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Andean peatlands are important carbon reservoirs for countries in the northern Andes and have a unique diversity. Peatland plant diversity is generally related to hydrology and water chemistry, and the response of the vegetation in tropical high-elevation peatlands to changes in elevation, climate, and disturbance is poorly understood. Here, we address the questions of what the main vegetation types of peat-forming vegetation in the northern Andes are, and how the different vegetation types are related to water chemistry and pH. We measured plant diversity in 121 peatlands. We identified a total of 264 species, including 124 bryophytes and 140 vascular plants. We differentiated five main vegetation types: cushion plants, Sphagnum, true mosses, sedges, and grasses. Cushion-dominated peatlands are restricted to elevations above 4000 m. Variation in peatland vegetation is mostly driven be elevation and water chemistry. Encroachment of sedges and Sphagnum sancto-josephense in disturbed sites was associated with a reduction in soil carbon. We conclude that peatland variation is driven first by elevation and climate followed by water chemistry and human disturbances. Sites with higher human disturbances had lower carbon content. Peat-forming vegetation in the northern Andes was unique to each site bringing challenges on how to better conserve them and the ecosystem services they offer.
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A pre-Columbian staple, Bactris gasipaes Kunth. is a palm tree domesticated around 4000 years ago, so appreciated that a Spanish chronicler wrote in 1545, "only their wives and children were held in higher regard" by the Mesoamerican natives. The peach palm is an integral part of the foodways and gastronomy of Ecuador, Colombia, Bolivia, Peru, Brazil, and other tropical American countries; meanwhile, it is almost unknown in the rest of the world, except for hearts of palm. Although abundant, the species faces anthropogenic threats. The purpose of this study is to describe and summarize the physicochemical, nutritional, and bioactive characteristics of the peach palm and its two main alimentary products: hearts of palm and fruits, highlighting the functional and antioxidant potential of the latter, showing both ancestral and modern uses. There is active research on peach palm products and coproducts that aim for better, more sustainable uses of its traditional and recently found properties. The review and presentation of studies on this strategically relevant species can motivate the protection of endangered populations and stimulate new lines of research to advance development in the food, pharmaceutical, and cosmetic industries, with fair trade, sustainable development goals, and adaptation to climate change in mind.
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BACKGROUND: There are 3 treatment options for placenta accreta spectrum: cesarean delivery with hysterectomy, expectant management, and uterine-sparing surgical techniques. One-step conservative surgery is the most extensively described conservative surgical technique, and it has extensive evidence supporting its usefulness; however, few groups apply it, most likely because of the misconception that it is a complex procedure that requires extensive training and is applicable to only a few patients. OBJECTIVE: This study aimed to evaluate the clinical outcomes of patients undergoing one-step conservative surgery in 4 placenta accreta spectrum reference hospitals and provided detailed steps for successfully applying this type of surgery. STUDY DESIGN: This was a multicenter, descriptive, prospective study that described the outcomes of patients with placenta accreta spectrum treated in 4 reference hospitals for this condition. The patients were divided into those managed with one-step conservative surgery and those managed with cesarean delivery and hysterectomy. RESULTS: Overall, 75 patients were included. One-step conservative surgery was possible in 85.3% of placenta accreta spectrum cases (64 patients). Intraoperative staging and placenta accreta spectrum topographic classification allowed for the selection of one-step conservative surgery candidates. The clinical outcomes of the 2 groups were similar, except for the frequency of transfusions (81.8% in the cesarean delivery and hysterectomy group vs 67.2% in the one-step conservative surgery group) and vascular interventions (27.3% in the cesarean delivery and hysterectomy group vs 4.7% in the one-step conservative surgery group), which were both higher in patients who underwent hysterectomy. In addition, the operation time was shorter in the one-step conservative surgery group (164.4 minutes vs 216.5 minutes). CONCLUSION: One-step conservative surgery is a valid procedure in most patients with placenta accreta spectrum. It is an applicable technique even in scenarios with limited resources. However, its safe application requires knowledge of the topographic classification and the application of intraoperative staging.
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This study aimed to examine the association between early childhood resilience profiles and later school outcomes (academic achievement and school involvement) among children in the U.S. child welfare system. This study compared 827 children aged 3-5 years in three latent profile groups (poor emotional and behavioral resilience, low cognitive resilience, and multi-domain resilience) to their baseline profiles using data from the National Survey of Child and Adolescent Well-Being (NSCAW-II). At the three-year follow-up, children with low emotional and behavioral resilience profiles and children with the multi-domain resilience profile had significantly higher basic reading skills, reading comprehension, and math reasoning compared to children with low scores on the cognitive resilience profile. Furthermore, children with the multi-domain resilience profile had significantly higher levels of emotional school engagement than did those with the low emotional and behavioral resilience profile and considerably higher levels of behavioral school engagement compared to those with the low cognitive resilience profile. The findings highlight the persistent effects of early resilience into the later childhood years. Moreover, our results suggest the need for early identification of and intervention for children with low cognitive or emotional/behavioral resilience during the preschool years to promote academic success and school engagement during the school-age years.
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Sucesso Acadêmico , Proteção da Criança , Adolescente , Criança , Proteção da Criança/psicologia , Pré-Escolar , Escolaridade , Emoções , Humanos , Instituições AcadêmicasRESUMO
Xylosma G. Forst. is a genus of plants belonging to the Salicaceae family with intertropical distribution in America, Asia, and Oceania. Of the 100 accepted species, 22 are under some level of conservation risk. In this review, around 13 species of the genus used as medicinal plants were found, mainly in Central and South America, with a variety of uses, among which antimicrobial is the most common. There is published research in chemistry and pharmacological activity on around 15 of the genus species, centering in their antibacterial and fungicidal activity. Additionally, a variety of active phytochemicals have been isolated, the most representative of which are atraric acid, xylosmine and its derivatives, and velutinic acid. There is still ample field for the validation and evaluation of the activity of Xylosma extracts, particularly in species not yet studied, and concerning uses other than antimicrobial and for the identification and evaluation of their active compounds.
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RESUMEN: En los hospitales públicos chilenos, los pacientes desdentados mandibulares pueden ser tratados con una Sobredentadura-Mucosoportada, Implanto-Retenida (SMIR). Para tal fin, se adaptaron los lineamientos del plan piloto "Programa de Prestaciones Valoradas. Odontología 2012 Ministerio de Salud", en ausencia de una Guía Ministerial. El objetivo de esta serie de casos fue evaluar si la implementación y adaptación del plan piloto del tratamiento con SMIR mejoró la calidad de vida de los pacientes. Se evaluaron sobrevida, éxito implantario, e impacto en la calidad de vida. Los resultados indican una sobrevida y éxito implantario del 100% y una mejora de la calidad de vida. Conclusión: el tratamiento con SMIR mejora la calidad de vida de los pacientes, en el servicio público.
ABSTRACT: In Chilean public hospitals, patients with Complete Edentulous Mandible are treated with Implant-Retained and Mucosa-supported Overdenture (IRMO). For this purpose, the guidelines of the pilot plan "Valued Benefits Program in Dentistry 2012, Ministry of Health" have been adapted. The aim of this study was to evaluate whether these adapted protocols have been successful. We measured implant survival and success, and impact on quality of life with OHIP-14 criteria. Results indicate 100% implant survival and success and improved quality of life. Conclusion: IRMO improves patients' quality of life in public services.
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In the United States, racial/ethnic and sexual youth and young adults (YYA) of color are disproportionately affected by HIV. Subsequently, YYA experience HIV stigma and engage in increased risk behaviors and reduced HIV testing. HIV communication has been identified as a potential buffer to HIV stigma, resulting in health-seeking behaviors, such as HIV testing. In this study, we respond to a meaningful gap in the literature by examining different types of HIV communication and their impact on HIV stigma and HIV testing in a diverse sample of YYA. We analyzed secondary data from the Kaiser Family Foundation National Survey of Teens and Young Adults on HIV/AIDS. A 40-question, web-based survey was conducted with 1437 youth (ages 15-24). Recruitment included a dual sampling method from households with: (1) listed phone numbers, (2) unlisted phone numbers, (3) telephones, (4) no telephone, and (5) only cell phone access. The purpose of the survey was to establish participants' HIV knowledge, communication, experiences, and testing behaviors. Findings suggested an association between intimate-partner HIV communication, increased HIV testing, and reduced HIV stigma. We also identified differentials in HIV testing and stigma based on gender, income, age, and sexual minority status, explained by HIV communication. Further research is needed that examines ways to use intimate-partner HIV communication to reduce stigma and increase HIV testing among YYA of different sociodemographic characteristics and sexual orientations.
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Síndrome de Imunodeficiência Adquirida , Infecções por HIV , Adolescente , Adulto , Comunicação , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Humanos , Comportamento Sexual , Parceiros Sexuais , Estigma Social , Estados Unidos , Adulto JovemRESUMO
Research in global change ecology relies heavily on global climatic grids derived from estimates of air temperature in open areas at around 2 m above the ground. These climatic grids do not reflect conditions below vegetation canopies and near the ground surface, where critical ecosystem functions occur and most terrestrial species reside. Here, we provide global maps of soil temperature and bioclimatic variables at a 1-km2 resolution for 0-5 and 5-15 cm soil depth. These maps were created by calculating the difference (i.e. offset) between in situ soil temperature measurements, based on time series from over 1200 1-km2 pixels (summarized from 8519 unique temperature sensors) across all the world's major terrestrial biomes, and coarse-grained air temperature estimates from ERA5-Land (an atmospheric reanalysis by the European Centre for Medium-Range Weather Forecasts). We show that mean annual soil temperature differs markedly from the corresponding gridded air temperature, by up to 10°C (mean = 3.0 ± 2.1°C), with substantial variation across biomes and seasons. Over the year, soils in cold and/or dry biomes are substantially warmer (+3.6 ± 2.3°C) than gridded air temperature, whereas soils in warm and humid environments are on average slightly cooler (-0.7 ± 2.3°C). The observed substantial and biome-specific offsets emphasize that the projected impacts of climate and climate change on near-surface biodiversity and ecosystem functioning are inaccurately assessed when air rather than soil temperature is used, especially in cold environments. The global soil-related bioclimatic variables provided here are an important step forward for any application in ecology and related disciplines. Nevertheless, we highlight the need to fill remaining geographic gaps by collecting more in situ measurements of microclimate conditions to further enhance the spatiotemporal resolution of global soil temperature products for ecological applications.
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Ecossistema , Solo , Mudança Climática , Microclima , TemperaturaRESUMO
Tragia L. is a genus of plants belonging to the Euphorbiaceae family with worldwide intertropical distribution, composed of more than 150 species. In this literature review, 26 species of the genus used as medicinal plants were found, mainly in East Africa and the Indian subcontinent, with a variety of uses among which antibacterial, anti-inflammatory, anticancer and reproductive health are most common. Research has been done on a few of the species, mostly those of the Old World, with emphasis on four of them: Tragia involucrata Linn., Tragia spathulata Benth., Tragia benthamii Baker and Tragia plukenetii Radcl.-Sm., confirming several ethnomedicinal claims. Moreover, a variety of active phytochemicals have been isolated, mainly ethers, hydrocarbons, flavonoids and sterols. There is ample field for the evaluation of the activity of Tragia extracts and essential oils and the identification of their active compounds, particularly of the New World species, for which there is still very little research.
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This work focuses on the search and development of drugs that may become new alternatives to the commercial drugs currently available for treatment of leishmaniasis. We have designed and synthesized 12 derivatives of bis(spiropyrazolone)cyclopropanes. We then characterized their potential application in therapeutic use. For this, the in vitro biological activities against three eukaryotic models-S. cerevisiae, five cancer cell lines, and the parasite L. mexicana-were evaluated. In addition, cytotoxicity against non-cancerous mammalian cells has been evaluated and other properties of interest have been characterized, such as genotoxicity, antioxidant properties and, in silico predictive adsorption, distribution, metabolism, and excretion (ADME). The results that we present here represent a first screening, indicating two derivatives of bis(spiropyrazolone)cyclopropanes as good candidates for the treatment of leishmaniasis. They have good specificity against parasites with respect to mammalian cells.
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Antiprotozoários/síntese química , Antiprotozoários/farmacologia , Ciclopropanos/síntese química , Ciclopropanos/farmacologia , Leishmaniose/tratamento farmacológico , Animais , Antiprotozoários/química , Antiprotozoários/uso terapêutico , Linhagem Celular , Técnicas de Química Sintética , Ciclopropanos/química , Ciclopropanos/uso terapêutico , Desenho de Fármacos , Humanos , Leishmania/efeitos dos fármacos , Relação Estrutura-AtividadeRESUMO
BACKGROUND: Pyrazoles have attracted particular attention due to the diverse biological activities associated with this heterocyclic system, and some have been shown to be cytotoxic to several human cell lines. Several drugs currently on the market have this heterocycle as the key structural motif, and some have been approved for the treatment of different types of cancer. RESULTS: 4,4'-(Arylmethylene)bis(1H-pyrazol-5-ols) derivatives 3a-q were synthetized by a three components reaction of 3-methyl-1-phenyl-5-pyrazolone (1) with various benzaldehydes 2 catalyzed by sodium acetate at room temperature. The structures of all synthesized compounds were characterized by physicochemical properties and spectral means (IR and NMR) and were evaluated for their radical scavenging activity by DPPH assay and tested in vitro on colorectal RKO carcinoma cells in order to determine their cytotoxic properties. All 4,4'-(arylmethylene)bis(1H-pyrazol-5-ols) derivatives 3a-q were synthetized in high to excellent yield, and pure products were isolated by simple filtration. All compounds have good radical scavenging activity, and half of them are more active than ascorbic acid used as standard. CONCLUSION: Several derivatives proved to be cytotoxic in the RKO cell line. In particular, compound 3i proved to be a very potent scavenger with an IC50 of 6.2 ± 0.6 µM and exhibited an IC50 of 9.9 ± 1.1 µM against RKO cell. Autophagy proteins were activated as a survival mechanism, whereas the predominant pathway of death was p53-mediated apoptosis.
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Global climate and land use change are causing woody plant encroachment in arctic, alpine, and arid/semi-arid ecosystems around the world, yet our understanding of the belowground impacts of this phenomenon is limited. We conducted a globally distributed field study of 13 alpine sites across four continents undergoing woody plant encroachment and sampled soils from both woody encroached and nearby herbaceous plant community types. We found that woody plant encroachment influenced soil microbial richness and community composition across sites based on multiple factors including woody plant traits, site level climate, and abiotic soil conditions. In particular, root symbiont type was a key determinant of belowground effects, as Nitrogen-fixing woody plants had higher soil fungal richness, while Ecto/Ericoid mycorrhizal species had higher soil bacterial richness and symbiont types had distinct soil microbial community composition. Woody plant leaf traits indirectly influenced soil microbes through their impact on soil abiotic conditions, primarily soil pH and C:N ratios. Finally, site-level climate affected the overall magnitude and direction of woody plant influence, as soil fungal and bacterial richness were either higher or lower in woody encroached versus herbaceous soils depending on mean annual temperature and precipitation. All together, these results document global impacts of woody plant encroachment on soil microbial communities, but highlight that multiple biotic and abiotic pathways must be considered to scale up globally from site- and species-level patterns. Considering both the aboveground and belowground effects of woody encroachment will be critical to predict future changes in alpine ecosystem structure and function and subsequent feedbacks to the global climate system.
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Ecossistema , Solo , Clima , Nitrogênio/análise , PlantasRESUMO
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Humanos , Medicina nas Artes , Filmes Cinematográficos , Xeroderma Pigmentoso/patologiaRESUMO
Traditional herbal medicine has become an important alternative in the treatment of various cancer types, including colon cancer, which represents one of the main health problems around the world. Therefore, the search for new therapies to counteract this disease is very active. Grias neuberthii is an endemic plant located in the Ecuadorian Amazon region, which has been used in traditional medicine for its pharmacological properties, including its ability to inhibit tumor cell growth, although scientific studies are limited. We have analyzed the effect of this plant on two colon carcinoma cell lines, that is, RKO (normal p53) and SW613-B3 (mutated p53) cells. Among several extracts obtained from various parts of G. neuberthii plant, we identified the extract with the greatest cytotoxic potential, derived from the stem bark. The cytotoxic effect was similar on both cell lines, thus indicating that it is independent of the status of p53. However, significant differences were observed after the analysis of colony formation, with RKO cells being more sensitive than SW613-B3. No evidence for apoptotic markers was recorded; nevertheless, both cell lines showed signs of autophagy after the treatment, including increased Beclin-1 and LC3-II and decreased p62. Finally, three chemical compounds, possibly responsible for the effect observed in both cell lines, were identified: lupeol (1), 3'-O-methyl ellagic acid 4-O-ß-D-rhamnopyranoside (2), and 19-α-hydroxy-asiatic acid monoglucoside (3).
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Resumen A pesar de que en Colombia se han dado avances acerca de la gestión de los residuos provenientes de las actividades constructivas, en ciudades como Villavicencio, no existen estudios a fondo acerca de su generación y manejo. Por ello, el objetivo de este artículo, consiste en identificar el estado actual, las barreras y los instrumentos que podrían ayudar a mejorar la gestión de los residuos de construcción y demolición en esta ciudad. Para llevar a cabo el estudio, se empleó el método de observación y de análisis, y el tipo de estudio descriptivo. Con el fin de obtener la información, fue necesario realizar visitas y encuestas a empresas constructoras. Posteriormente, la información recopilada fue examinada por medio del análisis multiatributo y el software estadístico SSPS. Como resultado, se obtuvo que las tierras de excavación y el concreto son los residuos que más se generan en las actividades constructivas. Como medida para reducir los residuos y mejorar su gestión, las empresas dieron mayor importancia a la etapa de prevención. La falta de conciencia medioambiental y de control en el cumplimiento de la legislación fueron las principales barreras detectadas. Los incentivos tributarios fueron considerados como instrumentos relevantes para la gestión.
Abstract Although in Colombia there have been advances in the management of waste from construction activities, in cities such as Villavicencio, there are no in-depth studies about their generation and management. Therefore, the objective of this article is to identify the current state, barriers and instruments that could help improve the management of construction and demolition waste in this city. To carry out the study the observation and analysis method, and the type of descriptive study, was used. In order to obtain the information, it was necessary to make visits and surveys to construction companies. Subsequently the information collected was examined through the multi-attribute analysis and the statistical software SSPS. As result it go that the excavation lands and the concrete are the most generated waste in the construction activities. As measure to reduce waste and improve its management, companies gave greater importance to the prevention stage. The lack of environmental awareness and control in compliance with the legislation were the main barriers detected. Tax incentives were considered as relevant instruments for management.
Resumo Embora na Colômbia tenha havido avanços em relação à gestão de resíduos das atividades de construção, em cidades como Villavicencio, não há estudos aprofundados sobre sua geração e gestão. Portanto, o objetivo deste artigo é identificar o estado atual, barreiras e instrumentos que possam ajudar a melhorar o gerenciamento de resíduos de construção e demolição nesta cidade. Para realizar o estudo, utilizou-se o método de observação e análise e o tipo de estudo descritivo. Para obter as informações, foi necessário fazer visitas e pesquisas às empresas de construção. Posteriormente, as informações coletadas foram examinadas por meio da análise multi-atributo e do software estatístico SSPS. Como resultado, obteve-se que as terras de escavação e o concreto são os resíduos mais gerados nas atividades de construção. Como medida para reduzir o desperdício e melhorar sua gestão, as empresas deram maior importância ao estágio de prevenção. A falta de conscientização e controle ambiental em conformidade com a legislação foram as principais barreiras detectadas. Os incentivos fiscais foram considerados instrumentos relevantes para a gestão.
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Some species of the Baccharis genus have been shown to possess important biomedical properties, including cytotoxic activity. In this study, we examined the cytotoxic effect of methanol extract from Baccharis obtusifolia (Asteraceae) in cancer cell lines of prostate (PC-3), colon (RKO), astrocytoma (D-384), and breast (MCF-7). The methanolic extract displayed the largest substantial cytotoxic effect in lines of colon cancer (RKO) and cerebral astrocytoma (D-384). Chromatographic purification of the B. obtusifolia methanolic extract led to the isolation and identification of 5,4'-dihydroxy-7-methoxyflavone (1) and 5-hydroxy-7,4'-dimethoxyflavone (2) compounds of the flavonoid type.
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BACKGROUND: Previous studies have demonstrated the effectiveness of information and communication technologies to support healthy lifestyle interventions. In particular, personal health record systems (PHR-Ss) empower self-care, essential to support lifestyle changes. Approaches such as the user-centered design (UCD), which is already a standard within the software industry (ISO 9241-210:2010), provide specifications and guidelines to guarantee user acceptance and quality of eHealth systems. However, no single PHR-S for metabolic syndrome (MS) developed following the recommendations of the ISO 9241-210:2010 specification has been found in the literature. OBJECTIVE: The aim of this study was to describe the development of a PHR-S for the management of MS according to the principles and recommendations of the ISO 9241-210 standard. METHODS: The proposed PHR-S was developed using a formal software development process which, in addition to the traditional activities of any software process, included the principles and recommendations of the ISO 9241-210 standard. To gather user information, a survey sample of 1,187 individuals, eight interviews, and a focus group with seven people were performed. Throughout five iterations, three prototypes were built. Potential users of each system evaluated each prototype. The quality attributes of efficiency, effectiveness, and user satisfaction were assessed using metrics defined in the ISO/IEC 25022 standard. RESULTS: The following results were obtained: 1) a technology profile from 1,187 individuals at risk for MS from the city of Popayan, Colombia, identifying that 75.2% of the people use the Internet and 51% had a smartphone; 2) a PHR-S to manage MS developed (the PHR-S has the following five main functionalities: record the five MS risk factors, share these measures with health care professionals, and three educational modules on nutrition, stress management, and a physical activity); and 3) usability tests on each prototype obtaining the following results: 100% effectiveness, 100% efficiency, and 84.2 points in the system usability scale. CONCLUSION: The software development methodology used was based on the ISO 9241-210 standard, which allowed the development team to maintain a focus on user's needs and requirements throughout the project, which resulted in an increased satisfaction and acceptance of the system. Additionally, the establishment of a multidisciplinary team allowed the application of considerations not only from the disciplines of software engineering and health sciences but also from other disciplines such as graphical design and media communication. Finally, usability testing allowed the observation of flaws in the designs, which helped to improve the solution.
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BACKGROUND: "Horchata" is an herbal mixture infusion consumed in Southern Ecuador; 66% of its plants are anti-inflammatory medicinal plant, and 51% are analgesics. Anti-inflammatory substances can prevent carcinogenesis mediated by cytotoxic effects and can prevent DNA damage. The aim of this study was to evaluate the cytotoxicity and apoptotic/antigenotoxic effects of horchata as well as its mechanism. METHODS: Nine different varieties of horchata were prepared in the traditional way and then freeze-dried. Phytochemical screening tested for the presence of secondary metabolites using standard procedures and antioxidant activities. The cytotoxic activity was evaluated on cerebral astrocytoma (D-384), prostate cancer (PC-3), breast cancer (MCF-7), colon cancer (RKO), lung cancer (A-549), immortalized Chinese hamster ovary cells (CHO-K1), and human peripheral blood lymphocytes via a MTS assay. The pro-apoptotic effects were evaluated with Anexin V/Propidium Iodide and western blot of Bax, Bcl-2, TP53, and TP73. Induction and reduction of ROS were assessed by fluorimetry. Genotoxic and antigenotoxic effects were evaluated with a comet assay and micronuclei on binucleated cells. RESULTS: Five of nine horchatas had cytotoxic effects against D-384 while not affecting normal cells. These horchatas induce cell death by apoptosis modulated by p53/p73. In CHO-K1 cells, the horchatas decrease the damage induced by hydrogen peroxide and Mitomycin C measured in the comet and micronucleus assay respectively. CONCLUSIONS: The IC50 range of effective horchatas in D-384 was 41 to 122 µg·mL-1. This effect may be related to its use in traditional medicine (brain tonic). On the other hand, immortalized Chinese hamster ovary cells (CHO-K1) and lymphocytes did not show a cytotoxic effect. The most potent horchata induced apoptosis via a p53/p73-mediated mechanism. The horchatas present antigenotoxic properties, which may be related to the antioxidant capacity. Future studies on horchata components are necessary to understand the interactions and beneficial properties.
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Antioxidantes/farmacologia , Bebidas , Sobrevivência Celular/efeitos dos fármacos , Dano ao DNA/efeitos dos fármacos , Preparações de Plantas/farmacologia , Plantas Medicinais , Animais , Células CHO , Linhagem Celular , Ensaio Cometa , Cricetinae , Cricetulus , Equador , Linfócitos/efeitos dos fármacos , Medicina Tradicional , Testes para MicronúcleosRESUMO
The implementation of excellence centers in specific diseases has been gaining recognition in the field of health; specifically in rheumatoid arthritis, where the prognosis of the disease is related to an early diagnosis and a timely intervention, it is necessary that the provision of health services is developed in an environment of quality, opportunity, and safety with the highest standards of care. A methodology that allows this implementation in such a way that is achievable by the most of the care centers is a priority to achieve a better attention to populations with this disease. In this paper, we propose a systematic and progressive methodology that will help all the institutions to develop successful models without faltering in the process. The expected impact on public health is defined by a better effective coverage of high-quality treatments, obtaining better health outcomes with safety and accessibility that reduces the budgetary impact for the health systems of our countries.
