Recommendations for Sustainable Ancient DNA Research in the Global South: Voices From a New Generation of Paleogenomicists.

Paleogenomics - the study of ancient genomes - has made significant contributions, especially to our understanding of the evolutionary history of humans. This knowledge influx has been a direct result of the coupling of next-generation sequencing with improved methods for DNA recovery and analysis of ancient samples. The appeal of ancient DNA studies in the popular media coupled with the trend for such work to be published in "high impact" journals has driven the amassing of ancestral human remains from global collections, often with limited to no engagement or involvement of local researchers and communities. This practice in the paleogenomics literature has led to limited representation of researchers from the Global South at the research design and subsequent stages. Additionally, Indigenous and descendant communities are often alienated from popular and academic narratives that both involve and impact them, sometimes adversely. While some countries have safeguards against 'helicopter science', such as federally regulated measures to protect their biocultural heritage, there is variable oversight in others with regard to sampling and exportation of human remains for destructive research, and differing requirements for accountability or consultation with local researchers and communities. These disparities reveal stark contrasts and gaps in regional policies that lend themselves to persistent colonial practices. While essential critiques and conversations in this sphere are taking place, these are primarily guided through the lens of US-based heritage legislation such as the Native American Graves and Protection Act (NAGPRA). In this article, we aim to expand the scope of ongoing conversations by taking into account diverse regional contexts and challenges drawing from our own research experiences in the field of paleogenomics. We emphasize that true collaborations involve knowledge sharing, capacity building, mutual respect, and equitable participation, all of which take time and the implementation of sustainable research methods; amass-and-publish strategy is simply incompatible with this ethos.

Mixoma auricular izquierdo gigante que causa obstrucción valvular mitral, hipertensión pulmonar y tromboembolia pulmonar / Giant atrial myxoma causing mitral valve obstruction, pulmonary hypertension and pulmonary thromboembolism

Resumen: Los tumores cardíacos pueden ser primarios o, más frecuentemente secundarios o metastásicos. Entre los tumores primarios es más frecuente el mixoma, cuya ubicación más común es en la aurícula izquierda. Las manifestaciones clínicas son diversas, producidas principalmente por obstrucción mecánica, embolizaciones, y manifestaciones constitucionales. Se comunica el caso de un paciente de 32 años, con cuadro clínico de insuficiencia cardíaca, hipertensión pulmonar severa y tromboembolismo pulmonar bilateral. Se hizo el diagnóstico de mixoma auricular izquierdo. Se resecó el tumor y se manejó la hipertensión pulmonar desde el ingreso al hospital con inhibidores de la fosfodiesterasa asociado a anticoagulación. Se discute el tema dando énfasis a aspectos fisiopatológicos involucrados tanto en la hipertensión pulmonar como en la presencia de tromboembolia pulmonar.

Abstract: Cardiac tumors may be primary or, more frequently secondary or associated to metastasis. Atril myxoma es the most frequent primary tumor, usually located in the left atrium. Clinical manifestations include those due to mitral valve occlusión, emboli and general non spedific symptoms and signs. Herein we report the clinical case of a 32 year old patient with severe pulmonary hypertension and bilateral pulmonary embolism. The tumor was extirpated, and he received phosphoro-diesterase inhiborts and anticoagulants. Subsequent clinical course was satisfactory. A brief discussion of this condicion is included.

Percepción de las Enfermeras frente al manejo del dolor en niños en un Servicio Oncológico Hospitalario en Chile / Percepção de enfermeiras sobre o manejo da dor em crianças em um Serviço Hospitalar de de Oncologia no Chile / Nurses' perception of pain management in children in a Hospital Oncology Service in Chile

Resumen:El manejo inadecuado del dolor en niños continúa siendo un problema. El dolor es un síntoma frecuente en los niños hospitalizados, siendo un gran desafío para enfermería, entendiendo que el dolor infantil en cáncer es multifactorial lo que dificulta su manejo. El objetivo fue conocer la percepción de los profesionales de enfermería frente al manejo del dolor en personas oncológicas pediátricas hospitalizadas durante el segundo semestre del año 2017. Metodología: Esta investigación se enmarca en el paradigma constructivista con enfoque en la teoría fundada. El estudio se realizó en el Servicio de Hemato-Oncología del Hospital Roberto del Río. Participaron seis enfermeras en una entrevista semiestructurada para un posterior análisis de contenido. Resultados: Fueron participantes de sexo femenino, adultos jóvenes y para la mayoría, esta constituye su primera experiencia laboral. El análisis cualitativo permitió estructurar la percepción del manejo del dolor en cuatro categorías con subcategorías: Definición de dolor: Concepto de dolor, Dolor en el servicio, Relevancia del dolor. Valoración del dolor: Subjetividad en la valoración, Aplicación de escalas de valoración, Experiencia personal, Rol familiar en valoración del dolor. Planificación de los cuidados: Rol de la familia en el manejo del dolor, Individualización de los cuidados, Trabajo en Equipo. Tratamiento del dolor: Tratamiento farmacológico, Tratamiento no farmacológico. Conclusiones: Se logró conocer la percepción de las enfermeras sobre el manejo del dolor, comprendiendo los niños y niñas como un ser multifactorial, que requiere una valoración adecuada, integrando el tratamiento farmacológico y no farmacológico para su remisión.

Resumo: O tratamento inadequado da dor em crianças continua a ser um problema. A dor é um sintoma frequente em crianças hospitalizadas, sendo um grande desafio para a enfermagem, por compreender que a dor na infância no câncer é multifatorial, o que dificulta seu manejo. O objetivo é conhecer a percepção dos profissionais de enfermagem sobre o manejo da dor em oncológicos pediátricos internados no segundo semestre de 2017. Metodologia: Esta pesquisa está enquadrada no paradigma construtivista com foco na teoria fundamentada, descritiva com desenho qualitativo. O estudo foi realizado no Serviço de Hemato-Oncologia do Hospital Roberto del Río. Seis enfermeiros participam de uma entrevista semiestruturada para posterior análise de conteúdo. Resultados: São sujeitos do sexo feminino, principalmente jovens adultos e, para a maioria, constituem sua primeira experiência de trabalho. A análise qualitativa permitiu estruturar a percepção do manejo da dor em quatro categorias com subcategorias: Definição de dor: Conceito de dor, Dor no serviço, Relevância da dor. Avaliação da dor: subjetividade na avaliação, aplicação de escalas de avaliação, experiência pessoal, papel da família na avaliação da dor. Planejamento do cuidado: Papel da família no manejo da dor, Individualização do cuidado, Trabalho em equipe. Tratamento da dor: tratamento farmacológico, tratamento não farmacológico. Conclusões: É possível conhecer a percepção dos enfermeiros sobre o manejo da dor, compreendendo meninos e meninas como um ser multifatorial, o que requer uma avaliação adequada, integrando o tratamento farmacológico e não farmacológico para remissão.

Abstract: Inadequate pain management in children continues to be a problem. Pain is a frequent symptom in hospitalized children, being an excellent challenge for nursing, understanding that childhood pain in cancer is multifactorial, which makes its management difficult. The objective is to know the perception of nursing professionals regarding pain management in pediatric oncology people hospitalized during the second half of 2017. Methodology: This research is part of the constructivist paradigm focusing on grounded theory, descriptive with qualitative design. A study carried out at the Hemato-Oncology Service of the Roberto del Río Hospital proposed. Six nurses participate in a semi-structured interview for subsequent content analysis. Results: They are female subjects, mainly young adults and for the majority this constitutes their first work experience. The qualitative analysis allowed structuring the perception of pain management in four categories with subcategories: Definition of Pain: Concept of Pain, Pain in the service, Relevance of Pain. Pain assessment: Subjectivity in assessment, Application of rating scales, Personal experience, Family role in pain assessment. Care planning: Role of the family in pain management, Individualization of care, Teamwork. Pain management: Pharmacological treatment, Non-pharmacological treatment. Conclusions: It is possible to know the nurses' perception of pain, understanding boys and girls as a multifactorial being, which requires an adequate assessment, integrating pharmacological and non-pharmacological treatment for remission.

Diverse variola virus (smallpox) strains were widespread in northern Europe in the Viking Age.

Smallpox, one of the most devastating human diseases, killed between 300 million and 500 million people in the 20th century alone. We recovered viral sequences from 13 northern European individuals, including 11 dated to ~600-1050 CE, overlapping the Viking Age, and reconstructed near-complete variola virus genomes for four of them. The samples predate the earliest confirmed smallpox cases by ~1000 years, and the sequences reveal a now-extinct sister clade of the modern variola viruses that were in circulation before the eradication of smallpox. We date the most recent common ancestor of variola virus to ~1700 years ago. Distinct patterns of gene inactivation in the four near-complete sequences show that different evolutionary paths of genotypic host adaptation resulted in variola viruses that circulated widely among humans.

The prehistoric peopling of Southeast Asia.

The human occupation history of Southeast Asia (SEA) remains heavily debated. Current evidence suggests that SEA was occupied by Hòabìnhian hunter-gatherers until ~4000 years ago, when farming economies developed and expanded, restricting foraging groups to remote habitats. Some argue that agricultural development was indigenous; others favor the "two-layer" hypothesis that posits a southward expansion of farmers giving rise to present-day Southeast Asian genetic diversity. By sequencing 26 ancient human genomes (25 from SEA, 1 Japanese Jomon), we show that neither interpretation fits the complexity of Southeast Asian history: Both Hòabìnhian hunter-gatherers and East Asian farmers contributed to current Southeast Asian diversity, with further migrations affecting island SEA and Vietnam. Our results help resolve one of the long-standing controversies in Southeast Asian prehistory.

Efectividad y seguridad del tratamiento anticoagulante con acenocumarol en fibrilación auricular no valvular / Effectiveness and safety of oral anticoagulation treatment with acenocoumarol in non-valvular atrial fibrillation

Background: Vitamin K antagonists significantly decrease the incidence of stroke but increase the risk of bleeding. Aim: To assess the effectiveness and risk of bleeding of vitamin K antagonists in non-valvular atrial fibrillation. Material and Methods: Retrospective cohort study of 524 patients, 236 women (45%) and 288 men (55%) with non-valvular atrial fibrillation (NVAF) admitted to the oral anticoagulation treatment (OAT) clinic at four public hospitals, between 2009 and 2012. They were followed until March 2013, measuring the quality of OAT, ischemic and bleeding events. Results: The mean follow-up was 26.1 months, with 1,154.7 person-years of follow-up accrued. The percentage of time in therapeutic range (TTR) was 35.2 ± 18%; this was deemed to represent the quality of OAT. The cumulative incidence of ischemic events, either stroke or systemic embolism, was 2.25/100 person-years, being greater in patients with previous embolism (Risk ratio 5.21, 95% confidence intervals 2.31- 11.73, p < 0.01). The cumulative incidence of major bleeding events-extracranial and intracraneal-was 4.08/100 person-years. The main site of extracranial major bleeding was the gastrointestinal tract (32%). Conclusions: In our clinical practice, the effectiveness of OAT with acenocoumarol in NVAF patients is similar to that published abroad. However, the incidence of bleeding complications is higher. The quality of the OAT measured by the TTR was lower than abroad.

Latin American Clinical Epidemiology Network Series - Paper 2: Apixaban was cost-effective vs. acenocoumarol in patients with nonvalvular atrial fibrillation with moderate to severe risk of embolism in Chile.

OBJECTIVE: Nonvalvular atrial fibrillation (NVAF) is a risk factor for ischemic stroke and systemic embolism. New oral anticoagulants are currently available. The objective of this study was to assess the incremental cost-utility ratio (ICUR) for apixaban vs. acenocoumarol in patients treated in Chile's public health system. STUDY DESIGN AND SETTING: We assessed cost-utility from the payer perspective with a lifetime Markov model. Epidemiologic characteristics, costs, and utilities were obtained from a Chilean cohort; data were completed with information from international literature. RESULTS: Incremental costs when using apixaban vs. acenocoumarol over a lifetime are CH$2,108,600 with an incremental effectiveness of 0.173 years of life gained (YLG) and 0.182 quality-adjusted life-year (QALY). The ICUR of apixaban vs. acenocoumarol was CH$12,188,439 per YLG and CH$11,585,714 per QALY. One to 3 times gross domestic product (GDP) per capita threshold is acceptable based on World Health Organization (WHO) norms. Chilean GDP per capita was CH$7,797,021 in 2013. The sensitivity analysis shows that these results are sensitive to the ischemic stroke risk with apixaban, and the intracranial hemorrhage risk due to the use of acenocoumarol. CONCLUSION: The use of apixaban in patients with NVAF in moderate-to-high risk of stroke is cost-effective, considering the payment threshold suggested by WHO.

Salud y trabajo de docentes de instituciones educativas distritales de la localidad uno de Bogotá / Health and work of district schools faculty of the district one of Bogotá

Las instituciones educativas constituyen un escenario importante para la promoción de la salud de docentes, estudiantes, personal administrativo e, incluso, las familias; pero para utilizarlo eficazmente, en particular para el caso de los(as) docentes, es necesario conocer sus condiciones de trabajo y salud. Objetivo: describir algunas de las condiciones de trabajo y salud del personal docente que labora en las Instituciones Educativas Distritales de la Localidad uno (I) de Usaquén, Bogotá, en el 2010. Metodología: Estudio de abordaje cuantitativo, descriptivo transversal. Se inició después de la obtención de la autorización por parte de las directivas de las instituciones y del aval del Comité de Ética de la Facultad de Enfermería de la Universidad Nacional; posteriormente se procedió a la presentación del estudio ante los docentes directivos de estas Instituciones, se inició la recolección de información. El tamaño de la muestra fue de 230 docentes. Resultados: El 68.7% del personal docente era de sexo femenino; el 51.7% realizaba extensión del trabajo docente; 37.8% reportó presencia del ruido dentro del aula, situación que les exigía elevar el volumen de la voz para lograr la atención de los estudiantes. En relación con las condiciones de salud, refirieron que la causa de mayor frecuencia en la consulta médica era el estrés, con un 40.9%; seguido de los problemas vasculares y várices en miembros inferiores, con un 29.1%; de colon irritable, 28.3, y disfonías o afonías, con un 27.8%. Conclusiones: En este contexto se ratifica la necesidad de comprender la actividad docente como un proceso laboral de interés para el área de la salud y seguridad en el trabajo, por el alto valor social que representa y el fuerte impacto que tiene en el desarrollo de la sociedad. Se plantea la necesidad de continuar con estudios de intervención en la población que participó del estudio.

Educational institutions are an important scenario for promoting faculty, students, administrative staff, and even families health. However, in order to use it effectively, particularly in the case of the faculty, it is necessary to know their work conditions and health status. Objective: To describe some of the working and health status of the staff working in the educational institutions of the District One (I) of Usaquén, Bogotá, in 2010. Methodology: Quantitative, cross-sectional and descriptive study that was started after obtaining authorization of the schools administrations and the endorsement of the Ethics Committee of the Nursing School of the National University. The study was then introduced to the schools principals, and the data collection was started. 230 teachers made up the sample. Outcomes: 68.7% of the faculties were female teachers; 51.7% perform extension activities; 37.8% reported that students made so much noise in the room, so they had to speak louder in order to get students` attention. Regarding health status, 40.9% reported that the main reason to see a doctor was stress, followed by vascular problems and varicose veins in lower limbs, with 29.1%; irritable bowel, 28.3, and dysphonias or aphonias, with 27.8%. Conclusions: on this basis, it was confirmed the need to understand teaching activities as a labor process of interest to the health field and work safety, due to the high social value it represents and its strong impact on the society`s development. It raises the need to carry out further studies of intervention on population participating in the trial.

As instituições de ensino são cenário importante para a promoção da saúde dos professores, estudantes, pessoal administrativo e até mesmo das famílias. No entanto, a fim de usá-lo de forma eficaz, especialmente no caso dos professores, é necessário conhecer suas condições de trabalho e nível de saúde. Objetivo. Descrever algumas das condições de trabalho e nível de saúde do pessoal que trabalhava nas Instituições de Ensino do Primeiro Distrito de Usaquén, Bogotá, em 2010. Metodologia: o estudo foi apresentado aos docentes diretores dessas instituições, e a coleta dos dados iniciou-se. A amostra foi composta de 230 docentes. Resultados: 68.7% do pessoal eram mulheres; 51.7% faziam trabalho de extensão; 37.8% indicaram que tinha muito barulho na sala de aulas, o que fez com elas falassem mais alto para chamar a atenção dos alunos. No que diz respeito ao nível de saúde, indicaram que o principal motivo para visitar o médico era estresse, com 40.9%; seguido dos problemas vasculares e varizes nas pernas, com 29.1%; de cólon irritável, 28.3, e disfonias ou afonias, com 27.8%. Conclusões: nesse contexto, verifica-se a necessidade de entender a atividade docente como um processo laboral de interesse para a área da saúde e segurança no trabalho, pelo elevado valor social que representa, bem como o forte impacto sobre o desenvolvimento da sociedade. Coloca-se a necessidade de continuar levando em diante pesquisas de intervenção na população que participou do estudo.

[HIV-related lymphoma in a public hospital in Chile. Analysis of 55 cases]. / Linfoma relacionado a infección por virus de la inmunodeficiencia humana en un hospital público de Santiago, Chile.

BACKGROUND: Cancer is the third cause of death in patients infected with human immunodeficiency virus (HIV) and lymphoma is the most common type. AIM: To describe the clinical characteristics, histology, risk factors and prognosis of these patients, in a Chilean public hospital in Chile. MATERIAL AND METHODS: Records of 55 patients (45 males) aged between 23 and 67 years with lymphoma and HIV positive serology, diagnosed between 1992-2008, were reviewed. RESULTS: Six patients (11%) had Hodgkin lymphoma (HL) and the rest, non-Hodgkin lymphoma (NHL). B-cell phenotype constituted 83.7% of NHL cases. The most common subtypes of all the lymphoma were diffuse large B cell lymphoma in 24 cases (43.6%), Burkitt lymphoma in 12 cases (21.8%), and plasmablastic lymphoma in 5 cases (9.1%). Thirty five patients (64%) underwent curative intended chemotherapy (CT) concomitantly with highly active antiretroviral therapy (HAART). Three year survival of the whole cohort was 27%. By multivariate analysis, the most important prognostic factors for long term survival, were complete responses to CT, (p < 0.01) and a low international prognostic index (IPI) score for NHL, (p = 0.01). HAART, histologic subtype and CD4 lymphocyte count at diagnosis, did not influence survival. CONCLUSIONS: The most important prognostic factors for HIV patients with lymphoma, were achieving CR with CT and low IPI score. Prognosis remains poor, even with HAART therapy.

Linfoma relacionado a infección por virus de la inmunodeficiencia humana en un hospital público de Santiago, Chile / HIV-related lymphoma in a public hospital in Chile. Analysis of 55 cases

Background: Cancer is the third cause of death in patients infected with human immunodeficiency virus (HIV) and lymphoma is the most common type. Aim: To describe the clinical characteristics, histology, risk factors and prognosis of these patients, in a Chilean public hospital in Chile. Material and Methods: Records of 55 patients (45 males) aged between 23 and 67years with lymphoma and HIV positive serology, diagnosed between 1992-2008, were reviewed. Results: Six patients (11%) had Hodgkin lymphoma (HL) and the rest, non-Hodgkin lymphoma (NHL). B-cell phenotype constituted 83.7% of NHL cases. The most common subtypes of all the lymphoma were diffuse large B cell lymphoma in 24 cases (43.6%), Burkitt lym-phoma in 12 cases (21.8%), andplasmablastic lymphoma in 5 cases (9.1%). Thirty five patients (64%) underwent curative intended chemotherapy (CT) concomitantly with highly active antiretroviral therapy (HAART). Three year survival of the whole cohort was 27%. By multivariate analysis, the most important prognostic factors for long term survival, were complete responses to CT, (p < 0.01) and a low international prognostic index (IPI) score for NHL, (p = 0.01). HAART, histologic subtype and CD4 lymphocyte count at diagnosis, did not influence survival. Conclusions: The most important prognostic factors for HIV patients with lymphoma, were achieving CR with CT and low IPI score. Prognosis remains poor, even with HAART therapy.