on hemolymph metabolites.

[Protocol for peripheral parenteral nutrition management ready to use in surgical patients]. / Protocolo para el manejo de nutrición parenteral periférica lista para usar en paciente quirúrgico.

INTRODUCTION: Patients undergoing elective surgery, require a comprehensive clinical treatment that tends to maintain or prevent deterioration of nutritional status and promote clinical outcomes, and in turn improve the safety of parenteral nutrition therapy through optimization of technology, as a option aimed at minimizing risk and lower operating costs in institutions providing health services. AIM: To review the literature in order to study the requirements and recommendations of peripheral parenteral nutritional support and / or complementary ready to use in people undergoing surgery. METHODS: Data synthesis after reviewing the relevant literature, to allow the protocol design. The search was conducted in the following databases: PubMed, Medline, Embase and ScienceDirect. CONCLUSIONS: Peripheral parenteral nutrition is a ready to use alternative nutritional support that improves the contribution Protein-Energy and demonstrate improvements in patient safety, decrease costs and increase patient satisfaction.

Introducción: Los pacientes sometidos a cirugía electiva, requieren de un tratamiento clínico integral que propenda por mantener o evitar el deterioro del estado nutricional y favorecer los resultados clínicos, y a su vez mejorar la seguridad de la terapia nutricional parenteral mediante la optimización de la tecnología, como una opción enfocada a la minimización de riesgo y la disminución de los costos operativos en las instituciones de prestación de servicios de salud. Objetivo: Realizar una revisión de la literatura con el fin de estudiar las indicaciones y recomendaciones del soporte nutricional parenteral periférico y/o complementario listo para usar en personas sometidas a una intervención quirúrgica. Métodos: Síntesis de datos tras la revisión de la bibliografía pertinente, que permitiera el diseño del protocolo. Se realizó la búsqueda en las siguientes bases de datos: PubMed, Medline, ScienceDirect y Embase. Conclusiones: La nutrición parenteral periférica lista para usar es una alternativa de soporte nutricional, que permite mejorar el aporte Proteico-Energético así como demostrar mejoras en la seguridad del paciente, disminución de los costos y aumentar la satisfacción del paciente.

Production response and digestive enzymatic activity of the Pacific white shrimp Litopenaeus vannamei (Boone, 1931) intensively pregrown in microbial heterotrophic and autotrophic-based systems.

Shrimp postlarvae were reared into different microcosm systems without water exchange; a traditional system based on simple fertilization to improve microalgae concentration (control), an autotrophic system (AS) based on the promotion of biofloc and biofilm by the addition of fertilizer and artificial substrates and a heterotrophic system (HS) based on the promotion of heterotrophic bacteria by the addition of nitrogenous and carbonaceous sources and artificial substrates. Better growth performance and survival were registered in shrimp from the AS and HS compared to the control. Feed conversion ratios were below 0.7 for all treatments, but AS and HS were significantly lower than the control. Regarding digestive performance, no significant differences were observed for trypsin, amylase and lipase activities among AS and control shrimp; however, shrimp from HS showed a higher trypsin and amylase activities, suggesting a higher digestive activity caused by the presence of microbial bioflocs. The presence of biofilm and bioflocs composed by either autotrophic or heterotrophic organisms in combination with formulated feed improved the growth performance and survival of shrimp. Apparently, such combination fits the nutritional requirements of shrimp.

Wild type N-ras displays anti-malignant properties, in part by downregulating decorin.

Previously, we have shown that wild type N-ras (wt N-ras) harbors an anti-malignant effect against mutated Ras and in tumors without Ras mutations. To investigate the molecular bases of this anti-malignant activity, we have studied the potency of this anti-malignant effect in a model system against SV40 large T antigen (SV40T). We show that wild-type N-ras (wt N-ras) counteracts the effects of SV40T in NIH3T3 cells as seen by a decrease in proliferation, anchorage independence and changes in migration. We also show that wt N-ras elicits the same anti-malignant effects in some human tumor cell lines (HT1080 and MDA-MB-231). Through mRNA and microRNA (miRNAs) expression profiling we have identified genes (decorin) and miRNAs (mir-29A, let-7b) modulated by wt N-ras potentially responsible for the anti-malignant effect. Wt N-ras appears to mediate its anti-malignant effect by downregulating some of the targets of the TGFß pathway and decorin, which are able to reverse the inhibition of migration induced by wt N-ras. Our experiments show that the molecules that mediate the anti-malignant effect by wt N-ras appear to be different from those modulated by transforming N-ras. The components of the pathways modulated by wt N-ras mediating its anti-malignant effects are potential targets for therapeutic intervention in cancer.

Cadmium, copper, lead, and zinc in Mugil cephalus from seven coastal lagoons of NW Mexico.

The increasing order of the mean concentrations of Cd, Cu, and Zn in the tissues of Mugil cephalus of seven coastal lagoons of Sinaloa State (NW Mexico) was liver > gills > muscle, while for Pb it was gills > muscle ≥ liver. There were no differences between the mean concentrations of Cd and Pb of the three tissues determined in the samples of the seven lagoons and, although there were some significant differences, there was no indication of a latitude-related trend in the distribution of Cu and Zn: the Cu content of the muscle tended to be higher in the northern than in the southern lagoons, although in the case of the gills the highest and lowest mean values indicated an opposite trend, with the highest and lowest values in one southern and one northern lagoon. In the case of the liver, there were no differences and no indication of a regional trend. There were no differences in the mean Zn contents of muscle and gills; in the case of the liver, one of the lagoons of the central part of the state had a significantly higher value than one of the southern lagoons and all the rest had similar values. In addition, there was no clear indication of season-related differences in any of the three tissues. According to our results, the metal contents of the muscle of this species are not of concern for human health, since the allowable ingestion would be in the order of 0.9 kg/day.

Heart and skeletal muscle are targets of dengue virus infection.

BACKGROUND: Dengue fever is one of the most significant re-emerging tropical diseases, despite our expanding knowledge of the disease, viral tropism is still not known to target heart tissues or muscle. METHODS: A prospective pediatric clinical cohort of 102 dengue hemorrhagic fever patients from Colombia, South America, was followed for 1 year. Clinical diagnosis of myocarditis was routinely performed. Electrocardiograph and echocardiograph analysis were performed to confirm those cases. Immunohistochemistry for detection of dengue virus and inflammatory markers was performed on autopsied heart tissue. In vitro studies of human striated skeletal fibers (myotubes) infected with dengue virus were used as a model for myocyte infection. Measurements of intracellular Ca2+ concentration as well as immunodetection of dengue virus and inflammation markers in infected myotubes were performed. RESULTS: Eleven children with dengue hemorrhagic fever presented with symptoms of myocarditis. Widespread viral infection of the heart, myocardial endothelium, and cardiomyocytes, accompanied by inflammation was observed in 1 fatal case. Immunofluorescence confocal microscopy showed that myotubes were infected by dengue virus and had increased expression of the inflammatory genes and protein IP-10. The infected myotubes also had increases in intracellular Ca2+ concentration. CONCLUSIONS: Vigorous infection of heart tissues in vivo and striated skeletal cells in vitro are demonstrated. Derangements of Ca2+ storage in the infected cells may directly contribute to the presentation of myocarditis in pediatric patients.