Using GIS to Estimate Population at Risk Because of Residence Proximity to Asbestos Processing Facilities in Colombia.

The recent enactment of the law banning asbestos in Colombia raises a significant number of challenges. The largest factories that have historically processed asbestos include five asbestos-cement facilities located in the cities of Sibaté (Cundinamarca), Cali (Valle del Cauca), and Barranquilla (Atlántico), and Manizales (Caldas), which has two, as well as a friction products facility in Bogotá D.C. An asbestos chrysotile mine has also operated in Colombia since 1980 in Campamento (Antioquia). In the framework of developing the National Asbestos Profile for Colombia, in this study, we estimated the population residing in the vicinity of asbestos processing plants or the mine and, therefore, potentially at risk of disease. Using a geographic information system, demographic data obtained from the last two general population censuses were processed to determine the number of people living within the concentric circles surrounding the asbestos facilities and the mine. In previous studies conducted in different countries of the world, an increased risk of asbestos-related diseases has been reported for people living at different distance bands from asbestos processing facilities. Based on these studies, circles of 500, 1000, 2000, 5000, and 10,000 m radii, centered on the asbestos processing facilities and the mine that operated in Colombia, were combined with the census data to estimate the number of people living within these radii. Large numbers of people were identified. It is estimated that in 2005, at the country level, 10,489 people lived within 500 m of an asbestos processing facility or mine. In 2018, and within a distance of 10,000 m, the number of people was 6,724,677. This information can aid public health surveillance strategies.

Metabolic physiology of the Mayan cichlid fish (Mayaheros uropthalmus): Re-examination of classification as an oxyconformer.

The Mayan cichlid (Mayaheros uropthalmus) is a freshwater fish inhabiting warm, potentially hypoxic and/or brackish waters, in Mexico and Central America. Despite its description as highly hypoxia tolerant, M. uropthalmus has been classified physiologically as an 'oxyconformer', which would place it in a very small (and shrinking) category of fishes that purportedly cannot maintain oxygen consumption (MO2) as ambient PO2 falls. However, hypoxia tolerance is often associated with strong oxyregulation, not oxyconformation as described for M. uropthalmus. To resolve these inconsistencies, we measured MO2, the ambient PO2 at which MO2 begins to decline as PO2 falls (PCrit), and gill ventilation rate (fG) in the Mayan cichlid. Variables were measured at 23o, 28 o and 33 °C and temperature sensitivity (Q10) calculated for each function. MO2 at air saturation was 2.9 ±â€¯0.2, 4.3 ±â€¯0.4, and 5.9 ±â€¯0.3 µmol O2/g/h at 23o, 28o and 33 °C, respectively. PCrits were low at 2.6 ±â€¯0.8 kPa, 3.2 ±â€¯0.8 kPa and 4.7 ±â€¯0.9 kPa at 23o, 28o and 33 °C, respectively. Q10 values for MO2 were 2.56 ±â€¯0.21 (23-28 °C), 1.89 ±â€¯0.15 (28-33 °C) and 2.2 ±â€¯0.1 (full temperature range of 23-33 °C), suggesting overall Q10s typical for tropical freshwater fish. fG was 39 ±â€¯3, 45 ±â€¯4, and 53 ±â€¯6 breaths/min at 23o, 28o and 33 °C, respectively, and increase 2-3 fold in severe hypoxia at each temperature. Experiments employing hyperoxia up to 35 kPa indicate a strong 'hypoxic drive' for gill ventilation. Collectively, these data show that, in contrast to a previous characterization, the Mayan cichlid is a strong oxyregulator exhibiting attributes (e.g. very low PCrit) typical of very hypoxia-tolerant fishes.

Reconstrucción de la continuidad digestiva tras cirugía de la diverticulitis aguda complicada. Estudio retrospectivo multicéntrico / Stoma reversal after surgery for complicated acute diverticulitis: A multicentre retrospective study

INTRODUCCIÓN: El objetivo del estudio es analizar la tasa de reconstrucción del estoma tras cirugía por diverticulitis aguda complicada (DAC), su demora, factibilidad, complicaciones y factores de riesgo de mantenerlo. MÉTODOS: Estudio retrospectivo multicéntrico de pacientes intervenidos mediante cirugía urgente por DAC con realización de un estoma en 10 hospitales durante 6 años. Se analiza la frecuencia de reconstrucción del estoma, fundamentalmente de los terminales, y el tiempo en que se produce, así como los factores relacionados con ella. RESULTADOS: De 385 pacientes intervenidos por DAC, a 312 (81%) se les realizó un estoma: 292 fueron colostomías terminales y 20 estomas derivativos. Durante el seguimiento, en 161 (51,6%), se intentó el cierre a una mediana de 9 meses. Las causas más frecuentes de no efectuarlo fueron la comorbilidad y el fallecimiento del paciente. La edad más avanzada se mostró factor adverso en el análisis multivariante y la tasa actuarial de reconstrucción fue mayor en hombres y en quienes no se realizó un Hartmann. La cirugía pudo completarse en todos menos en un paciente y en 4 se asoció un estoma derivativo. La morbimortalidad fue del 35,7 y 1,9%, respectivamente. Hubo un 8,4% de reintervenciones y un 6% de fallos de sutura, quedando 12 pacientes (7,9%) con un estoma tras el intento de reconstrucción. CONCLUSIONES: La cirugía de la DAC se asocia muy frecuentemente a la construcción de un estoma terminal, que en casi un 50% no se reconstruirá. Además, la intervención de reconstrucción tiene una demora notable y está asociada a una morbimortalidad nada despreciable

INTRODUCTION: The aim was to analyse the stoma reversal rate after surgery for complicated acute diverticulitis (CAD), and more specifically the end-stoma-reversal, as well as the delay, feasibility, complications and risk factors for stoma maintenance. METHODS: A multicentre retrospective study of patients who had undergone urgent surgery for CAD with stoma formation in ten hospitals during a period of 6 years. The frequency of reversal over time and the factors affecting the decision for reversal were analysed. RESULTS: Out of 385 patients operated for CAD, 312 underwent stoma creation: 292 end colostomies and 20 diverting stomas. During follow-up, stoma reversal surgery was performed in 161 patients (51.6%) after a median of 9 months. The main causes for not performing stoma reversal were comorbidities and the death of the patient. Advanced age was an adverse factor in the multivariate analysis, and the actuarial rate of reversal was higher in men and in patients with no previous Hartmann's operation. Stoma reversal surgery was completed in all but one patient, and a loop ileostomy was associated in four. Morbidity and mortality rates were 35.7% and 1.9%, respectively. A total of 8.4% of patients underwent re-operation, and 6% experienced an anastomotic leak. Twelve patients remained with a stoma after the attempted reconstruction surgery. CONCLUSIONS: Surgery for CAD is frequently associated with an end stoma, which will ultimately not be reversed in almost 50% of patients. Moreover, reversal surgery is frequently delayed and is associated with significant morbidity and mortality

Stoma reversal after surgery for complicated acute diverticulitis: A multicentre retrospective study. / Reconstrucción de la continuidad digestiva tras cirugía de la diverticulitis aguda complicada. Estudio retrospectivo multicéntrico.

INTRODUCTION THE AIM: was to analyse the stoma reversal rate after surgery for complicated acute diverticulitis (CAD), and more specifically the end-stoma-reversal, as well as the delay, feasibility, complications and risk factors for stoma maintenance. METHODS: A multicentre retrospective study of patients who had undergone urgent surgery for CAD with stoma formation in ten hospitals during a period of 6 years. The frequency of reversal over time and the factors affecting the decision for reversal were analysed. RESULTS: Out of 385 patients operated for CAD, 312 underwent stoma creation: 292 end colostomies and 20 diverting stomas. During follow-up, stoma reversal surgery was performed in 161 patients (51.6%) after a median of 9 months. The main causes for not performing stoma reversal were comorbidities and the death of the patient. Advanced age was an adverse factor in the multivariate analysis, and the actuarial rate of reversal was higher in men and in patients with no previous Hartmann's operation. Stoma reversal surgery was completed in all but one patient, and a loop ileostomy was associated in four. Morbidity and mortality rates were 35.7% and 1.9%, respectively. A total of 8.4% of patients underwent re-operation, and 6% experienced an anastomotic leak. Twelve patients remained with a stoma after the attempted reconstruction surgery. CONCLUSIONS: Surgery for CAD is frequently associated with an end stoma, which will ultimately not be reversed in almost 50% of patients. Moreover, reversal surgery is frequently delayed and is associated with significant morbidity and mortality.

Long-term follow-up of chronic anal fissure (CAF) on diltiazem 2% using a telephone questionnaire. Do results change?

INTRODUCTION: Calcium channel blockers have an excellent effectiveness in the conservative management of chronic anal fissure (CAF). OBJECTIVES: To assess the long-term results of management with diltiazem 2% ointment using a telephone questionnaire. METHODS: A descriptive, retrospective study from March 2004 to March 2011 in patients with CAF on diltiazem 2%, 3 applications daily for 4-6 weeks. Starting at 12 months a questionnaire was administered over the phone by medical staff outside the surgery department to record socio-demographic data, predominant manifestations, and response to diltiazem on a 5-point scale measuring symptom relief (1 = poorest, 5 = best). Patients with therapy failure were referred to surgery. RESULTS: The study was completed for 166 patients with a mean age of 54.1 years. CAF was posterior in 82.3% of subjects. Diltiazem tolerability was excellent with only 4 adverse event cases (3 skin irritation, 1 hypotension). We obtained symptom relief in 62.1% of patients and CAF healing in 51.2%, and referred 33.7% to surgery. The questionnaire showed that 74.1% of patients had used only 2 applications daily, and that results were better with an increased number of applications, albeit without statistical significance. CONCLUSIONS: The telephone questionnaire showed symptom relief for 62% and healing for 51.2% of patients with CAF on diltiazem 2%, which should be considered first-choice for the conservative management of this condition.

Seguimiento a largo plazo de la fisura anal crónica (FAC) tratada con diltiazem 2% mediante un cuestionario telefónico. ¿Cambian los resultados? / Long-term follow-up of chronic anal fissure (CAF) on diltiazem 2% using a telephone questionnaire. Do results change?

INTRODUCCIÓN: los antagonistas del calcio son fármacos con una excelente efectividad en el tratamiento conservador de la fisura anal crónica (FAC). OBJETIVOS: evaluar los resultados a largo plazo del tratamiento con pomada de diltiazem al 2% mediante un cuestionario telefónico. MÉTODOS: estudio descriptivo y retrospectivo desde marzo de 2004 a marzo de 2011 de pacientes con FAC y tratados con diltiazem 2%, 3 aplicaciones diarias, durante 4-6 semanas. A partir de los 12 meses se efectuó un cuestionario telefónico por personal médico ajeno al Servicio de Cirugía recogiendo datos sociodemográficos de los pacientes, sintomatología predominante, respuesta al diltiazem mediante una escala de alivio sintomático del 1 al 5 (1 = muy malo, 5 = muy bueno). Los pacientes con fracaso terapéutico se derivaron a cirugía. RESULTADOS: el estudio se completó en 166 pacientes con una edad media de 54,1 años. La localización de la FAC fue posterior en el 82,3%. La tolerancia al diltiazem fue excelente, con sólo 4 casos de efectos adversos (3 por irritación dérmica y 1 por hipotensión). Obtuvimos un alivio sintomático del 62,1% y curación de la FAC en un 51,2%, remitiendo un 33,7% a cirugía. El cuestionario evidenció que el 74,1% de los pacientes utilizó sólo dos aplicaciones al día y que a mayor número de aplicaciones mejoraban los resultados, sin alcanzar significación estadística. CONCLUSIONES: el cuestionario telefónico evidencia un alivio sintomático del 62% y una curación del 51,2% de la FAC con diltiazem 2% debiendo ser considerada como primera opción en el manejo conservador de la misma

INTRODUCTION: Calcium channel blockers have an excellent effectiveness in the conservative management of chronic anal fissure (CAF). OBJECTIVES: To assess the long-term results of management with diltiazem 2% ointment using a telephone questionnaire. METHODS: A descriptive, retrospective study from March 2004 to March 2011 in patients with CAF on diltiazem 2%, 3 applications daily for 4-6 weeks. Starting at 12 months a questionnaire was administered over the phone by medical staff outside the surgery department to record socio-demographic data, predominant manifestations, and response to diltiazem on a 5-point scale measuring symptom relief (1 = poorest, 5 = best). Patients with therapy failure were referred to surgery. RESULTS: The study was completed for 166 patients with a mean age of 54.1 years. CAF was posterior in 82.3% of subjects. Diltiazem tolerability was excellent with only 4 adverse event cases (3 skin irritation, 1 hypotension). We obtained symptom relief in 62.1% of patients and CAF healing in 51.2%, and referred 33.7% to surgery. The questionnaire showed that 74.1% of patients had used only 2 applications daily, and that results were better with an increased number of applications, albeit without statistical significance. CONCLUSIONS: The telephone questionnaire showed symptom relief for 62% and healing for 51.2% of patients with CAF on diltiazem 2%, which should be considered first-choice for the conservative management of this condition

Linfoma rectal primario: caso clínico y revisión de la literatura médica / Primary rectal lymphoma: Clinical case and a review of the literature

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Evisceración vaginal. Abordaje abdominal y reparación con malla sintética / Vaginal evisceration. Abdominal approach and synthetic mesh repair

La evisceración vaginal espontánea es un fenómeno raro en la práctica clínica diaria. Se han publicado más de 70 casos hasta la actualidad desde que McGregor comunicara el primer caso a comienzos del siglo pasado. La situación ocurre generalmente en pacientes posmenopáusicas con hipoestrogenismo asociado a cirugía ginecológica previa. Recientemente, se ha descrito también en situaciones no ginecológicas tras una proctectomía perineal. Presentamos un nuevo caso de evisceración vaginal espontánea en una mujer posmenopáusica con cirugía ginecológica previa. La reparación se efectuó con malla a través de una laparotomía convencional (AU)

Spontaneous vaginal evisceration is a rare phenomenon in daily clinical practice. Since McGregor reported the first case at the beginning of the past century, more than 70 cases have been reported to date. Spontaneous vaginal evisceration usually occurs in patients with postmenopausal hypoestrogenism associated with previous gynecologic surgery. This entity has recently been described in non-gynecological conditions after perineal proctectomy. We present a new case of spontaneous vaginal evisceration in a postmenopausal woman with previous gynecological surgery. Surgical mesh repair was performed through conventional laparotomy (AU)