Lead exposure and its relationship with fecal cortisol levels in black howler monkeys (Alouatta pigra).

Efficiently detecting early environmental threats to wildlife is vital for conservation. Beyond obvious dangers like habitat loss or deforestation, our study focuses on one of the most hazardous toxic metals for wildlife: lead (Pb). Pb is a widespread, cumulative, and insidious environmental pollutant that can trigger a wide range of physiological, biochemical, and behavioral disorders. In fact, Pb can cause permanent dysfunction of the major stress system, the hypothalamic pituitary adrenal (HPA) axis. We analyzed Pb and cortisol concentrations in fecal samples from Alouatta pigra in southern Mexico. Fecal samples were collected across six sites categorized as free-ranging (n = 65; conserved and disturbed) and from captive animals (n = 58). Additionally, we collected soil samples (n = 35). We found that Pb was present in 28% of fecal samples and 83% of soil samples. There was a positive relation between fecal and soil Pb levels, and fecal Pb concentration was negatively associated with cortisol levels. However, the claim of Pb being a direct interference with HPA axis requires further investigation. Given our findings, assessing wildlife exposure can be a valuable tool for understanding potential Pb exposure levels in the environment and its possible implications for human health. It can also serve as an early warning system of these consequences.

Use of the CONSIDER statement by eye health researchers when conducting and reporting research involving Indigenous peoples: an online survey.

BACKGROUND: Indigenous peoples experience worse eye health compared to non-Indigenous peoples. Service providers and researchers must avoid perpetuating this inequity. To help achieve this, researchers can use the CONSolIDated critERia for strengthening the reporting of health research involving Indigenous peoples (CONSIDER) statement. This study aimed to identify the degree to which the CONSIDER statement has been used by eye health researchers when conducting and reporting research with an Indigenous component, and how they perceive its relevance in their future research. METHODS: We used purposive sampling to recruit eye health researchers from any country who have undertaken research with an Indigenous component. The online survey collected quantitative and qualitative data and was analysed using descriptive statistics and reflexive thematic analysis. Responses were gathered on a four-point Likert scale (1 to 4), with four being the most positive statement. RESULTS: Thirty-nine eye health researchers from nine countries completed the survey (Aotearoa New Zealand, Argentina, Australia, Brazil, Canada, Colombia, Guatemala, Panama, Peru); almost two-thirds (n = 24) undertake epidemiological research. On average, participants disclosed only 'sometimes' previously reporting CONSIDER items (2.26 ± 1.14), but they thought the items were relevant to eye health research and were motivated to use these guidelines in their future research. Some participants requested clarity about how CONSIDER aligned with existing guidelines, and when and how to apply the statement. Others shared rich experiences of the benefits to their research of Indigenous leadership and collaboration. CONCLUSIONS: The CONSIDER statement is perceived as a valuable tool by these eye health researchers, and there are opportunities to maximise uptake and use, including increasing awareness of the statement, clarity about when it applies, and availability of institutional-level support.

Diagnóstico de la variante conductual de demencia frontotemporal basado en estadios clínicos adaptado para países con baja educación: el caso de Perú

Demencia frontotemporal (DFT) es una condición neurodegenerativa escasamente reconocida en personas menores a 65 años de edad. El diagnóstico de DFT variante conductual (DFTvc) se basa en una entrevista clínica comprehensiva, complementada por una evaluación multidimensional (neurológica, cognitiva, neuropsiquiátrica, de biomarcadores e imágenes cerebrales) adaptada y validada a la población a estudiar; sin embargo, a pesar del incremento de su prevalencia en Latinoamérica y el Caribe, existe necesidad de herramientas estandarizadas y un consenso para el diagnóstico de DFTvc. El artículo intenta realizar una aproximación del enfoque de diagnóstico de DFTvc en escenario de paises con bajos y medianos ingresos, como el Perú.

Frontotemporal dementia (FTD) is a widely recognized neurodegenerative condition in people under 65 years old. The diagnosis of behavioral variant FTD (bvFTD) is based on a comprehensive clinical assessment, complemented by a multidimensional assessment (neurological, cognitive, neuropsychiatric, biomarker and brain imaging) adapted and validated to the population to be studied; however, despite its increasing prevalence in Latin America and the Caribbean, there is a need for standardized tools and consensus for the bvFTD diagnosis. The manuscript attempts to approximate the approach for the diagnosis of bvFTD in the setting of low and middle-income countries, including Peru.

Indigenous Eye Health in the Americas: The Burden of Vision Impairment and Ocular Diseases.

Review of the burden of vision impairment and blindness and ocular disease occurrence in Indigenous Peoples of the Americas. We systematically reviewed findings of the frequency of vision impairment and blindness and/or frequency of ocular findings in Indigenous groups. The database search yielded 2829 citations, of which 2747 were excluded. We screened the full texts of 82 records for relevance and excluded 16. The remaining 66 articles were examined thoroughly, and 25 presented sufficient data to be included. Another 7 articles derived from references were included, summing a total of 32 studies selected. When considering adults over 40 years old, the highest frequencies of vision impairment and blindness in Indigenous Peoples varied from 11.1% in high-income North America to 28.5% in tropical Latin America, whose rates are considerably higher than those in the general population. Most of the ocular diseases reported were preventable and/or treatable, so blindness prevention programs should focus on accessibility to eye examinations, cataract surgeries, control of infectious diseases, and spectacles distribution. Finally, we recommend actions in six areas of attention towards improving the eye health in Indigenous Peoples: access and integration of eye services with primary care; telemedicine; customized propaedeutics; education on eye health; and quality of data.

Cataract services for all: Strategies for equitable access from a global modified Delphi process.

Vision loss from cataract is unequally distributed, and there is very little evidence on how to overcome this inequity. This project aimed to engage multiple stakeholder groups to identify and prioritise (1) delivery strategies that improve access to cataract services for under-served groups and (2) population groups to target with these strategies across world regions. We recruited panellists knowledgeable about cataract services from eight world regions to complete a two-round online modified Delphi process. In Round 1, panellists answered open-ended questions about strategies to improve access to screening and surgery for cataract, and which population groups to target with these strategies. In Round 2, panellists ranked the strategies and groups to arrive at the final lists regionally and globally. 183 people completed both rounds (46% women). In total, 22 distinct population groups were identified. At the global level the priority groups for improving access to cataract services were people in rural/remote areas, with low socioeconomic status and low social support. South Asia and Sub-Saharan Africa were the only regions in which panellists ranked women in the top 5 priority groups. Panellists identified 16 and 19 discreet strategies to improve access to screening and surgical services, respectively. These mostly addressed health system/supply side factors, including policy, human resources, financing and service delivery. We believe these results can serve eye health decision-makers, researchers and funders as a starting point for coordinated action to improve access to cataract services, particularly among population groups who have historically been left behind.

Knowledge, Attitudes, and Practices of Hygiene and the Prevention of Trachoma in the Indigenous Population of the Colombian Amazon Vaupés Department.

The Colombian program to end trachoma implements the component F of the SAFE strategy in the Vaupés department of the Amazon rainforest. Cultural, linguistic, and geographical barriers and the coexistence of an ancestral medical system demand the technical and sociocultural adaptation of this component. A cross-sectional survey combined with focus-group discussions to understand the knowledge, attitudes, and practices of the indigenous population related to trachoma was conducted in 2015. Of the 357 heads of households that participated, 45.1% associated trachoma with a lack of hygiene, and 94.7% associated the concept of hygiene with taking one or more body baths per day, using commercial or handcrafted soap. In total, 93% reported cleaning their children's faces and eyes more often when they have conjunctivitis, but 66.1% also did this with clothes or towels in use, and 52.7% of people shared towels; in total, 32.8% indicated that they would use ancestral medicine to prevent and treat trachoma. The SAFE strategy in Vaupés requires an intercultural approach to facilitate stakeholder support and participation to promote general and facial hygiene, washing clothes with soap, and not sharing towels and clothes to dry and clean children's faces for effective and sustainable elimination of trachoma as a public health problem. This qualitative assessment facilitated an intercultural approach locally and in other Amazonian locations.

Estimating the impact of the illegal trade of primates in Mexico: a potential threat to wildlife.

The primates of Mexico, Ateles geoffroyi, Alouatta palliata, and Alouatta pigra, are seriously threatened by habitat loss, fragmentation, and illegal hunting and trade. Very little is known about the extent of illegal trade and its impacts on declining primate populations. Our study proposes a potential method based on estimating the number of individuals that die in the trade before being detected and those that probably cannot be detected. This facilitates estimating the number of animals extracted and allows an assessment of how trafficking impacts their populations. We derive estimates from seizure data of primates in Mexico between 2010 and 2019. To do this, we created wildlife detection rates and mortality rates from the existing literature (scientific articles, journalistic articles, and notes) to estimate the number of primates that die during capture, transport, and sale and the number of trafficked primates that were not detected by Mexican authorities. We estimate that 946 primates were removed from the wild for the pet trade each year (spider monkey Ateles geoffroyi = 854; black howler monkeys Alouatta pigra = 38, mantled howler monkey Alouatta palliata = 54). The annual reduction in population size caused by trafficking was greatest for Ateles geoffroyi (2.2%), followed by Alouatta pigra (1.3%), and Alouatta palliata (0.4%). Our estimates show the percentage of impacts that trafficking has on Mexican primate populations. Nevertheless, trade has the potential to impact declining populations and still must be addressed.

Biomolecule-Based Optical Metamaterials: Design and Applications.

Metamaterials are broadly defined as artificial, electromagnetically homogeneous structures that exhibit unusual physical properties that are not present in nature. They possess extraordinary capabilities to bend electromagnetic waves. Their size, shape and composition can be engineered to modify their characteristics, such as iridescence, color shift, absorbance at different wavelengths, etc., and harness them as biosensors. Metamaterial construction from biological sources such as carbohydrates, proteins and nucleic acids represents a low-cost alternative, rendering high quantities and yields. In addition, the malleability of these biomaterials makes it possible to fabricate an endless number of structured materials such as composited nanoparticles, biofilms, nanofibers, quantum dots, and many others, with very specific, invaluable and tremendously useful optical characteristics. The intrinsic characteristics observed in biomaterials make them suitable for biomedical applications. This review addresses the optical characteristics of metamaterials obtained from the major macromolecules found in nature: carbohydrates, proteins and DNA, highlighting their biosensor field use, and pointing out their physical properties and production paths.

Grand Challenges in global eye health: a global prioritisation process using Delphi method.

BACKGROUND: We undertook a Grand Challenges in Global Eye Health prioritisation exercise to identify the key issues that must be addressed to improve eye health in the context of an ageing population, to eliminate persistent inequities in health-care access, and to mitigate widespread resource limitations. METHODS: Drawing on methods used in previous Grand Challenges studies, we used a multi-step recruitment strategy to assemble a diverse panel of individuals from a range of disciplines relevant to global eye health from all regions globally to participate in a three-round, online, Delphi-like, prioritisation process to nominate and rank challenges in global eye health. Through this process, we developed both global and regional priority lists. FINDINGS: Between Sept 1 and Dec 12, 2019, 470 individuals complete round 1 of the process, of whom 336 completed all three rounds (round 2 between Feb 26 and March 18, 2020, and round 3 between April 2 and April 25, 2020) 156 (46%) of 336 were women, 180 (54%) were men. The proportion of participants who worked in each region ranged from 104 (31%) in sub-Saharan Africa to 21 (6%) in central Europe, eastern Europe, and in central Asia. Of 85 unique challenges identified after round 1, 16 challenges were prioritised at the global level; six focused on detection and treatment of conditions (cataract, refractive error, glaucoma, diabetic retinopathy, services for children and screening for early detection), two focused on addressing shortages in human resource capacity, five on other health service and policy factors (including strengthening policies, integration, health information systems, and budget allocation), and three on improving access to care and promoting equity. INTERPRETATION: This list of Grand Challenges serves as a starting point for immediate action by funders to guide investment in research and innovation in eye health. It challenges researchers, clinicians, and policy makers to build collaborations to address specific challenges. FUNDING: The Queen Elizabeth Diamond Jubilee Trust, Moorfields Eye Charity, National Institute for Health Research Moorfields Biomedical Research Centre, Wellcome Trust, Sightsavers, The Fred Hollows Foundation, The Seva Foundation, British Council for the Prevention of Blindness, and Christian Blind Mission. TRANSLATIONS: For the French, Spanish, Chinese, Portuguese, Arabic and Persian translations of the abstract see Supplementary Materials section.

Eye health indicators for universal health coverage: results of a global expert prioritisation process.

INTRODUCTION: In its recent World Report on Vision, the WHO called for an updated approach to monitor eye health as part of universal health coverage (UHC). This project sought to develop a consensus among eye health experts from all world regions to produce a menu of indicators for countries to monitor eye health within UHC. METHODS: We reviewed the literature to create a long-list of indicators aligned to the conceptual framework for monitoring outlined in WHO's World Report on Vision. We recruited a panel of 72 global eye health experts (40% women) to participate in a two-round, online prioritisation exercise. Two-hundred indicators were presented in Round 1 and participants prioritised each on a 4-point Likert scale. The highest-ranked 95 were presented in Round 2 and were (1) scored against four criteria (feasible, actionable, reliable and internationally comparable) and (2) ranked according to their suitability as a 'core' indicator for collection by all countries. The top 30 indicators ranked by these two parameters were then used as the basis for the steering group to develop a final menu. RESULTS: The menu consists of 22 indicators, including 7 core indicators, that represent important concepts in eye health for 2020 and beyond, and are considered feasible, actionable, reliable and internationally comparable. CONCLUSION: We believe this list can inform the development of new national eye health monitoring frameworks, monitor progress on key challenges to eye health and be considered in broader UHC monitoring indices at national and international levels.

Access to school-based eye health programs: a qualitative case study, Bogotá, Colombia

[ABSTRACT]. Objectives. To identify barriers and enablers to accessing school-based eye health programs in Bogotá, Colombia. Methods. We undertook a qualitative case study that explored how structural factors, and social and cultural norms influence access to school-based eye health programs. We conducted focus groups discussions and interviews with a purposive sample of 37 participants: government stakeholders (n = 4), representatives from nongovernmental organizations (n = 3), and an eye-care practitioner, as well as teachers (n = 7), a school nurse, parents (n = 7), and children (n = 14) from private and public schools. Data were analyzed using a priori themes from the availability, accessibility, acceptability and quality framework. Results. Routine vision screening in schools is not currently provided nor is there a budget to support it. Lack of collaboration between the health and education ministries and the absence of national planning affected the delivery of eye care in schools. Factors related to acceptability of school-based eye health programs included: poor acceptance of training teachers as vision screeners; stigma related to wearing spectacles; and distrust of health services. The cost of spectacles and poor access to eye health information were identified as barriers to positive child eye health outcomes by socioeconomically disadvantaged parents and children. Conclusion. Our findings suggest the need for a national school eye health plan and improved cooperation between health and education ministries. Interventions to improve trust in health services, tackle the lack of human resources while respecting professional qualifications, and raise awareness of the importance of eye health are recommended.

[RESUMEN]. Objetivo. Determinar los obstáculos y los elementos facilitadores para acceder a los programas de salud ocular en las escuelas en Bogotá (Colombia). Métodos. Se llevó a cabo un estudio cualitativo de casos que exploró cómo influyen los factores estructurales y las normas sociales y culturales en el acceso a la atención oftalmológica. Se realizaron entrevistas y grupos de opinión con una muestra intencionada de 37 participantes: interesados directos gubernamentales (n = 4), representantes de organizaciones no gubernamentales (n = 3) y un profesional de atención oftalmológica, así como docentes (n = 7), una enfermera escolar, padres (n = 7) y niños (n = 14) de escuelas privadas y públicas. Se analizaron los datos empleando temas determinados a priori sobre la disponibilidad, la accesibilidad, la aceptabilidad y el marco de calidad. Resultados. Actualmente, no se proporciona un tamizaje sistemático de la visión en las escuelas, ni se dispone de presupuesto para respaldarlo. La falta de colaboración entre los ministerios de salud y de educación, y la falta de planificación a nivel nacional tuvo repercusiones sobre la prestación de atención oftalmológica en las escuelas. Entre los factores relacionados con la aceptabilidad de los programas de salud ocular en las escuelas se encuentran una escasa aceptación de la posibilidad de capacitar a los docentes para que examinen la visión; el estigma relacionado con el uso de anteojos y la desconfianza de los servicios de salud. Los padres y los niños en una situación socioeconómica desfavorable indicaron que el costo de las gafas y el acceso limitado a la información sobre la salud ocular eran obstáculos para obtener resultados positivos de salud ocular en los niños. Conclusiones. Los resultados indican la necesidad de un plan nacional de salud ocular en las escuelas y una mejor cooperación entre los ministerios de salud y de educación. Se recomiendan intervenciones para mejorar la confianza en los servicios de salud, abordar la falta de recursos humanos al tiempo que se respetan las cualificaciones profesionales y concientizar sobre la importancia de la salud ocular.

[RESUMO]. Objetivos. Identificar barreiras e facilitadores para o acesso a programas escolares de saúde ocular em Bogotá, Colômbia. Métodos. Estudo de caso qualitativo que explorou como fatores estruturais e normas socioculturais influenciam o acesso aos cuidados com a visão. Realizamos discussões em grupos focais e entrevistas com uma amostra intencional de 37 participantes: partes interessadas do governo (n = 4), representantes de organizações não governamentais (n = 3) e um oftalmologista, bem como professores (n = 7), uma enfermeira escolar, pais de alunos (n = 7) e alunos (n = 14) de escolas públicas e particulares. Os dados foram analisados de acordo com temas escolhidos a priori, a partir do marco de disponibilidade, acessibilidade, aceitabilidade e qualidade. Resultados. O exame de visão de rotina não é realizado atualmente nas escolas, nem há espaço orçamentário para fazê-lo. A falta de colaboração entre os Ministérios da Saúde e da Educação e a ausência de planejamento em escala nacional afetaram a prestação de cuidados oftalmológicos nas escolas. Fatores relacionados à aceitabilidade dos programas escolares de saúde ocular incluíram baixa aceitação do treinamento de professores para realizar triagem de problemas visuais, estigma relacionado ao uso de óculos e desconfiança nos serviços de saúde. O custo dos óculos e o acesso limitado a informações sobre saúde ocular foram identificados como barreiras para desfechos positivos de saúde ocular infantil em pais e crianças em situação de desvantagem socioeconômica. Conclusão. Os resultados sugerem a necessidade de um plano nacional de saúde ocular nas escolas e de uma melhor cooperação entre os Ministérios da Saúde e da Educação. Recomendam-se intervenções para aumentar a confiança nos serviços de saúde, combater a falta de recursos humanos (respeitando as qualificações profissionais) e aumentar a conscientização sobre a importância da saúde ocular.

The Primate Cultural Significance Index: applications with Popoluca Indigenous people at Los Tuxtlas Biosphere Reserve.

BACKGROUND: The study of the cultural significance (CS) of biodiversity provides key information to develop conservation strategies consistent with traditions and perceptions of human communities. In Los Tuxtlas Biosphere Reserve (TBR) in Mexico, the mantled howler monkeys (Alouatta palliata mexicana) and the black-handed spider monkeys (Ateles geoffroyi vellerosus) have historically coexisted with Popoluca Indigenous Peoples. This study sought to determine how the presence of a natural protected area (TBR location) and a range of sociodemographic factors (gender, age, origin, language proficiency, education level, religion) relate to the CS held by the Popoluca Indigenous People in relation to these two endangered primate species. METHODS: The first Primate Cultural Significance Index (PCSI) was designed as a composed index of 11 cultural variables (sub-indices) and was applied randomly to a representative size sample of people over 15 years old in two Popolucas communities, one within the TBR (Piedra Labrada = 81 people) and another outside (Los Mangos = 91). U Mann-Whitney tests were used to compare the PCSI between communities and Generalized Linear Models (GLM) to evaluate the sociodemographic factors of participants that influenced the sub-indices in the PCSI. RESULTS: The cultural significance of spider monkeys held by the Popolucas was higher for the community within the TBR than for the community outside, while for howler monkeys it was higher outside. For both primate species across the two communities, the most relevant sub-indices were (1) interest in conservation and (2) touristic significance of primates. Sociodemographic factors of participants influenced nine sub-indices of cultural significance out of the possible 10 sub-indices applied for each primate species. The demographic factors that most influenced each sub-index for both species were location and gender. CONCLUSIONS: The main differences found between communities may be linked to the conservation and sustainable development programs promoted by the reserve, as well as the greater persistence of Popolucan ancestral traditions within the boundaries of the reserve. We recommend that conservation efforts should focus on people less interested about primate conservation (women, non-natives and residents outside the reserve), and turn to the leadership of people more interested (native men who reside inside the reserve).

Keeping an eye on eye care: monitoring progress towards effective coverage.

The eye care sector is well positioned to contribute to the advancement of universal health coverage within countries. Given the large unmet need for care associated with cataract and refractive error, coupled with the fact that highly cost-effective interventions exist, we propose that effective cataract surgery coverage (eCSC) and effective refractive error coverage (eREC) serve as ideal indicators to track progress in the uptake and quality of eye care services at the global level, and to monitor progress towards universal health coverage in general. Global targets for 2030 for these two indicators were endorsed by WHO Member States at the 74th World Health Assembly in May, 2021. To develop consensus on the data requirements and methods of calculating eCSC and eREC, WHO convened a series of expert consultations to make recommendations for standardising the definitions and measurement approaches for eCSC and eREC and to identify areas in which future work is required.

Cataract as a Cause of Blindness and Vision Impairment in Latin America: Progress Made and Challenges Beyond 2020.

PURPOSE: To provide an update of cataract as a cause of vision loss in Latin America and to analyze sex inequalities in cataract surgical coverage (CSC) and effective CSC (eCSC) in the region. DESIGN: Population-based systematic review with longitudinal comparisons. METHODS: The Latin American and Caribbean Health Sciences Literature (LILACS) and PubMed databased were searched for population-based studies reporting cataract blindness, surgical coverage, and outcomes published between January 2014 and December 2019. Information on the number of surgeries performed from the 2014-2016 period was obtained from ministries of health and was used for calculation of the cataract surgical rate (CSR). Sources such as Rapid Assessment of Avoidable Blindness (RAAB) and Rapid Assessment of Cataract Surgical Services data were reanalyzed to calculate sex inequality in CSC and eCSC by subtracting the rate in women from the rate in men. RESULTS: Cataract was the cause of 29.8%-77.6% of cases of blindness in the included studies; the CSR improved in 10 countries. The CSC pinhole visual acuity of 3/60 varied from 24.1% in Peru to 97.1% in Argentina, and the median absolute gender inequality CSC pinhole visual acuity 3/60 was -0.7%. The eCSC pinhole visual acuity 3/60 varied from 14.8% in Guatemala to 92.1% in Argentina, and the median absolute gender inequality eCSC pinhole visual acuity 3/60 was -0.8%. CONCLUSIONS: Cataract remains a leading cause of blindness in Latin America. Coverage is suboptimal, and surgical results are also below target levels in many countries. Incentives for a better distribution of human resources, adequate training of ophthalmologists, and the inclusion of vision services in universal health care coverage could reduce the burden of cataract in Latin America.

Trauma abdominal contuso por golpe con manubrio de bicicleta: evaluación y tratamiento / Blunt abdominal trauma due to handlebar injury

INTRODUCCIÓN: Los accidentes en bicicleta son una causa frecuente de trauma abdominal contuso en pediatría. En Chile no existen publicaciones científicas que traten sobre las lesiones abdominales por manubrio de bicicleta, su presentación y manejo. OBJETIVO: Describir tres casos clínicos de trauma abdominal contuso provocados por manubrio de bicicleta en niños, ilustrar las distintas lesiones observadas, sus formas de presentación y manejo. CASOS CLÍNICOS: 1) Paciente masculino, 11 años, consulta tras golpe con manubrio de bicicleta en epigastrio; en la Tomografía Computada (TC) de abdomen y pelvis se describió neumoretroperitoneo. Se realizó laparotomía exploradora, reparándose una perforación duodenal. 2) Paciente masculino, 14 años, consulta tras golpe en el hipocondrio izquierdo con el manubrio de la bicicleta; en la TC se evidenció fractura esplénica con múltiples laceraciones. Por la presencia de sangrado activo se trató con angioembolización, lográndose resolución de la lesión y viabilidad del órgano luego de 6 semanas de seguimiento. 3) Paciente masculino, 9 años, ingresó tras sufrir golpe con manubrio de bicicleta en el hipocondrio derecho. En TC se observó una laceración hepática, que fue manejada de forma expectante, con resolución de la lesión luego de 8 semanas de seguimiento. Todos los pacientes tuvieron una evolución favorable. CONCLUSIÓN: El trauma abdominal contuso por golpe con manubrio de bicicleta puede ser potencialmente grave en pacientes pediátricos, pudiendo afectar órganos sólidos y vísceras huecas. El manejo no quirúrgico cada vez es más utilizado, logrando altas tasas de éxito en pacientes estables. Los pacientes inestables o en los que se sospeche perforación de víscera hueca, requerirán cirugía como primera aproximación.

INTRODUCTION: Bicycle accidents are a frequent cause of blunt abdominal trauma in children. In Chile, there are no scientific articles about such accidents, their presentation and management. OBJECTIVE: The aim of this study is to describe three cases of blunt abdominal trauma due to handlebar injury in children, in order to illustrate the different kinds of lesions, their presentation, and management. CLINICAL CASES: 1) 11-year-old boy presented to Emergency Department (ED) after falling on a bi cycle handlebar, hitting his epigastric region. A CT scan showed signs of duodenal perforation. A la parotomy was performed and the duodenal perforation repaired. 2) 14-year-old boy seen at ED after a bicycle accident in which the handlebar hit him in the abdomen area. A CT scan showed a splenic injury with multiple lacerations and active bleeding that was treated with angioembolization. After 6 weeks of follow-up, he presented resolution of the lesion and viability of the spleen. 3) 9-year-old boy admitted due to a hit with the bicycle handlebar on the abdomen area. A CT scan showed a he patic injury that was managed with non-surgical procedures, achieving resolution of the lesion after 8 weeks of follow-up. CONCLUSION: Blunt abdominal trauma caused by handlebar can be potentially serious in pediatric patients, since it may affect solid and hollow abdominal viscera. Non-surgical ma nagement is becoming more used for stable patients, achieving high success rates. Unstable patients or those with suspicion of hollow viscera perforation will require surgery as first approach.

Salivary proteome of a Neotropical primate: potential roles in host defense and oral food perception.

BACKGROUND: Saliva contains a very complex mixture of proteins for defense against microbiological pathogens and for oral food perception. Howler monkeys are Neotropical primates that can consume a mostly leaf diet. They are well known to thrive in highly disturbed habitats where they may cope with a diversity of dietary challenges and infection risks. We aimed to describe the salivary proteome of howlers to contribute to better understanding of their physiology. METHODS: We analyzed the salivary proteins of wild black howler monkeys (Alouatta pigra), by SDS-PAGE-1-D and Nano LC-MS/MS and categorized them by their function involved in host defense and oral food perception. RESULTS: Our proteomic analysis identified 156 proteins in howler saliva including a number of host defense peptides that are the first line of defense in mammals, such as defensin, cathelicidin, dermcidin, and lactotransferrin, and proteins with anti-bacterial, anti-fungal, and anti-viral capacity, such as IgA, IgG, IgM, BPI, salivary heat shock 70 kDa protein, beta-2-microbulin, and protein S-100. We also identified key proteins necessary for taste perception, including salivary carbonic anhydrase VI, cystatin D, IgA, and fatty acid-binding protein. Proteins to detect astringent foods were identifying, including four members of cystatins (A, B, C and D), lactoperoxidase, and histidine-rich proteins. No chitinase and amylase were identified as would be expected because howlers do not eat insects and little starch. These findings provide basic information to future studies in oral biology, ingestive physiology, and physiological ecology of mammals and non-human primates.

Are we advancing universal health coverage through cataract services? Protocol for a scoping review.

INTRODUCTION: Universal health coverage (UHC) includes the dimensions of equity in access, quality services that improve health and protection against financial hardship. Cataract continues to be the leading cause of blindness globally, despite cataract surgery being an efficacious intervention. The aim of this scoping review is to map the nature, extent and global distribution of data on cataract services for UHC in terms of equity, access, quality and financial protection. METHODS AND ANALYSIS: The search will be constructed by an Information Specialist and undertaken in MEDLINE, Embase and Global Health databases. We will include all published non-interventional primary research studies and systematic reviews that report a quantitative assessment of access, equity, quality or financial protection of cataract surgical services for adults at the subnational, national, regional or global level from population-based surveys or routinely collected health service data since 1 January 2000 and published through to February 2020.Screening and data charting will be undertaken using Covidence systematic review software. Titles and abstracts of identified studies will be screened by two authors independently. Full-text articles of potentially relevant studies will be obtained and reviewed independently by two authors against the inclusion criteria. Any discrepancies between the authors will be resolved by discussion, and with a third author as necessary. A data charting form will be developed and piloted on three studies by three authors and amendments made as necessary. Data will be extracted by two reviewers independently and summarised narratively and using maps. ETHICS AND DISSEMINATION: Ethical approval was not sought as the scoping review will only use published and publicly accessible data. The review will be published in an open access peer-reviewed journal. A summary of the results will be developed for website posting, stakeholder meetings and inclusion in the ongoing Lancet Global Health Commission on Global Eye Health.

Primates Can Be a Rallying Symbol to Promote Tropical Forest Restoration.

With 60% of all primate species now threatened with extinction and many species only persisting in small populations in forest fragments, conservation action is urgently needed. But what type of action? Here we argue that restoration of primate habitat will be an essential component of strategies aimed at conserving primates and preventing the extinctions that may occur before the end of the century and propose that primates can act as flagship species for restoration efforts. To do this we gathered a team of academics from around the world with experience in restoration so that we could provide examples of why primate restoration ecology is needed, outline how primates can act as flagship species for restoration efforts of tropical forest, review what little is known about how primate populations respond to restoration efforts, and make specific recommendations of the next steps needed to make restoration of primate populations successful. We set four priorities: (1) academics must effectively communicate both the value of primates and the need for restoration; (2) more research is needed on how primates contribute to forest restoration; (3) more effort must be put into Masters and PhD level training for tropical country nationals; and finally (4) more emphasis is needed to monitor the responses of regenerating forest and primate populations where restoration efforts are initiated. We are optimistic that populations of many threatened species can recover, and extinctions can be prevented, but only if concerted large-scale efforts are made soon and if these efforts include primate habitat restoration.

Evidence-based conservation education in Mexican communities: Connecting arts and science.

Several studies suggest that 63% of primate species are currently threatened due to deforestation, pet-trade, and bushmeat hunting. Successful primate conservation strategies require effective educational programs capable of enhancing critical system-thinking and responsible behavior towards these species. Arts-based conservation education can simultaneously foster cognitive and emotional processes. In this paper, we evaluate an arts-based educational program focused on the conservation of black howler monkeys (Alouatta pigra). Our goals were to determine (1) whether children's knowledge changed with our educational techniques, (2) if there was a particular educational technique that better improved the children's learning, and (3) the children's emotional feedback regarding the whole program. A total of 229 children from communities located in primate-habitat areas, both inside and outside protected areas, participated in the study. Different educational techniques were tested (storytelling, theater and shadow puppets), contrasted with a control group, and evaluated through an analysis of drawings. Our results showed that children's knowledge increase with each art-based technique, with storytelling being the most effective for children's learning. Specific drawings indicators also revealed the increase of children's knowledge and a decrease of misconceptions between pre and post evaluations. Finally, a satisfaction survey about the program showed a high positive feedback. The study highlights the value of designing multidisciplinary projects, where arts-based education program (grounded in scientific information) has shown to be a successful way to communicate animal knowledge and promote conservation.

Exploitation of reaction mechanisms for sensitivity enhancement in the determination of phosphorus by sequential injection analysis.

The molybdenum blue method using antimony and ascorbic acid was studied for the determination of phosphorus (as orthophosphate) by means of sequential injection analysis (SIA). In order to avoid the interference of the Schlieren effect in the photometric measurements a stopped-flow kinetic approach was adopted monitoring the absorbance of the reaction bolus inside the flow cell. Aiming at enhancing the sensitivity of the method, the effect of the order of addition of the reactants was studied. It was found that the best sensitivity was attained by adding separate reagents and acidifying only after the phosphate, molybdate and antimony solutions were already mixed; the reductant (ascorbic acid) was then added. In this way a sensitivity enhancement in excess of 10 times was obtained when compared to the addition of the phosphate solution to the acidified mixture of molybdate and antimony. It is proposed that the difference in sensitivities could be explained by the existence of different mechanisms for the formation of the intermediate phosphoantimonyl molybdic acid (PMA). Thus the selected sequence in the order of addition, where sulphuric acid is added to the mixture of the other reactants would lead to higher production of PMA in turn conducting to a faster reduction reaction. The resulting SIA method was validated finding limits of detection (3s/m) and quantification (10s/m) of 0.0077 and 0.026 mg-P L-1 respectively. Linearity was confirmed in the range up to 2 mg-P L-1. Precisions (sr, n = 10) were in the range 1.8%-4.0%. 32 water samples of different types and origins were analysed by the proposed method and by ion chromatography, obtaining a regression curve y = 0.990× - 0.0019, with a determination coefficient R2 = 0.973.