Geological context and human exposures to element mixtures in mining and agricultural settings in Colombia.

Anthropogenic and natural sources contribute to chemical mixtures in air, water, and soil, posing potential risks to the environment and human health. To understand the interplay between element profiles in the human body, geographical location, and associated economic activities, we carried out an observational analytic cross-sectional study. The study recruited 199 participants from three municipalities, two of which had gold-mining as their primary economic activity, while the other was dedicated to agricultural and other local activities not related to mining. The concentrations of a total of 30 elements in human hair samples and 21 elements in environmental soil samples were measured using various spectrometry techniques. Unsupervised clustering analysis using Self-Organizing Maps was applied to human hair samples to analyze element concentrations. Distinct clusters of individuals were identified based on their hair element profiles, which were mapped to geographical location and economic activities. While higher levels of heavy metals (Ag, As, Hg, and Pb) were observed in individuals engaged in mining activities in certain clusters, individuals in agricultural areas show higher concentrations of elements found in pesticides (Ba and Sr). However, the elemental composition of hair is influenced not only by the anthropogenic activities but also by the inherent geological context where people live. Our findings highlight the significance of accounting for environmental factors when evaluating human health risks, as the intricate mixture of elements can yield valuable insights for targeted health interventions.

Diagnóstico fortuito de neoplasia mucinosa de apéndice establecido durante la cesárea / Incidental diagnosis of mucinous neoplasm of appendix established during caesarean section

Resumen ANTECEDENTES: Los tumores del apéndice son bastante excepcionales y el adenocarcinoma mucinoso es el más frecuente de estos tumores. Esta patología es aún más infrecuente en pacientes embarazadas. CASO CLÍNICO: Paciente de 43 años, en curso de las 38.1 semanas del primer embarazo. Antecedentes: diabetes gestacional y obesidad mórbida. Se hospitalizó para practicarle la cesárea de urgencia, indicada por restricción del crecimiento intrauterino, sin posibilidad de una conducta expectante. En la ecografía de control prenatal del primer trimestre se describió la existencia de una masa quística, tabicada, de aproximadamente 12 x 12 cm. En la resonancia magnética nuclear de abdomen se encontró una lesión quística en el flanco derecho, de probable origen de masa anexial derecha de 12 x 9 cm. El estudio histopatológico reportó el hallazgo de una neoplasia mucinosa de bajo grado, asociada con extravasación extramural de mucina del apéndice cecal y un pseudomixoma peritoneal. CONCLUSIÓN: El hallazgo de una neoplasia mucinosa del apéndice en una paciente embarazada es sumamente raro. Su diagnóstico supone un reto, sobre todo en quienes no tienen síntomas. Aunque hay padecimientos más frecuentes en las mujeres, como los tumores de ovario o la apendicitis, vale la pena tener en cuenta este cuadro clínico en futuras pacientes. Se requiere mayor investigación de esta neoplasia en embarazadas para optimizar los métodos diagnósticos y poder tratarla de manera oportuna y evitar dañar al feto o la madre.

Abstract BACKGROUND: Tumours of the appendix are quite rare, with mucinous adenocarcinoma being the most frequent of these tumours. This pathology is even rarer in pregnant patients. CLINICAL CASE: 43-year-old patient, in the course of 38.1 weeks of her first pregnancy. History: gestational diabetes and morbid obesity. She was hospitalised for emergency caesarean section, indicated for intrauterine growth restriction, with no possibility of expectant management. The first trimester prenatal ultrasound scan showed a cystic mass, septate, measuring approximately 12 x 12 cm. Magnetic resonance imaging of the abdomen revealed a cystic lesion in the right flank, probably caused by a right adnexal mass measuring 12 x 9 cm. Histopathological study reported the finding of a low-grade mucinous neoplasm associated with extramural extravasation of mucin from the cecal appendix and a peritoneal pseudomyxoma. CONCLUSION: The finding of a mucinous neoplasm of the appendix in a pregnant patient is extremely rare. It is challenging to diagnose, especially in those without symptoms. Although there are more common conditions in women, such as ovarian tumours or appendicitis, this condition is worth considering in future patients. Further investigation of this neoplasm in pregnant women is needed to optimise diagnostic methods to treat it in a timely manner and to avoid harm to the foetus or the mother.

A Higher Fructose Intake Is Associated with Greater Albuminuria in Subjects with Type 2 Diabetes Mellitus.

The aim of this single center cross-sectional study was to investigate the association between fructose intake and albuminuria in subjects with type 2 diabetes mellitus (T2DM). This is a single center cross-sectional study. One hundred and forty-three subjects with T2DM were recruited from the Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran. The median daily fructose intake was estimated with a prospective food registry during 3 days (2 week-days and one weekend day) and they were divided into low fructose intake (<25 g/day) and high fructose intake (≥ 25 g/day). Complete clinical and biochemical evaluations were performed, including anthropometric variables and a 24-hour urine collection for albuminuria determination. One hundred and thirty-six subjects were analyzed in this study. We found a positive significant association between daily fructose intake and albuminuria (ρ= 0.178, p=0.038) in subjects with type 2 diabetes mellitus. Other variables significantly associated with albuminuria were body mass index (BMI) (ρ= 0.170, p=0.048), mean arterial pressure (MAP) (ρ= 0.280, p=0.001), glycated hemoglobin (A1c) (ρ= 0.197, p=0.022), and triglycerides (ρ= 0.219, p=0.010). After adjustment for confounding variables we found a significant and independent association between fructose intake and albuminuria (ß= 13.96, p=0.006). We found a statistically significant higher albuminuria (60.8 [12.8-228.5] versus 232.2 [27.2-1273.0] mg/day, p 0.002), glycated hemoglobin (8.6±1.61 versus 9.6±2.1 %), p= 0.003, and uric acid (6.27±1.8 versus 7.2±1.5 mg/dL), p=0.012, in the group of high fructose intake versus the group with low fructose intake, and a statistically significant lower creatinine clearance (76.5±30.98 mL/min versus 94.9±36.8, p=0.014) in the group with high fructose intake versus the group with low fructose intake. In summary we found that a higher fructose intake is associated with greater albuminuria in subjects with T2DM.

Embryonic development of the skull of the Andean lizard Ptychoglossus bicolor (Squamata, Gymnophthalmidae).

The study of cranial design and development in Gymnophthalmidae is important to understand the ontogenetic processes behind the morphological diversity of the group and to examine the possible effects of microhabitat use and other ecological parameters, as well as phylogenetic constraints, on skull anatomy. Complete morphological descriptions of embryonic skull development within Gymnophthalmidae are non-existent. Likewise, very little is known about the complete chondrocranium of the family. Herein, the development of the skull of the semi-fossorial lizard Ptychoglossus bicolor is described along with an examination of the chondrocranium of other gymnophthalmid taxa and the teiid Cnemidophorus lemniscatus. Cranial chondrification begins with early condensations in the ethmoid, orbitotemporal and occipital regions of the chondrocranium as well as the viscerocranium. Ossification of the skull starts with elements of the dermatocranium (pterygoid, prefrontal, maxilla and jugal). The orbitosphenoid is the last chondral bone to appear. At birth, the skull is almost completely ossified and exhibits a large frontoparietal fontanelle. In general terms, the chondrocranium of the gymnophthalmids studied is characteristic of lacertiform terrestrial lizards, in spite of their life habits, and resembles the chondrocranium of C. lemniscatus in many aspects. However, the gymnophthalmids show great variation in the orbitosphenoid and a complex nasal capsule. The latter exhibits greater development of some nasal cartilages, which make it more complex than in C. lemniscatus. These characteristics might be related to microhabitat use and the well-developed olfactory and vomeronasal systems observed within this clade.

Intervención frente a un brote de influenza A (H1N1) en un albergue de pacientes con VIH durante julio de 2009 en la ciudad de Lima, Perú / Intervention during an outbreak of influenza A (H1N1) in a shelter for HIV patients July 2009, Lima-Peru

En abril de 2009, en Estados Unidos de América, se identificó un nuevo virus de la Influenza A (H1N1). En el Perú, los primeros casos se reportaron en Lima y Callao como pequeños brotes en poblaciones de ambientes cerrados (colegios, universidades, albergues, etc.). El día 08 de julio de 2009 se reportó un probable brote de influenza A (H1N1) en un albergue de niños y adultos con VIH. Objetivo: Describir las acciones desarrolladas por el equipo de Epidemiología de la Red de Salud Lima Ciudad en la investigación e intervención frente a un brote de influenza A (H1N1) en un albergue de pacientes con VIH. Métodos: Se realizó la evaluación clínica, epidemiológica y de laboratorio de los niños y adultos del albergue, a través de un equipo multidisciplinario. Resultados: En el albergue vivían 35 personas (13 eran niños y adultos con VIH). Se obtuvo muestra de hisopado nasal y faríngeo de ocho pacientes, de las cuales cuatro fueron confirmadas con PCR, representando una tasa de ataque de 11.4%. Se identificaron 20 casos sospechosos (57.1%) y se brindó tratamiento antiviral con oseltamivir. A las demás personas se les dio quimioprofilaxis. Se dispuso el aislamiento y seguimiento de todas las personas del albergue por tres periodos de incubación desde la presentación del último caso. Conclusiones: En la intervención hubo oportunidad en la toma de muestra y en el inicio de tratamiento antiviral. La Red Lima Ciudad tomó muestra a cinco pacientes con cuadro clínico y les dio tratamiento antiviral, además cinco pacientes fueron atendidos en hospitales, a tres le tomaron muestra. Se confirmaron por laboratorio cuatro casos, uno infectado con VIH. Se realizó el seguimiento y monitoreo diario de todos los residentes del albergue. Todos los casos confirmados y sospechosos evolucionaron favorablemente. Mediante la intervención fue posible controlar el brote de influenza A (H1N1) en el albergue.

In April 2009, a new strain of influenza A (H1N1) was identified in the United States of America. In Peru, the first cases reported in Lima and Callao populations were small outbreaks in closed environments (schools, universities, shelters, among others). On July 8, 2009 a probable outbreak of influenza A (H1N1) in a shelter for children and adults with HIV was reported. Aim: To describe the actions taken by the Epidemiology team from the Red de Salud Lima Ciudad in the research and intervention concerning an outbreak of influenza A (H1N1) in a shelter for HIV patients. Methods: We performed a clinical, epidemiological and laboratory evaluation of the children and adults at the shelter, through a multidisciplinary team. Results: There were 35 people living at the shelter of which 13 were children and adults with HIV. We collected samples of nasal and pharyngeal swabs from eight patients, four of which were confirmed by PCR, representing an attack rate of 11.4%. We identified 20 suspected cases (57.1%) and provided antiviral treatment with oseltamivir. We gave chemoprophylaxis to the rest. We set the isolation and monitoring of all people in the shelter for three incubation periods since the submission of the last case. Conclusions: There was an opportunity for sample collection and initiation of antiviral treatment during the intervention. The Red Lima Ciudad took samples from five patients with clinical symptoms and antiviral treatment was given to them; in addition five patients were treated at hospitals, and samples were collected from three of them. Laboratory-confirmed four cases, one of them had HIV. Patient evolved favorably and were followed and monitored daily. Through the intervention, it was possible to control an outbreak of influenzaA(H1N1) in the shelter.

Criterios o elementos determinantes de la libre escogencia de EPS e IPS en Bogotá D. C. por parte de los usuarios del régimen contributivo / Critérios ou elementos determinantes da livre escolha de eps e ips em bogotá D.C. Pelos usuários do regime contributivo / Determining criteria for free choice of health promotion entities and health providing institutions (Eps and Ips in Spanish) in the users of the contributive regime of Bogota, Colombia

En el presente artículo se aborda el análisis de la problemática del Sistema de Seguridad Social en Salud, centrándose en la problemática que se desprende de las relaciones del sistema con sus usuarios, aspecto éste que ha permanecido desatendido en los estudios y en los análisis sobre el tema. En particular se analizan los criterios y los aspectos determinantes que definen la elección de EPS (Entidades Promotoras de Salud) e IPS (Instituciones Prestadores de Servicios de Salud) por parte de los usuarios del régimen contributivo en la ciudad de Bogotá, prestando particular atención al ejercicio de la libre elección y la toma de decisiones informadas. El análisis de los resultados cualitativos y cuantitativos permite concluir que la información relevante disponible y el ejercicio de la libre elección son limitados.

This paper presents the analysis of the problems in Social Security and Health System due to the relations of the system with its users; problems that have been neglected in the studies and in the analyses on this subject. The determining criteria and aspects that define the election of Health Promotion Entities (EPS) and health providing institutions (IPS ) by the users of Bogota are analyzed whereby free election and an informed decision are pointed out. The analysis of the qualitative and quantitative results allows concluding that the available information and the exercise of the free election are limited.

No presente artigo analisa-se o Sistema de Seguridade Social em saúde concentrando-se na problemática que surge a partir das relações do sistema com os seus usuários, aspecto que tem sido negligenciado nos estudos e nas análises sobre o assunto. Em particular analisam-se os critérios e aspectos determinantes que definem a escolha da EPS (Entidades Promotoras de Saúde) e IPS (Instituições Prestadoras de Serviços de Saúde) pelos usuários do regime contributivo na cidade de Bogotá, com especial atenção ao exercício da liberdade de escolha e a tomada de decisão informada. A análise dos resultados qualitativos e quantitativos permite chegar à conclusão de que as informações relevantes disponíveis e o exercício da livre escolha são limitados.