Monitoring Changes in the Volatile Profile of Ecuadorian Cocoa during Different Steps in Traditional On-Farm Processing.

The present work was conducted to evaluate the volatile profile of Ecuadorian Forastero, CCN-51, ETT103 and LR14 cocoa beans during traditional fermentation in laurel wood boxes followed by a sun-drying process. Fifty-six volatiles were identified with HS-SPME-GC-MS. Aldehydes, alcohols and ketones were the compounds that mainly characterized the fresh cocoa. The main compounds formed during the anaerobic fermentation step were esters and acids, while in the aerobic fermentation step, an increase in ester-, aldehyde- and acid-type compounds was observed. Finally, after the drying step, a notable increase in the acid (i.e., acetic acid) content was the predominant trend. According to the genotypes, ETT103 presented high contents of terpenes, alcohols, aldehydes and ketones and low contents of unfavorable acid compounds. The CCN-51 and LR14 (Trinitarian) varieties stood out for their highest amounts in acids (i.e., acetic acid) at the end of primary processing. Finally, the Forastero cocoa beans were highlighted for their low acid and high trimethylpyrazine contents. According to the chemometric and Venn diagram analyses, ETT-103 was an interestingly high-aromatic-quality variety for cocoa gourmet preparations. The results also showed the need for good control of the processing steps (using prefermentative treatments, starter cultures, etc.) on Ecuadorian genotypes of Trinitarian origin.

Effects of Different Heating Treatments on the Antioxidant Activity and Phenolic Compounds of Ecuadorian Red Dacca Banana.

The banana is a tropical fruit characterized by its composition of healthy and nutritional compounds. This fruit is part of traditional Ecuadorian gastronomy, being consumed in a wide variety of ways. In this context, unripe Red Dacca banana samples and those submitted to different traditional Ecuadorian heating treatments (boiling, roasting, and baking) were evaluated to profile their phenolic content by ultra-high-performance liquid chromatography coupled to high-resolution mass spectrometry (UHPLC-HRMS) and the antioxidant activity by ORAC, ABTS, and DPPH assays. A total of sixty-eight phenolic compounds were identified or tentatively identified in raw banana and treated samples, highlighting the content in flavonoids (flavan-3-ols with 88.33% and flavonols with 3.24%) followed by the hydroxybenzoic acid family (5.44%) in raw banana samples. The total phenolic compound content significantly decreased for all the elaborations evaluated, specifically from 442.12 mg/100 g DW in fresh bananas to 338.60 mg/100 g DW in boiled (23.41%), 243.63 mg/100 g DW in roasted (44.90%), and 109.85 mg/100 g DW in baked samples (75.15%). Flavan-3-ols and flavonols were the phenolic groups most affected by the heating treatments, while flavanones and hydroxybenzoic acids showed higher stability against the heating treatments, especially the boiled and roasted samples. In general, the decrease in phenolic compounds corresponded with a decline in antioxidant activity, evaluated by different methods, especially in baked samples. The results obtained from PCA studies confirmed that the impact of heating on the composition of some phenolic compounds was different depending on the technique used. In general, the heating processes applied to the banana samples induced phytochemical modifications. Even so, they remain an important source of bioactive compounds for consumers.

Experiencia de cuatro años con la cinta reajustable para incontinencia urinaria de esfuerzo / 4-year experience with the use of readjustable tape for stress urinary incontinence

Resumen OBJETIVO: Describir la experiencia con el cabestrillo reajustable Remeex® en pacientes con incontinencia urinaria de esfuerzo recurrente, como una alternativa de tratamiento. MATERIALES Y MÉTODOS: Estudio retrospectivo, observacional, de serie de casos llevado a cabo en un solo centro de la ciudad de Medellín, Colombia, en pacientes atendidas en la Unidad de Uroginecología de la Clínica Universitaria Bolivariana. Criterios de inclusión: mujeres mayores de 18 años, con diagnóstico de incontinencia urinaria recidivante después de una o más cirugías fallidas para corregir la incontinencia urinaria o con diagnóstico de deficiencia intrínseca del esfínter a las que se les practicó el procedimiento de cabestrillo reajustable (Remeex Female Neomedic) entre el 2016 y el 2019. RESULTADOS: Se evaluaron 19 pacientes con media de edad de 62 años (DE ± 9). La mediana de seguimiento fue de 19.4 meses (RIQ 10-26.5). Todas las pacientes tenían urodinamia prequirúrgica que confirmó el diagnóstico de incontinencia urinaria de esfuerzo. Las 19 pacientes tuvieron diagnóstico de incontinencia urinaria moderada-severa-recurrente, 4 con hipoactividad del detrusor y 1 con deficiencia intrínseca del esfínter. De las 19 pacientes, a 10 se les intervino para corrección de prolapso de órganos pélvicos concomitante, que se distribuyeron en: 6 pacientes con colporrafia anterior o posterior, 3 colpocleisis y 1 sacrocolpopexia por laparotomía. CONCLUSIONES: El cabestrillo reajustable es una buena opción para mujeres con intervenciones previas antiincontinencia con recidiva en quienes se demostró la mejoría en el grado de incontinencia en relación con el inicial, beneficio que se reflejó en mejor calidad de vida.

Abstract OBJECTIVE: To describe the experience with the readjustable sling Remeex® in patients with recurrent stress urinary incontinence as a treatment alternative. MATERIALS AND METHODS: Retrospective, observational, case series study carried out in a single center in the city of Medellin, Colombia, in patients attended at the Urogynaecology Unit of the Bolivarian University Clinic. Inclusion criteria: women over 18 years of age, with a diagnosis of recurrent urinary incontinence after one or more failed surgeries to correct urinary incontinence or with a diagnosis of intrinsic sphincter deficiency who underwent the readjustable sling procedure (Remeex Female Neomedic) between 2016 and 2019. RESULTS: Nineteen patients were evaluated with mean age 62 years (SD ± 9). The median follow-up was 19.4 months (RIQ 10-26.5). All patients had preoperative urodynamics that confirmed the diagnosis of stress urinary incontinence. All 19 patients had a diagnosis of moderate-severe-recurrent urinary incontinence, 4 with detrusor hypoactivity and 1 with intrinsic sphincter deficiency. Of the 19 patients, 10 underwent surgery for correction of concomitant pelvic organ prolapse, which were distributed as follows: 6 patients with anterior or posterior colporrhaphy, 3 colpocleisis and 1 sacrocolpopexy by laparotomy. CONCLUSIONS: The readjustable sling is a good option for women with previous anti-incontinence interventions with recurrence in whom improvement in the degree of incontinence in relation to the initial one was demonstrated, a benefit that was reflected in better quality of life.

Giant Cell Lesions of the Jaws Involving RASopathy Syndromes.

Objective: Giant cell lesions of the jaws (GCLJ) may rarely occur in the setting of RASopathy syndromes such as Noonan syndrome or neurofibromatosis I. Recently, central giant cell granulomas (CGCG), the most common of the GCLJ, have been recognized as benign neoplasms characterized by Ras/MAPK signaling pathway mutations. This provides a rational basis for understanding GCLJ in RASopathy syndromes as syndromically occurring CGCG. This review aims to summarize the clinicopathologic features of syndromic CGCG and to review the salient clinical and craniofacial features of the syndromes in which they may rarely occur. Material and Methods: An electronic search in 3 databases was performed, looking for GCLJ/CGCG in RASopathy syndromes. Results: 124 CGCG in 56 patients were identified across 6 RASopathy syndromes. Median age at syndromic CGCG diagnosis is 11 years; 69.6% (39/56) patients developed two or more CGCG; 58.9% (33/56) presented with bilateral posterior mandibular CGCGs, mimicking cherubism. Of 88 CGCG with follow-up, 22.4% (13/58) of excised/resected CGCG recurred while 46.7% (14/30) of monitored CGCG showed continued growth. Conclusion: Syndromic CGCG involves multiple RASopathy syndromes and may mimic cherubism or, when solitary, sporadically occurring CGCG. Familiarity with other clinical findings of RASopathy syndromes is critical for appropriate diagnosis and patient management.

Effectiveness of an intervention to reduce stigma towards people with a severe mental disorder diagnosis in primary health care personnel: Programme Igual-Mente.

This study assessed the effectiveness of a program (called Igual-Mente, Equal-Mind) designed to reduce stigma in primary health care personnel. A random clinical trial was performed (ISRCTN46464036). There were 316 primary care professionals and technicians who were randomized and assigned to the experimental or control group. The program considered as strategies the education, the contact and the development of skills. There were six sessions with the primary care staff and two sessions with the managers of the health centers. It was executed by two facilitators, a professional psychologist and an expert by experience, i.e., a person diagnosed with a severe mental disorder (SMD). Attitudes, social distance, and humane treatment behaviors toward people with SMD were assessed. The intervention was effective in reducing stigma attitudes y social distance towards people diagnosed with SMD. The magnitude of the changes ranged from moderate to high in all these variables and the effects were maintained for four months after the end of the program. Regarding humane treatment behaviors, the effects were less clear. This study shows good results indicating that well-designed interventions can effectively reduce stigma towards people diagnosed with SMD, which is one of the main challenges of health systems.

Potential areas for the establishment of citrus leprosis virus vectors, Brevipalpus spp., in Mexico.

Citrus leprosis is a viral disease vectored by the mites Brevipalpus californicus and Brevipalpus yothersi. This work aimed to determine the potential areas for establishment of both mites and viruses in Mexico, based on the geographical distribution of the hosts and the climatic suitability for the vectors. Life tables of both mites were constructed to determine their thermal requirements-base temperature and degree-days required to complete life cycle-and population growth parameters-net reproduction rate, generation time, and intrinsic growth rate. For this, the mites were confined in Citrus aurantium fruits at 20, 22.5, 25 or 30 °C, 60 ± 5% RH and L14:D10 h photoperiod. Maps were generated where the climatic suitability for establishment of the mites and the citrus leprosis viruses was estimated in citrus-producing municipalities. The climatic suitability was determined through historical temperature records to calculate the potential number of generations per year, and ecological niche modeling based on collecting localities and bioclimatic variables using the algorithm Maxent. The base temperature was 9.5 °C for B. californicus and 10.2 °C for B. yothersi; degree-days required to reach adulthood were 372.1 and 331.7 °C, respectively. Potential sites for establishment of B. yothersi are mostly lowlands, whereas for B. californicus they are both lowlands and highlands. Temperature data indicate that B. californicus has fewer sites where it can develop > 16 generations per year than B. yothersi. According to our results, the sites where citrus leprosis is most likely to present high incidence are the sweet orange cultivars bordering the Gulf of Mexico.

Beauty centers: an overview of their biosafety conditions in Valledupar, Colombia.

INTRODUCTION: The risk of transmission of microorganisms in aesthetic and beauty centers is high when mitigation measures are not adopted; thus, it is necessary to constantly review the conditions of these centers, in order to prevent diseases and make the corresponding decisions. OBJECTIVES: To assess biosafety conditions of beauty centers in Valledupar, Colombia. METHODS: This study followed a descriptive methodology and was based on the administration of a survey focused on determining which services are provided in beauty centers, on which activities are developed by their staff, and the conditions under which services are provided. RESULTS: Study results that 93% of centers are legally constituted; furthermore, the most commonly provided service was hairdressing, with 21%. Only 9% of workers were covered by a social insurance system. In terms of social insurances, centers did not comply with minimum requirements. CONCLUSIONS: The aesthetic centers in Valledupar are not complying with requirements from biosafety protocols set forth by legislation and are thus adopting inadequate procedures.

Analysis of the implementation of occupational safety and health standards at manufacturing companies in the city of Valledupar.

Introduction: Occupational safety and health is a process that requires the adoption of measures that guarantee the physical, social and mental wellness of a person, under normative parameters that must be met, supervised, and controlled. Objectives: To diagnose occupational safety and health conditions at manufacturing companies in the city of Valledupar, Colombia. Methods: The study focused on the development of a diagnosis on occupational health and safety conditions at manufacturing companies, based on the application of two instruments which focused mainly on identifying socioeconomic conditions of workers and determining the compliance status of the minimum occupational health and safety standards. Results: According to the determined socioeconomic conditions of the workers participating in the study, it was found that, on average, the companies are complying with only 23% of all the requirements established in the resolution 0312 of 2019. Conclusions: Seventy percent of workers affirm that their companies are not taking any action to implement safety and health procedures at work.

Enfermedad indiferenciada del tejido conectivo con progresión a esclerosis sistémica / Undifferentiated disease of the connective tissue with progression to systemic sclerosis

La enfermedad indiferenciada del tejido conectivo es una condición de etiología desconocida que comparte características clínicas, patológicas y de laboratorio de varias colagenosis, sin cumplir los criterios del Colegio Americano de Reumatología para el diagnóstico de una enfermedad reumática específica y muchos pacientes evolucionan a condiciones definidas a lo largo del tiempo tales como Lupus, Esclerosis sistémica progresiva, Enfermedad de Sjögren entre otros. Antecedentes: Linfoma Hodgkin diagnosticado desde 2012 para lo cual recibió múltiples esquemas de quimioterapia. Las muestras de ganglio y médula ósea se habían enviado al laboratorio de Inmunopatologia de la Universidad de Stanford y allí no se apreciaron hallazgos compatibles con enfermedad linfoproliferativa. Enfermedad actual: Mujer de 27 años de edad con cuadro clínico de 1 mes de evolución, caracterizado por edema blando en miembros inferiores acompañado de edema palpebral matutino; concomitantemente presenta aumento de temperatura intermitente sin patrón especifico y dolor osteomuscular generalizado con limitación para la deambulación. Se ingresa. Al examen físico, regulares condiciones clínicas. En la piel se aprecia engrosamiento cutáneo importante. Se realizó biopsia cutánea y los hallazgos fueron compatibles con Esclerosis Sistémica(AU)

Undifferentiated connective tissue disease is a condition of unknown etiology that shares clinical, pathological and laboratory characteristics of several collagenopathies that do not meet the criteria of the American College of Rheumatology for the diagnosis of a specific disease; a large number of patients evolve to conditions defined over time such as Lupus, Systemic Sclerosis, Sjogren's Disease, among others. Past history: Hodgkin lymphoma was diagnosed since 2012 for which she received multiple chemotherapy schemes. A gland biopsy was sent to the Stanford University, as well as a bone marrow sample, and lymphoma was discarded. Present history: this 27-year-old female consulted for edema in lower limbs present during one month, accompanied by eyelid edema in the mornings; also fever without a specific pattern, myalgias and arthralgias. On physical examination, the skin was thickened and limb edema was present. A skin biopsy was performed, and the findings were consistent with Systemic Sclerosis. The patient is receiving cyclophosphamide and Azathioprine and leading her normal life(AU)

An Integrative Program to Reduce Stigma in Primary Healthcare Workers Toward People With Diagnosis of Severe Mental Disorders: A Protocol for a Randomized Controlled Trial.

Background: People with severe mental disorders (SMDs) have higher disease and death rates than the general population. Stigma (negative attitudes and perceptions) contributes to limited access to health services and a lower quality of medical assistance in this population, and it is manifested as negative attitudes, social distance, and discrimination toward this social group. For these reasons, healthcare workers are a priority group for anti-stigma interventions. This study aims to assess the effectiveness of a program specifically designed to decrease negative attitudes and social distance and increase inclusive behaviors in healthcare workers toward people with SMD. Methods: The study will be a randomized clinical trial. A minimum of 210 healthcare workers from 11 primary care centers in the province of Concepción, Chile, will be randomly chosen to receive the program or be part of the control group. There will be a pre-, post-, and 4-months evaluation of social distance, attitudes, and behaviors of participants toward people with SMD using standardized scales such as the social distance scale, which is a scale of clinician attitude toward mental illness adapted from attitudes of clinicians toward mental illness, and self-reports. The intervention program will consist of education strategies, direct, and indirect contact with people diagnosed with SMD, and skill development. There will be six face-to-face sessions directly with the participants and two additional sessions with the directors of each healthcare center. The program will involve a facilitator who will be a healthcare professional and a co-facilitator who will be a person diagnosed with SMD. Discussion: This study will evaluate an intervention program especially designed to reduce stigma in healthcare workers toward people with SMD, a topic on which there is little background information, particularly in low- and middle-income countries. It is important to have interventions with proven effectiveness for this purpose to ensure equity in healthcare services. Trial Registration: This study was registered under ISRCTN.com (ISRCTN46464036).

Tabaquismo, Glutation S-Transferasa, N-Acetiltransferasa 2 y riesgo de cáncer de vejiga / Tabaquism, S-Transferase Glutation, N-Acetiltrasferase 2 and bladder cancer risk

El hábito tabáquico es el factor de riesgo más conocido para cáncer de vejiga. Ciertas arilaminas presentes en el cigarrillo han sido identificadas como carcinógenos para la vejiga en humanos. El objetivo de nuestro estudio es establecer el riesgo de padecer de cáncer de vejiga en individuos fumadores, acetiladores lentos para NAT2 y genotipos nulos de GSTM1 y GSTT1. Materiales y métodos: Se reunieron en total 150 pacientes, 75 pertenecientes al grupo de carcinoma urotelial de vejiga y 75 del grupo control, en este último no se incluyeron pacientes con enfermedad neoplásica de ninguna índole. El ADN se aisló de la muestra de sangre a partir de linfocitos utilizando un kit disponible comercialmente (QIAmp DNA Blood Mini and Maxi Kit, QIAGen GMBH). Mediante el uso de técnicas de reacción en cadena de polimerasa y de restricción/ fragmentación se determinaron los polimorfismos de las enzimas: NAT2, GSTT1 y GSTM1.Resultados: Se incluyeron un total de 150 pacientes, de los cuales 75 pertenecían al grupo controly 75 al grupo de cáncer de vejiga, la media de edad del grupo de cáncer de vejiga fue 60,5 +/-11,4 y del grupo control fue 51,3 +/- 11,4. En cuanto al género en grupo de cáncer de vejiga 64 por ciento pertenecían al sexo masculino. En el grupo control 41 por ciento pertenecían al sexo masculino. Al estudiar el hábito tabáquico se halló que 51 por ciento de los pacientes del grupo de cáncer de vejiga continuaban siendo fumadores, mientras que sólo 21 por ciento fumaba en el grupo control. En el análisis de los genotipos de la enzima NAT2 en el grupo de los pacientes con cáncer de vejiga 52 por ciento resultaron acetiladores lentos, y 4 por ciento acetiladores rápidos. En el grupo control 45 por ciento de los pacientes eran acetiladores lentos y 12 por ciento acetiladores rápidos. En cuanto a la determinación de GSTT1 19 por ciento de los pacientes del grupo de cáncer de vejiga y 24 por ciento del grupo control exhibieron el genotipo nulo...

Introduction: Smoking is the most studied risk factor for bladder cancer. Certain arilamines present in cigarettes have been identified as carcinogenic for the bladder in humans. The purpose of this study is to establish the risk of bladder cancer in smokers, slow acetilators for NAT2 and none active genotypes for GSTM1 and GSTT1. Material and methods: 150 patients were studied, 75 in the group of urothelial carcinoma of the bladder and 75 in the control group. The DNA was isolated from lymphocytes of blood samples using commercially available kit (QIAmp DNA Blood Mini and Maxi Kit, QIAG en GMBH). Enzyme polymorphisms of NAT2, GSTT1 and GSTM1 were determined using techniques of polymerase chain reaction and restriction/fragmentation. Results: 150 patients were included, of who 75 belonged to the control group and 75 had bladder cancer, the average of age of the bladder cancer group was 60.5 +/- 11.4 and of the control group 51.3 +/- 11.4. Regarding gender, in the bladder cancer group 64 percent were males. In the control group 41percent were males. 51 percent of the patients in the bladder cancer group continued being smokers, whereas only 21 percent smoked in control group. In NAT2 enzyme genotype analysis the bladder cancer group 52 percent were slow acetilators, and 4 percent fast acetilators. In the control group 45 percent were slow acetilators and 12 percent fast acetilators. Regarding GSTT1 determination, 19 percent of the bladder cancer group and 24 percent of the control group showed the non-active genotype. GSTM1 showed its non-active form in 44 percent of the bladder cancer group and 48 percent of the control group. Discussion: Bladder cancer is clearly related with smoking habit. We observed a very significant relationship when evaluating smoking habit, slow acetilators for NAT2, and none-active genotypes of GSTM1 and bladder cancer...

Mid-term coral-algal dynamics and conservation status of a Gorgona Island (Tropical Eastern Pacific) coral reef.

Colombian coral reefs, as other reefs worldwide, have deteriorated significantly during the last few decades due to both natural and anthropogenic disturbances. The National Monitoring System for Coral Reefs in Colombia (SIMAC) was established in 1998 to provide long-term data bases to assess the changes of Colombian coral reefs against perturbations and to identify the factors responsible for their decline or recovery. On the Pacific coast, data on coral and algal cover have been collected yearly during seven consecutive years (1998-2004) from 20 permanent transects in two sites at La Azufrada reef, Gorgona Island. Overall, coral cover was high (55.1%-65.7%) and algal cover low (28.8%-37.5%) and both exhibited significant changes among years, most notably on shallow areas. Differences between sites in both coral and algal cover were present since the study began and may be explained by differences in sedimentation stress derived from soil runoff. Differences between depths most likely stem from the effects of low tidal sub-aerial exposures. Particularly intense sub-aerial exposures occurred repeatedly during January-March, 2001 and accounted for a decrease in coral and an increase in algal cover on shallow depths observed later that year. Additionally, the shallow area on the Northern site seems to be negatively affected by the combined effect of sedimentation and low tidal exposure. However, a decrease in coral cover and an increase of algal cover since 2001 on deep areas at both sites remain unexplained. Comparisons with previous studies suggest that the reef at La Azufrada has been more resilient than other reefs in the Tropical Eastern Pacific (TEP), recovering pre-disturbance (1979) levels of coral cover within a 10 year period after the 1982-83 El Niño, which caused 85% mortality. Furthermore, the effects of the 1997-98 El Niño, indicated by the difference in overall live coral cover between 1998 and 1999, were minor (< 6% reduction). Despite recurrent natural disturbances, live coral cover in 2004 was as high as that existing before 1982 at La Azufrada, and one of the highest observed on healthy coral reefs in the TEP region.

Mid-term coral-algal dynamics and conservation status of a Gorgona Island (Tropical Eastern Pacific) coral reef

Colombian coral reefs, as other reefs worldwide, have deteriorated significantly during the last few decades due to both natural and anthropogenic disturbances. The National Monitoring System for Coral Reefs in Colombia (SIMAC) was established in 1998 to provide long-term data bases to assess the changes of Colombian coral reefs against perturbations and to identify the factors responsible for their decline or recovery. On the Pacific coast, data on coral and algal cover have been collected yearly during seven consecutive years (1998-2004) from 20 permanent transects in two sites at La Azufrada reef, Gorgona Island. Overall, coral cover was high (55.1%-65.7%) and algal cover low (28.8%-37.5%) and both exhibited significant changes among years, most notably on shallow areas. Differences between sites in both coral and algal cover were present since the study began and may be explained by differences in sedimentation stress derived from soil runoff. Differences between depths most likely stem from the effects of low tidal sub-aerial exposures. Particularly intense sub-aerial exposures occurred repeatedly during January-March, 2001 and accounted for a decrease in coral and an increase in algal cover on shallow depths observed later that year. Additionally, the shallow area on the Northern site seems to be negatively affected by the combined effect of sedimentation and low tidal exposure. However, a decrease in coral cover and an increase of algal cover since 2001 on deep areas at both sites remain unexplained. Comparisons with previous studies suggest that the reef at La Azufrada has been more resilient than other reefs in the Tropical Eastern Pacific (TEP), recovering pre-disturbance (1979) levels of coral cover within a 10 year period after the 1982-83 El Niño, which caused 85% mortality. Furthermore, the effects of the 1997-98 El Niño, indicated by the difference in overall live coral cover between 1998 and 1999, were minor (<6% reduction). Despite recurrent natural disturbances, live coral cover in 2004 was as high as that existing before 1982 at La Azufrada, and one of the highest observed on healthy coral reefs in the TEP region. Rev. Biol. Trop. 58 (Suppl. 1): 81-94. Epub 2010 May 01.

A través del Sistema Nacional de Monitoreo de Arrecifes Coralinos en Colombia (SIMAC) se han colectado anualmente (1998-2004) datos de cobertura de corales y algas en 20 transectos de 10m localizados en dos profundidades de dos sitios del arrecife de La Azufrada, Isla Gorgona (costa Pacífica). En general, la cobertura coralina fue alta (55.1% - 65.7%) y la de algas baja (28.8% - 37.5%), con una significativa variación entre años, más notablemente en áreas someras. Las diferencias entre sitios tanto en cobertura de coral como de algas estuvieron presentes desde que comenzó el estudio y pueden ser explicadas por diferencias en estrés por sedimentación (escorrentía terrestre). Las diferencias entre las profundidades muy probablemente se deben a los efectos de exposiciones aéreas durante mareas bajas. Las exposiciones aéreas particularmente intensas y repetidas entre enero-marzo de 2001 explican la disminución de la cobertura de coral, y aumento de la de algas en áreas someras observadas más tarde ese año. Adicionalmente, el área somera del sitio norte parece ser negativamente afectada por el efecto combinado de la sedimentación y la exposición mareal. Sin embargo, una tendencia a la disminución de la cobertura coralina y aumento de la de algas desde 2001 en las áreas profundas de ambos sitios permanece sin explicación. Comparaciones con estudios previos indican que el arrecife de La Azufrada ha sido más elástico que otros arrecifes del Pacífico Oriental Tropical (POT). A pesar de las perturbaciones naturales recurrentes, la cobertura coralina en 2004 fue tan alta como la existente antes de 1982 en La Azufrada, y una de las más altas observadas en arrecifes coralinos saludables de la región del POT.

Acute emergence of Elizabethkingia meningoseptica infection among mechanically ventilated patients in a long-term acute care facility.

OBJECTIVE: To describe an outbreak of infection associated with an infrequently implicated pathogen, Elizabethkingia meningoseptica, in an increasingly prominent setting for health care of severely ill patients, the long-term acute care hospital. DESIGN: Outbreak investigation. SETTING: Long-term acute care hospital with 55 patients, most of whom were mechanically ventilated. METHODS: We defined a case as E. meningoseptica isolated from any patient specimen source from December 2007 through April 2008, conducted an investigation of case patients, obtained environmental specimens, and performed microbiologic testing. RESULTS: Nineteen patients had E. meningoseptica infection, and 8 died. All case patients had been admitted with respiratory failure that required mechanical ventilation. Among the 8 individuals who died, the time from collection of the first specimen positive for E. meningoseptica to death ranged from 6 to 43 days (median, 16 days). Environmental sampling was performed on 106 surfaces; E. meningoseptica was isolated from only one swab. Three related pulsed-field gel electrophoresis patterns were identified in patient isolates; the environmental isolate yielded a fourth, unrelated pattern. CONCLUSION: Long-term acute care hospitals with mechanically ventilated patients could serve as an important transmission setting for E. meningoseptica. This multidrug-resistant bacterium could pose additional risk when patients are transferred between long-term acute care hospitals and acute care hospitals.

Aggressive management of necrotizing fasciitis through a multidisciplinary approach using minimal surgical procedures: a case report.

Necrotizing fasciitis is an aggressive, destructive infection of the soft tissue and fascia and is a life-threatening surgical emergency. A case study is presented of necrotizing fasciitis in the right lower extremity of a 53-year-old male resident of a long-term skilled nursing facility. Limb salvage was achieved through a multidisciplinary approach with early surgical management and aggressive postoperative management. Through 3 surgical procedures, the combined efforts of podiatric surgery, orthopaedic surgery, general/trauma surgery, and infectious disease provided early wound closure and limb salvage. An aggressive multidisciplinary approach to the management of necrotizing fasciitis in the lower extremity is necessary for limb salvage. Use of this multidisciplinary approach will minimize the number of surgical procedures and decrease the potential morbidity and mortality seen in patients with this infection.

Hacia una perspectiva bioética y cultural de la exclusión social

Este es un artículo que trabaja una aproximación Bioética a la relación entre exclusión social, biodiversidad y diversidad cultural. Su propósito es presentar el “momento hermenéutico” mediante una perspectiva etnográfica, intercultural y procesal. Ha sido organizado con base en una investigación de campo realizada en Colombia, en los dos últimos años, mediante grupos focales interculturales. El constitucionalismo colombiano ha encarado y asumido la diversidad cultural, como un hecho que fundamenta la existencia del Estado, las políticas públicas, el ejercicio de la justicia, la valoración y conservación de la biodiversidad, la protección de la diversidad, y también el reconocimiento de las diferencias.

Cuerpos, tecnologías y bioética y culturas: dilemas culturales

Este artículo tiene el propósito de percibir y distinguir el comportamiento de algunos dilemas culturales en relación con el cuerpo humano, la tecnología y la bioética. Piensa que la introducción del factor cultural en la bioética abrirá mayores horizontes de comprensión ética y humana para el manejo de la vida en general, y, en particular, de los cuerpos biológicos, animales y humanos. Desarrolla los dilemas entre cuerpo y mentalidad histórica, animalidad y humanidad, tecnología y gestión corporal, y en general los cambios culturales en relación con el cuerpo como un problema para ser abordado juiciosamente por la bioética cultural.

Hemorragia digestiva alta no originada por várices / Nonvariceal upper gastrointestinal bleeding

La hemorragia digestiva alta no originada por várices, continúa siendo un desafío para el médico gastroenterólogo tanto desde el punto de vista diagnóstico como de manejo. La causa más frecuente sigue siendo un desafío para el médico gastroenterólogo tanto desde el punto de vista diagnóstico como de manejo. La causa más frecuente sigue siendo la úlcera péptica, con un 50 por ciento en promedio en la literatura publicada. Las hemorragias activas más severas son provocadas por la lesión de Dieulafoy y algunas formas de presentación de hemorragia por úlcera. Por lo general, son menos severas las hemorragias producidas por el mallory-Weiss, gastritis, esofagitis, las ectasias vasculares o angiodisplasias y el "watermelon stomach" (una variante de esta última). Las angiodisplasias, son más una causa de una hemorragia crónica. Los nuevos avances en el tratamiento de estas lesiones, básicamente con la endoscopía terapéutica en estigmas de alto riesgo de recurrencia, el uso de supresión ácida más profunda y sostenida con los inhibidores de nomba de protones y el manejo en unidades especializadas e interdisciplinario, ha permitido una reducción significativa en la recurrencia de hemorragia, necesidad de transfusiones, necesidad de cirugía y días de hospitalización. Y, en algunos estudios se demuestra también una reducción en la mortalidad, de un 10 por ciento que era el estándar, a 2,3 - 5,4 por ciento, según revisiones últimas.

Dimensiones culturales en la bioética: aproximación para una bioética intercultural y pública

Este artículo piensa la constitución de una bioética intercultural y pública. ¿Tiene, la bioética, capacidad para organizar la convivencia –de modo plural y diferenciado- de las distintas percepciones culturales sobre lo vivo en el planeta y los afanes tecnocientífi cos para controlarlas? Se aproxima la respuesta discurriendo la diferencia cultural, criticando el anti-relativismo banal, y, proponiendo el entendimiento intercultural como la base de los acumulados históricos que las sociedades disponen para desarrollar sus propios emprendimientos bioéticos en condiciones de diversidad cultural.

Tratamiento moderno de colectomía laparoscópica para lesiones malignas y benignas del colon / The modern treatment by laparoscopic colectomy for malignant and benign lesions of the colon

Objetivo: Demostrar la seguridad, eficacia, morbilidad, mortalidad y calidad de vida que ofrece la colectomía laparoscópica asistida en el tratamiento de la patología maligna y benigna del colon. Método: Se estudiaron 47 de 60 pacientes entre 25 y 83 años de edad sometidos a colectomía laparoscópica asistida en el periodo 1995 - 2005. Los pacientes fueron evaluados clínicamente y con exámenes de Eco-TAC ó resonancia magnética, colonoscopía y/o Rx. de colon, CEA para determinar el diagnóstico y estadiaje en caso de neoplasia. No se incluyeron pacientes con perforación colónica y peritonitis, ni tumores T4, ni mayores de 8 cms. Resultados: Las indicaciones fueron adenocarcinoma 27, diverticulitis crónica 17, adenoma velloso benigno 1, enfermedad de Crohn del íleon terminal con severa estenosis 1, poliposis familiar múltiple 1, vólvulo del ciego 1. 27 pacientes fueron del sexo femenino y 20 del sexo masculino con edades que fluctuaron entre 25 y 83 años. Las operaciones practicadas fueron colectomía derecha (12), colectomía izquierda (31), colectomía segmentaria (1), colectomía total (1), resección anterior (3). En los casos de neoplasia se completó con linfadenectomía en bloque. El tiempo operatorio osciló entre 5 horas en los casos iniciales y 3 horas en los últimos casos. El sangrado operatorio fue escaso x: 150 cc. (50-300 cc.). No se requirió de transfusiones de sangre. La eliminación de flatos se produjo en las primeras 24-36 horas en los operados del colon derecho y 24-56 horas en las del colon izquierdo. La patología mostró Dukes A, 2 pacientes (8 por ciento); Dukes B, 10 pacientes (37 por ciento); Dukes C, 15 pacientes (55 por ciento) en los casos de patología maligna. El número de ganglios extirpados fue de x: 20 (14-45). El tiempo de hospitalización fue de 4,5 días (2-6) para el colon derecho y 5.5 (3-9) para el colon izquierdo; en colectomía total 10 días por íleo prolongado y posterior control de diarrea. No hubo reoperaciones ni mortalidad. En los casos de cáncer de colon, el 60 por ciento recibió QT adyuvante. En el seguimiento no se ha documentado siembra peritoneal, recurrencia local ni recurrencia en los puertos de entrada. La sobrevida actuarial de los pacientes operados por cáncer es similar a la reportada de pacientes operados por técnica abierta y está directamente relacionada al grado de penetración en la pared del colon y al número de ganglios comprometidos...