Efecto del pulso de inundación sobre el ensamble de ostrácodos (Ostracoda: Podocopida) en microambientes en la Ciénaga Río Viejo, Colombia / Effect of the flood pulse on the ostracod assemblage (Ostracoda: Podocopida) in microenvironments in the Ciénaga Río Viejo, Colombia

Resumen Introducción: Las ciénagas hacen parte de la llanura de inundación de un río y son influenciadas por el pulso de inundación, fuerza que modula los cambios anuales en las variables bióticas y abióticas. Los ensambles biológicos tienen diferentes respuestas a este pulso y podrían presentar cambios en la composición y abundancia. Objetivo: Evaluar cómo se modifican las condiciones físico-químicas en los microambientes de vegetación flotante y el ensamble de ostrácodos a lo largo de un pulso de inundación en la Ciénaga Río Viejo, Santander, Colombia. Métodos: Se caracterizaron las variables físico-químicas de los microambientes de plantas acuáticas flotantes durante las cuatro fases hidrológicas del pulso de inundación: aguas bajas, altas, ascenso y descenso, en tres estaciones donde el pulso tuvo mayor efecto. Ostrácodos dulceacuícolas fueron recolectados de estos microambientes, identificados y contados. Resultados: Las condiciones ambientales dentro de los microhábitats fluctuaron siguiendo el pulso de inundación en el sistema. Se encontraron tres familias taxonómicas y seis especies de ostrácodos. No hubo diferencias en la composición y abundancia del ensamble de ostrácodos en el espacio y el tiempo, lo que sugiere que están protegidas contra los cambios ambientales causados por las fluctuaciones hidrológicas. La abundancia de especies cambió en respuesta a la variabilidad ambiental. Strandesia cf. sphaeroidea y Keysercypria sp. 2 están asociadas con aguas más someras y con mayor cobertura de vegetación acuática densa. Otras especies mostraron ser tolerantes a fluctuaciones hidrológicas y pueden estar relacionadas con la plasticidad ecológica, como Cytheridella ilosvayi, Diaphanocypris meridana y Stenocypris major, que han sido registradas en una variedad de ambientes acuáticos y con distribuciones a escala continental. Conclusiones: Los pulsos de inundación indujeron cambios ambientales en la Ciénaga de Río Viejo, pero los microhábitats con cobertura de vegetación flotante parecen estar protegidos contra el pulso hidrológico, permitiendo así que las comunidades de ostrácodos permanezcan casi sin alteraciones durante un pulso de inundación. Este conjunto de datos actualizado de agua dulce tropical contribuye a llenar los vacíos de conocimiento relacionados con la idoneidad del hábitat y la distribución de las comunidades de ostrácodos en Colombia.

Abstract Introduction: Swamps are lowland shallow tropical lakes in rivers floodplains, characterized by annual flood pulses that modulate changes in biotic and abiotic variables. Biological assemblages have different responses to flood pulses, remaining either undisturbed or with significant changes in composition and abundance. Objective: To evaluate how physical and chemical conditions are modified in mixed macrophytes microenvironments and ostracod species assemblages throughout a flood pulse in Rio Viejo swamp, Santander, Colombia. Methods: We characterized physical and chemical variables of microenvironments of aquatic floating plants, during four different hydrologic periods of the flood pulse: low, high, rising, and descending waters, at three stations where the flood pulse have the most important effect. Freshwater ostracods were collected from such microenvironments, identified, and counted. Results: Environmental conditions within microhabitats fluctuated following the flood pulse in the system. Three taxonomic families and six species of ostracods were observed. No differences in the composition and abundance of the spatio-temporal ostracod assemblages were observed, suggesting that they are buffered against environmental changes driven by hydrological fluctuations. Species abundance changed in response to environmental variability. Species such as Keysercypria sp. and Keysercypria sp. 2 are associated to shallower waters and more likely to dense aquatic vegetation cover. Other species showed to be more tolerant to hydrological fluctuations and may be related to ecological plasticity, species such as Cytheridella ilosvayi, Diaphanocypris meridana and Stenocypris major that have been recorded in a variety of aquatic environments and with distributions at continental scale. Conclusions: Flood pulses induced environmental changes in Rio Viejo Swamp, but microhabitats in mixed macrophyte cover seems to be buffered against the hydrological pulse, thus allowing almost undisturbed ostracod assemblages throughout a flood pulse. This updated tropical freshwater dataset contributes towards filling the knowledge gaps related to habitat suitability and distribution of ostracods communities in Colombia.

Actualización de las guías del tratamiento farmacológico de la artritis reumatoide del Colegio Mexicano de Reumatología 2018 / Update of the Mexican College of Rheumatology Guidelines for the Pharmacological Treatment of Rheumatoid Arthritis, 2018

Los avances terapéuticos en la artritis reumatoide obligan a revisión periódica de las guías de tratamiento. Objetivo: Actualizar las guías del Colegio Mexicano de Reumatología del tratamiento farmacológico de la artritis reumatoide. Método: Participaron reumatólogos certificados de diferentes instituciones de salud y regiones del país. Se conformaron equipos de trabajo que revisaron las guías previas, elaboraron nuevas preguntas, revisaron la literatura y calificaron la evidencia, que fue presentada y discutida en sesión plenaria. Las conclusiones se comentaron con infectólogos, ginecobstetras y pacientes. Se emiten recomendaciones basadas en niveles de evidencia de acuerdo con la metodología GRADE. Resultados: Se presentan recomendaciones actualizadas para el empleo de los medicamentos disponibles en México hasta 2017 para el tratamiento de la artritis reumatoide. Se enfatiza la importancia del control adecuado y sostenido de la enfermedad y se describen aspectos relevantes de seguridad. Se incluyen conflictos bioéticos y se invita a la acción gubernamental para fortalecer el tratamiento adecuado de la enfermedad. Conclusiones: La actualización de las recomendaciones del Colegio Mexicano de Reumatología del tratamiento farmacológico de la artritis reumatoide integra la mejor información disponible para ser utilizada en el sistema de salud de México.(AU)

Therapeutic advances in rheumatoid arthritis require periodic review of treatment guidelines.Objective: To update the Mexican College of Rheumatology guidelines on the pharmacological treatment of rheumatoid arthritis. Method: Board certified rheumatologists from different health institutions and regions of the country participated. Work teams were formed that reviewed the previous guidelines, elaborated new questions, reviewed the literature, and scored the evidence that was presented and discussed in plenary session. The conclusions were presented to infectologists, gynaecologists and patients. Recommendations were based on levels of evidence according to GRADE methodology. Results: Updated recommendations on the use of available medications for rheumatoid arthritis treatment in Mexico up to 2017 are presented. The importance of adequate and sustained control of the disease is emphasized and relevant safety aspects are described. Bioethical conflicts are included, and government action is invited to strengthen correct treatment of the disease. Conclusions: The updated recommendations of the Mexican College of Rheumatology on the pharmacological treatment of rheumatoid arthritis incorporate the best available information to be used in the Mexican health care system.(AU)

Update of the Mexican College of Rheumatology Guidelines for the Pharmacological Treatment of Rheumatoid Arthritis, 2018. / Actualización de las guías del tratamiento farmacológico de la artritis reumatoide del Colegio Mexicano de Reumatología 2018.

Therapeutic advances in rheumatoid arthritis require periodic review of treatment guidelines. OBJECTIVE: To update the Mexican College of Rheumatology guidelines on the pharmacological treatment of rheumatoid arthritis. METHOD: Board certified rheumatologists from different health institutions and regions of the country participated. Work teams were formed that reviewed the previous guidelines, elaborated new questions, reviewed the literature, and scored the evidence that was presented and discussed in plenary session. The conclusions were presented to infectologists, gynaecologists and patients. Recommendations were based on levels of evidence according to GRADE methodology. RESULTS: Updated recommendations on the use of available medications for rheumatoid arthritis treatment in Mexico up to 2017 are presented. The importance of adequate and sustained control of the disease is emphasized and relevant safety aspects are described. Bioethical conflicts are included, and government action is invited to strengthen correct treatment of the disease. CONCLUSIONS: The updated recommendations of the Mexican College of Rheumatology on the pharmacological treatment of rheumatoid arthritis incorporate the best available information to be used in the Mexican health care system.

Outcomes of drug-induced acute pancreatitis: a ten-year experience of an academic center.

BACKGROUND: drug-induced pancreatitis is an unexplored entity. METHODS: a retrospective cohort study was performed at a referral center. Patients with drug-induced acute pancreatitis between 2008 and 2018 were included. Baseline patient characteristics, involved drugs, clinical course and recurrence were analyzed. RESULTS: drug-induced pancreatitis represented 2.8 % of acute pancreatitis (47/1,665) and 18 different drugs were involved (thiopurines 61.8 %). The latency period was less than one month in 87.2 % of cases. Pancreatitis was mild in 89.3 % and recurrence risk was 2.3 %. CONCLUSION: drugs are a rare cause of pancreatitis, which mostly occurs within the first month of treatment, is usually mild and is associated with a low risk of recurrence.

The Kasei Valles, Mars: a unified record of episodic channel flows and ancient ocean levels.

There is widespread evidence across Mars of past flows in major channel systems as well as more than one palaeo ocean level. However, evidence for the timing of channel flows and ocean levels is based on geographically diverse sources with a limited number of dates, making reconstructions of palaeo flows and ocean levels patchy. Here, based on high-resolution topography, image analysis and crater statistics, we have dated 35 different surfaces in Kasei Valles, that are predominantly found within erosional units enabling us to reconstruct a fascinating timeline of episodic flooding events (ranging from 3.7 to 3.6 Ga to ca. 2.0 Ga) interacting with changing ocean/base levels. The temporal correlation of the different surfaces indicates five periods of channel flows driving the evolution of Kasei Valles, in conjunction with the development of (at least) two ocean levels. Furthermore, our results imply that such ocean rose in elevation (ca. 1000 m) between ca. 3.6 Ga and 3.2 Ga and soon afterwards disappeared, thereby indicating a complex ancient Martian hydrosphere capable of supporting a vast ocean, with an active hydrological cycle stretching into the Amazonian.

Watch and wait approach in rectal cancer: Current controversies and future directions.

According to the main international clinical guidelines, the recommended treatment for locally-advanced rectal cancer is neoadjuvant chemoradiotherapy followed by surgery. However, doubts have been raised about the appropriate definition of clinical complete response (cCR) after neoadjuvant therapy and the role of surgery in patients who achieve a cCR. Surgical resection is associated with significant morbidity and decreased quality of life (QoL), which is especially relevant given the favourable prognosis in this patient subset. Accordingly, there has been a growing interest in alternative approaches with less morbidity, including the organ-preserving watch and wait strategy, in which surgery is omitted in patients who have achieved a cCR. These patients are managed with a specific follow-up protocol to ensure adequate cancer control, including the early identification of recurrent disease. However, there are several open questions about this strategy, including patient selection, the clinical and radiological criteria to accurately determine cCR, the duration of neoadjuvant treatment, the role of dose intensification (chemotherapy and/or radiotherapy), optimal follow-up protocols, and the future perspectives of this approach. In the present review, we summarize the available evidence on the watch and wait strategy in this clinical scenario, including ongoing clinical trials, QoL in these patients, and the controversies surrounding this treatment approach.

Recovery of Neodymium (III) from Aqueous Phase by Chitosan-Manganese-Ferrite Magnetic Beads.

Neodymium is a key rare-earth element applied to modern devices. The purpose of this study is the development of a hybrid biomaterial based on chitosan (CS) and manganese ferrite (MF) for the recovery of Nd(III) ions from the aqueous phase. The preparation of the beads was performed in two stages; first, MF particles were obtained by the assessment of three temperatures during the co-precipitation synthesis, and the best nano-MF crystallites were incorporated into CS to obtain the hybrid composite material (CS-MF). The materials were characterized by FTIR, XRD, magnetization measurements, and SEM-EDX. The adsorption experiments included pH study, equilibrium study, kinetics study, and sorption-desorption reusability tests. The results showed that for MF synthesis, 60 °C is an appropriate temperature to obtain MF crystals of ~30 nm with suitable magnetic properties. The final magnetic CS-MF beads perform maximum adsorption at pH 4 with a maximum adsorption capacity of 44.29 mg/g. Moreover, the material can be used for up to four adsorption-desorption cycles. The incorporation of MF improves the sorption capacity of the neat chitosan. Additionally, the magnetic properties enable its easy separation from aqueous solutions for further use. The material obtained represents an enhanced magnetic hybrid adsorbent that can be applied to recover Nd(III) from aqueous solutions.

Management of pancreatic collections: an update

Pancreatic fluid collections frequently occur in the context of moderate and severe acute pancreatitis, and may also appear as a complication of chronic pancreatitis, pancreatic surgery or trauma. It is essential to adhere to the Atlanta classification nomenclature that subclassifies them into four categories (acute peripancreatic fluid collections, acute necrotic collections, pseudocysts, and walled-off necrosis) since it has an impact on prognosis and management. Pseudocysts and walled-off pancreatic necrosis are encapsulated pancreatic fluid collections characterized by a surrounding inflammatory wall, which typically develops three to four weeks after the onset of acute pancreatitis. Most pancreatic fluid collections resolve spontaneously and do not require intervention. However, when they become symptomatic or complicated drainage is indicated, and endoscopic ultrasound-guided drainage has become first-line treatment of encapsulated collections. Drainage of pseudocysts is relatively straightforward due to their liquid content. However, in walled-off necrosis the presence of solid necrotic debris can make treatment more challenging and therefore multidisciplinary management in experienced centers is recommended, being a step-up approach the current standard of care. In this review, we aim to address the management of pancreatic fluid collections with an especial focus on endoscopic drainage

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Management of pancreatic collections: an update.

Pancreatic fluid collections frequently occur in the context of moderate and severe acute pancreatitis, and may also appear as a complication of chronic pancreatitis, pancreatic surgery or trauma. It is essential to adhere to the Atlanta classification nomenclature that subclassifies them into four categories (acute peripancreatic fluid collections, acute necrotic collections, pseudocysts, and walled-off necrosis) since it has an impact on prognosis and management. Pseudocysts and walled-off pancreatic necrosis are encapsulated pancreatic fluid collections characterized by a surrounding inflammatory wall, which typically develops three to four weeks after the onset of acute pancreatitis. Most pancreatic fluid collections resolve spontaneously and do not require intervention. However, when they become symptomatic or complicated drainage is indicated, and endoscopic ultrasound-guided drainage has become first-line treatment of encapsulated collections. Drainage of pseudocysts is relatively straightforward due to their liquid content. However, in walled-off necrosis the presence of solid necrotic debris can make treatment more challenging and therefore multidisciplinary management in experienced centers is recommended, being a step-up approach the current standard of care. In this review, we aim to address the management of pancreatic fluid collections with an especial focus on endoscopic drainage.

Lumen-apposing metal stents versus biliary fully-covered metal stents for EUS-guided drainage of pancreatic fluid collections: a case control study: Meeting presentations: European Society of Gastrointestinal Endoscopy ESGE Days 2018.

Background and study aims Endoscopic ultrasound (EUS)-guided drainage has become first-line treatment for pancreatic fluid collections (PFC). The aim of this study was to compare the effectiveness and safety of biliary fully-covered self-expandable metal stents (BFCSEMS) and lumen-apposing metal stents with electrocautery (EC-LAMS). Patients and methods From April 2008 to March 2017, consecutive patients with symptomatic PFC drained under EUS-guidance with metal stents were included. Patients drained with EC-LAMS were considered the study group and those drained with BFCSEMS the control group. Two primary endpoints were evaluated: effectiveness (defined as reduction of ≥ 50 % of PFC size in cross-sectional imaging and improvement of symptoms 6 months after the transmural drainage) and safety. Results Thirty patients were drained with EC-LAMS and 60 patients with BFCSEMS. Patients and PFC baseline characteristics in both groups were similar. Use of a coaxial double pigtail plastic stent and a nasocystic lavage catheter was significantly less frequent in patients drained with EC-LAMS (33 % vs. 100 %, and 13 % vs. 58 %, respectively; P  < 0.0001). Technical success was 100 % in both groups. Procedure time was < 30 minutes in all patients drained with EC-LAMS and over 30 minutes in all patients drained with BFCSEMS ( P  = 0.0001). Clinical success was higher with a tendency to significance in patients drained with EC-LAMS (96 % vs. 82 %, P  = 0.055) and the adverse event rate was lower (4 % vs. 18 %, P  = 0.04). No case of procedure-related mortality was recorded. Conclusions EC-LAMS and BFCSEMS are both effective for EUS-guided drainage of PFC. However, EC-LAMS requires less time to be performed and appears to be safer.

Knickpoints in Martian channels indicate past ocean levels.

On Mars, the presence of extensive networks of sinuous valleys and large channels provides evidence for a wetter and warmer environment where liquid water was more abundant than it is at present. We undertook an analysis of all major channel systems on Mars and detected sharp changes in elevation along the river long profiles associated with steep headwall theatre-like valleys and terraces left downstream by channel incision. These breaks in channel longitudinal slope, headwalls and terraces exhibit a striking resemblance with terrestrial fluvial features, commonly termed 'knickpoints'. On Earth, such knickpoints can be formed by more resistant bedrock or where changes in channel base-level have initiated erosion that migrates upstream (such as tectonic uplift or sea level change). We observed common elevations of Martian knickpoints in eleven separate channel systems draining into the Martian Northern lowlands. Numerical modeling showed that the common elevations of some of these knickpoints were not random. As the knickpoints are spread across the planet, we suggest that these Martian knickpoints were formed in response to a common base level or ocean level rather than local lithology. Thus, they potentially represent a record of past ocean levels and channel activity on Mars.

Biliary sphincterotomy reduces the risk of acute gallstone pancreatitis recurrence in non-candidates for cholecystectomy.

BACKGROUND: Population aging and comorbidity are leading to an increase in patients unfit for cholecystectomy. AIMS: To evaluate whether endoscopic biliary sphincterotomy after a first episode of acute gallstone pancreatitis reduces the risk of pancreatitis recurrence and gallstone-related events in non-surgical candidates. METHODS: Retrospective study of patients admitted for a first episode of acute gallstone pancreatitis rejected for cholecystectomy between 2013-2018. The role of endoscopic sphincterotomy was evaluated by adjusting for age, severity of pancreatitis, and presence of choledocholithiasis. RESULTS: We included 247 patients (mean age 80 ±â€¯12 years; Charlson index: 5; severity of pancreatitis: 72% mild). Sphincterotomy was performed in 23.9%. Recurrence of pancreatitis occurred in 17.4% patients (median follow-up: 426 days). The one-year cumulative incidence of a new episode of pancreatitis was 1.8% (95% confidence interval [CI]: 0.2-12%) and 23% (95% CI: 17-31%) in patients with and without sphincterotomy, respectively (p = 0.006). In multivariate analysis, sphincterotomy showed a protective role for recurrence of pancreatitis (adjusted hazard ratio [HR]: 0.29, 95% CI: 0.08-0.92, p = 0.037) and for any gallstone-related event (HR 0.46, 95% CI: 0.21-0.98, p = 0.043). CONCLUSIONS: Endoscopic biliary sphincterotomy reduced the risk of gallstone pancreatitis recurrence and other biliary-related disorders in patients with a first episode of pancreatitis non-candidates for cholecystectomy.

Non-surgical urologic management of neurogenic bladder after spinal cord injury.

PURPOSE: To review the available data on non-surgical management for neurogenic bladder in patients with spinal cord injury (SCI). Before the introduction of urinary catheters and antibiotics, neurogenic bladder was one of the main culprits for death in those patients with SCI. Currently, the management of neurogenic bladder is focused in improving quality of life and preserving renal function. METHODS: A literature review was performed and therapeutic management for neurogenic bladder was divided in six sections: (1) intermittent bladder catheterization; (2) indwelling catheters; (3) condom catheter drainage; (4) reflex voiding and bladder expression with Valsalva or Credé; (5) oral drug therapy of the spinal cord injured bladder; and (6) botulinum neurotoxin (BoNT). RESULTS: Intermittent catheterization is recommended as the preferable method for management of neurogenic bladder in patients with SCI based on limited high-quality data. However, this may not be feasible or available to all and other alternative options include condom catheter drainage or indwelling catheters such as urethral catheters or suprapubic tube, reflex voiding, and bladder expression with Valsalva or Credé. Non-invasive medical therapies are the key to improve incontinence, urodynamic parameters, and quality of life in this population. Botulinum neurotoxin has revolutionized the management of neurogenic bladder in the last two decades decreasing the need for reconstruction or diversion. CONCLUSION: The Joint SIU-ICUD (Société Internationale d'Urologie) (International Consultation on Urological Diseases) International Consultation reviewed the available presented data and provided specific conclusions and recommendations for each non-surgical urologic method to address neurogenic bladder after SCI.

Tratamiento de pancreatitis recidivante por páncreas divisum y ansa pancreática mediante técnica de Rendez-Vous guiada por ecoendoscopia / The endoscopic ultrasound-assisted Rendez-Vous technique for treatment of recurrent pancreatitis due to pancreas divisum and ansa pancreatica

El tratamiento endoscópico de malformaciones ductales pancreáticas causantes de pancreatitis aguda de repetición, como el páncreas divisum o el ansa pancreática, se basa fundamentalmente en la esfinterotomía de la papila minor. En estos casos, no obstante, la complejidad técnica de la colangiopancreatografía endoscópica retrógrada (CPRE) convencional es mayor, pudiendo resultar fallida. Presentamos el caso de un páncreas divisum completo combinado con ansa pancreática, sintomático, en el que, tras fracasar el acceso endoscópico convencional a la papila minor, se logra la canulación y esfinterotomía de esta mediante técnica de Rendez-Vous guiada ecoendoscópicamente (AU)

Endoscopic treatment of pancreatic ductal malformations causing recurrent acute pancreatitis, such as pancreas divisum or ansa pancreatica, is mainly based on the sphincterotomy of the minor papilla. However, the technical complexity of conventional endoscopic retrograde cholangiopancreatography (ERCP) is increased in patients presenting anatomical variants like these and it may be unsuccessful. We report the case of a pancreas divisum combined with ansa pancreatica and describe the cannulation and sphincterotomy of the minor papilla using an ultrasound-assisted Rendez-Vous technique (AU)

The endoscopic ultrasound-assisted Rendez-Vous technique for treatment of recurrent pancreatitis due to pancreas divisum and ansa pancreatica.

Endoscopic treatment of pancreatic ductal malformations causing recurrent acute pancreatitis, such as pancreas divisum or ansa pancreatica, is mainly based on the sphincterotomy of the minor papilla. However, the technical complexity of conventional endoscopic retrograde cholangiopancreatography (ERCP) is increased in patients presenting anatomical variants like these and it may be unsuccessful. We report the case of a pancreas divisum combined with ansa pancreatica and describe the cannulation and sphincterotomy of the minor papilla using an ultrasound-assisted Rendez-Vous technique.

Mercaptopurine and inflammatory bowel disease: the other thiopurine

Background: Data about use and effectiveness of mercaptopurine in inflammatory bowel disease are relatively limited. Aims: To assess the possible therapeutic indications, efficacy and safety of mercaptopurine as an alternative to azathioprine in inflammatory bowel disease. Methods: Retrospective observational study in patients treated with mercaptopurine in a total cohort of 1,574 patients with inflammatory bowel disease. Results: One hundred and fifty-two patients received mercaptopurine, 15.7% of these patients as an initial thiopurine, 5.3% after azathioprine failure, and 79% after azathioprine intolerance. In 52.6% of patients (n = 80), adverse effects of mercaptopurine occurred, resulting in withdrawal in 49 of them. Mercaptopurine was effective in 39% of cases (95% CI 31-48%). In the remaining patients, failure was due mainly to withdrawal due to side effects (55.1%) and therapeutic step-up (33.7%). The average total time of mercaptopurine exposure was 36 months (IQR: 2-60). Myelotoxicitywith mercaptopurine was more common in patients with intermediate TPMT activity than in those with normal activity (p = 0.046). Conclusions: In our setting, mercaptopurine is primarily used as a rescue therapy in patients with azathioprine adverse effects. This could explain its modest efficacy and the high rate of adverse effects. However, this drug is still an alternative in this group of patients, before a therapeutic step-up to biologics is considered (AU)

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