Outcomes and Associated Extracardiac Malformations in Neonates from Colombia with Severe Congenital Heart Disease.

Congenital heart disease (CHD) is a common structural anomaly, affecting ~ 1% of live births worldwide. Advancements in medical and surgical management have significantly improved survival for children with CHD, however, extracardiac malformations (ECM) continue to be a significant cause of morbidity and mortality. Despite clinical significance, there is limited literature available on ECM in neonates with CHD, especially from Latin America. A cross-sectional study of neonates with severe CHD evaluated by the medical-surgical board team at Fundación Cardiovascular de Colombia from 2014 to 2019 was completed to characterize morbidity, mortality, surgical outcomes, and ECM. Demographics and surgical outcomes were compared between neonates with and without ECM. Medical record data were abstracted and descriptive statistical analysis was performed. Of 378 neonates with CHD, 262 had isolated CHD (69.3%) and 116 had ECM (30.7%). The most common ECM was gastrointestinal (n = 18, 15.5%) followed by central nervous system (n = 14, 12%). Most neonates required a biventricular surgical approach (n = 220, 58.2%). Genetic testing was performed more often for neonates with ECM (n = 65, 56%) than neonates with isolated CHD (n = 14, 5.3%). Neonates with ECM had lower birth weight, longer hospital stays, and higher postsurgical complications rates. There was no difference in survival between groups. Overall, Screening for ECM in neonates with CHD is important and identification of ECM can guide clinical decision-making. These findings have important implications for pediatric healthcare providers, especially in low- and middle-income countries, where the burden of CHD is high and resources for managing CHD and extracardiac malformations may be limited.

Vascular modulation through exercise improves chemotherapy efficacy in Ewing sarcoma.

Recent studies in mouse models of cancer have shown that exercise improves tumor vascular function, thereby improving chemotherapy delivery and efficacy. However, the mechanisms underlying this improvement remain unclear and the effect of exercise on Ewing sarcoma (ES), a pediatric bone and soft tissue cancer, is unknown. The effect of exercise on tumor vascular hyperpermeability, which inversely correlates with drug delivery to the tumor, has also not been evaluated. We hypothesized that exercise improves chemotherapy efficacy by enhancing its delivery through improving tumor vascular permeability. We treated ES-bearing mice with doxorubicin with or without moderate treadmill exercise. Exercise did not significantly alter ES tumor vessel morphology. However, compared to control mice, tumors of exercised mice had significantly reduced hyperpermeability, significantly decreased hypoxia, and higher doxorubicin penetration. Compared to doxorubicin alone, doxorubicin plus exercise inhibited tumor growth more efficiently. We evaluated endothelial cell sphingosine-1-phosphate receptors 1 and 2 (S1PR1 and S1PR2) as potential mediators of the improved vascular permeability and increased function afforded by exercise. Relative to tumors from control mice, vessels in tumors from exercised mice had increased S1PR1 and decreased S1PR2 expression. Our results support a model in which exercise remodels ES vasculature to reduce vessel hyperpermeability, potentially via modulation of S1PR1 and S1PR2, thereby improving doxorubicin delivery and inhibiting tumor growth more than doxorubicin alone does. Our data suggest moderate aerobic exercise should be tested in clinical trials as a potentially useful adjuvant to standard chemotherapy for patients with ES.

Aerobic Exercise During Early Murine Doxorubicin Exposure Mitigates Cardiac Toxicity.

We report the cardioprotective effects of moderate aerobic exercise from parallel pediatric murine models of doxorubicin (Doxo) exposure in non-tumor-bearing immune competent (NTB-IC) mice and tumor-bearing nude mice (TB-NM). In both models, animals at 4 weeks of age underwent Doxo treatment with or without 2 weeks of simultaneous exercise. In sedentary NTB-IC or TB-NM mice, Doxo treatment resulted in a statistically significant decrease in ejection fraction and fractional shortening compared with control animals. Interestingly, moderate aerobic exercise during Doxo treatment significantly mitigated decreases in ejection fraction and fractional shortening. In contrast, these protective effects of exercise were not observed when exercise was started after completion of Doxo treatments. Moreover, in the TB-NM model, Doxo caused a decrease in heart mass: tibia length and in body weight that was prevented by exercise, whereas NTB-IC mice exhibited no change in these measurements. Doxo delivery to the hearts of TB-NM was decreased by consistent moderate aerobic exercise before Doxo injection. These findings demonstrate the important but subtle differences in cardiotoxicity observed in different mouse models. Collectively, these results also strongly suggest that aerobic exercise during early-life Doxo exposure mitigates cardiotoxicity, possibly through altered delivery of Doxo to myocardial tissue.

Telemedicine in Pediatric Critical Care: A Retrospective Study in an International Extracorporeal Membrane Oxygenation Program.

INTRODUCTION: Extracorporeal membrane oxygenation (ECMO) is an invaluable rescue technique for critically ill children with imminent or present cardiopulmonary collapse. However, medical team expertise to optimize results and decrease complications is scarce. Telemedicine can be used to enhance the delivery of quality interventions. MATERIALS AND METHODS: This is a retrospective review of pediatric patients assisted with ECMO in the cardiac intensive care unit (CICU) at Fundación Cardiovascular de Colombia from July 2011 to June 2015 (telemedicine) compared with similar patients from a previous period (pretelemedicine). Collected information included demographic data, cardiac diagnosis, risk adjustment for congenital heart surgery (RACHS-1), hospital mortality, CICU and hospital length of stay (LOS), ECMO type, and ECMO run hours as well as specific telemedicine information. RESULTS: Fifty-seven patients in the pretelemedicine and 109 in the telemedicine periods were included in the analysis. Forty-nine teleconsulted patients received 218 teleconsultations, with a recommendation for diagnostic or interventional catheterization in 38 patients (77.5%). A surgical procedure for significant residual lesions was recommended in 30 patients (61.2%). Patients in the telemedicine period were older (4.7 months vs. 1.6 months, p = 0.006), more likely to receive operating room ECMO (43.1% vs. 24.6%, p = 0.02), and had a higher proportion of patients with two-ventricle physiology (73.4% vs. 54.4%, p = 0.013). Hospital survival was higher during the telemedicine period (54.1% vs. 29.8%, p = 0.002), with a longer hospital LOS (67 days vs. 28 days, p < 0.001). CONCLUSION: The implementation of telemedicine-assisted interventions in a pediatric ECMO program delivered valuable diagnostic and therapeutic advice, was associated with significant changes in selection criteria and model of care, and an increased hospital survival.

Vaccinium meridionale Swartz extracts and their addition in beef burgers as antioxidant ingredient.

BACKGROUND: Vaccinium meridionale Swartz (mortiño) constitutes a source of bioactive phytochemicals, but reports related to its efficient and green production are scarce. In this study, pressurized liquid extraction (PLE) and ultrasound-assisted extraction of mortiño were compared. Total phenolic content (TPC) and antioxidant capacity (ABTS•+ ) were determined. Beef burgers with 20 g kg-1 of mortiño (MM) or its PLE extract (ME) were manufactured. Lipid oxidation (TBARS) and instrumental color changes were measured after refrigerated storage. RESULTS: High TPC (up to 72 g gallic acid equivalent kg-1 extract) was determined in mortiño extracts, which was positively correlated with antioxidant activity. TBARS values of beef burgers containing either MM or ME did not change after refrigerated storage, whereas lipid oxidation of control burgers increased significantly. The color of burgers with added MM or ME was different (lower b* and a* values) from that of control burgers. However, the evolution of color after storage was similar between control and ME samples. CONCLUSION: Mortiño extracts with high TPC can be obtained by PLE. Both mortiño and its PLE extract are able to control lipid oxidation of beef burgers, but the extract is preferred from the color quality point of view. © 2017 Society of Chemical Industry.

[Nutrient dynamics in forest plantations of Azadirachta indica (Meliaceae) established for restoration of degraded lands in Colombia]. / Dinámica de nutrientes en plantaciones forestales de Azadirachta indica (Meliaceae) establecidas para restauración de tierras degradadas en Colombia.

Nutrient dynamics in forest plantations of Azadirachta indica (Meliaceae) established for restoration of degraded lands in Colombia. Azadirachta indica is a tree species which use is steadily increasing for restoration of tropical and subtropical arid and degraded lands throughout the world. The objective of this research study was to evaluate the potential of these plantations as an active restoration model for the recovery of soils under desertification in arid lands of Colombia. Litter traps and litter-bags were installed in twenty 250m2 plots. Green leaves and soil samples inside and outside this species plantations were taken, and their elemental concentrations were determined. Litterfall, leaf litter decomposition and foliar nutrient resorption were monitored for one year. The annual contributions of organic material, such as fine litterfall, represented 557.54kg/ha, a third of which was A. indica leaves. The greatest potential returns of nutrients per foliar litterfall were from Ca (4.6kg/ha) and N (2.4kg/ha), and the smallest potential returns came from P (0.06kg/ha). A total of 68% of the foliar material deposited in litter-bags disappeared after one year. The greatest release of nutrients was that of K (100%), and the least was that of N (40%). P was the most limiting nutrient, with low edaphic availability and high nutrient use efficiency from Vitousek's index (IEV = 3176) and foliar nutrient resorption (35%). Despite these plantations are young, and that they have not had forestry management practices, as an active restoration model, they have revitalized the biogeochemical cycle, positively modifying the edaphic parameters according to the increases in organic material, P and K of 72%, 31% and 61%, respectively. Furthermore, they improved the stability of aggregates and the microbe respiration rates. The forest plantation model with exotic species has been opposed by different sectors; however, it has been acknowledged that these projects derive many benefits for the restoration of biodiversity and ecosystemic functions. The conditions of severe land degradation demand the initial use of species, such as A. indica, that can adapt quickly and successfully, and progressively reestablish the biogeochemical cycle.

Infectious endarteritis in aortic coarctation: two spectra of an infrequent disease.

OBJECTIVE: To describe two different degrees of clinical commitment and results in the evolution of infectious endarteritis in patients without a previous diagnosis of aortic coarctation. CASE DESCRIPTION: Two male patients aged 13 and 9 years old were admitted. The first due to a fever for 2 months, which started after dental cleaning, and the second due to high blood pressure, both patients with asthenia and weight loss. In the first case, the transthoracic echocardiogram showed aortic coarctation, and the transesophageal echocardiogram showed the presence of vegetations in the post-coarctation area, without pseudoaneurysms, with blood culture positive for Streptococcus mitis. This patient was treated for six weeks with crystalline penicillin, resolving the infection without complications. The second case was assessed for high blood pressure with a history of fever, and was treated with antibiotics. When performing a transthoracic echocardiogram, aortic coarctation was observed with a saccular image classified as a pseudoaneurysm by angiography and tomography. Blood culture was negative, and the patient developed an episode of hematemesis whose initial etiology could not be determined. Before surgical repair, he had a second episode of copious hematemesis with hypovolemic shock and death. COMMENTS: We need to have a high index of clinical suspicion to establish the diagnosis of aortic coarctation complicated by endarteritis and start the appropriate antibiotic treatment, always maintaining surveillance for the early detection of pseudoaneurysms.

Comparison of three exercise interventions with and without gemcitabine treatment on pancreatic tumor growth in mice: No impact on tumor infiltrating lymphocytes.

Exercise has been shown to slow pancreatic tumor growth, but whether exercise interventions of differing volume or intensity yield differential effects on tumor outcomes is unknown. In this study, we compared three exercise training interventions implemented with and without chemotherapy on pancreatic tumor growth in mice. Methods: Male C57BL/6 mice (6-8 weeks old) were subcutaneously inoculated with pancreatic ductal adenocarcinoma tumor cells (PDAC 4662). Upon tumor detection, mice received gemcitabine 15 mg/kg intraperitoneally 3 days/week and were assigned to exercise: high volume continuous exercise (HVCE), low volume continuous exercise (LVCE), high intensity interval training (HIIT), or sedentary (SED). HVCE ran at 12 m/min for 45 min and LVCE for 15 min, 5 days/week. HIIT ran 1-min at 20 m/min, followed by 1-min walking at 8 m/min for 20 total intervals, 3 days/week. SED did not run. Additional sets of inoculated mice were assigned to the exercise interventions but did not receive gemcitabine. Tumor volume was measured every other day for 2 weeks; tumor-infiltrating lymphocytes were assessed by flow cytometry 3-week post-inoculation. Results: Tumor growth did not differ between groups that received gemcitabine (F(3, 34) = 1.487; p = 0.235; η2 = 0.116). In contrast, tumor growth differed between groups not provided gemcitabine (F(3,14) = 3.364; p = 0.049, η2 = 0.419), with trends for slower growth in LVCE than SED (p = 0.088) and HIIT (p = 0.084). Groups did not differ in tumor infiltrating lymphocytes. Conclusion: Contrary to our hypotheses, the exercise interventions compared here did not further reduce pancreatic tumor growth beyond that provided by gemcitabine. However, in mice not receiving gemcitabine, there was a trend for reduced tumor growth in LVCE.

Infectious endarteritis in aortic coarctation: two spectra of an infrequent disease / Endarterite infecciosa na coarctação da aorta: dois espectros de uma doença pouco frequente

ABSTRACT Objective: To describe two different degrees of clinical commitment and results in the evolution of infectious endarteritis in patients without a previous diagnosis of aortic coarctation. Case description: Two male patients aged 13 and 9 years old were admitted. The first due to a fever for 2 months, which started after dental cleaning, and the second due to high blood pressure, both patients with asthenia and weight loss. In the first case, the transthoracic echocardiogram showed aortic coarctation, and the transesophageal echocardiogram showed the presence of vegetations in the post-coarctation area, without pseudoaneurysms, with blood culture positive for Streptococcus mitis. This patient was treated for six weeks with crystalline penicillin, resolving the infection without complications. The second case was assessed for high blood pressure with a history of fever, and was treated with antibiotics. When performing a transthoracic echocardiogram, aortic coarctation was observed with a saccular image classified as a pseudoaneurysm by angiography and tomography. Blood culture was negative, and the patient developed an episode of hematemesis whose initial etiology could not be determined. Before surgical repair, he had a second episode of copious hematemesis with hypovolemic shock and death. Comments: We need to have a high index of clinical suspicion to establish the diagnosis of aortic coarctation complicated by endarteritis and start the appropriate antibiotic treatment, always maintaining surveillance for the early detection of pseudoaneurysms.

RESUMO Objetivo: Descrever dois diferentes graus de comprometimento clínico e resultados na evolução de endarterite infecciosa em pacientes sem diagnóstico prévio de coarctação da aorta. Descrição do caso: Dois pacientes do sexo masculino com idades entre 13 e nove anos foram internados. O primeiro por febre durante dois meses, iniciada após limpeza dentária. O segundo por hipertensão arterial. Ambos com astenia e perda de peso. No primeiro caso, o ecocardiograma transtorácico mostrou coarctação da aorta e o ecocardiograma transesofágico revelou vegetações na área pós-coarctação, sem pseudoaneurismas. A hemocultura foi positiva para de Streptococcus mitis. Este paciente foi tratado por seis semanas com penicilina cristalina, resolvendo a infecção sem complicações. O segundo caso foi avaliado pela presença de hipertensão arterial, com história de febre tratada com antibióticos. Ao realizar o ecocardiograma transtorácico, observou-se coarctação da aorta com imagem sacular classificada como pseudoaneurisma pela angiografia e tomografia. A hemocultura foi negativa. O paciente desenvolveu um episódio de hematêmese, cuja etiologia inicial não pôde ser determinada. Antes da correção cirúrgica, apresentou um segundo episódio de hematêmese profusa, com choque hipovolêmico e óbito. Comentários: Devemos ter um alto índice de suspeição clínica para poder estabelecer o diagnóstico de coarctação da aorta complicada com endarterite e iniciar o tratamento antibiótico adequado. É preciso manter a vigilância para a detecção precoce de pseudoaneurismas.

Vaccinium meridionale Swartz Supercritical CO2 Extraction: Effect of Process Conditions and Scaling Up.

Vaccinium meridionale Swartz (Mortiño or Colombian blueberry) is one of the Vaccinium species abundantly found across the Colombian mountains, which are characterized by high contents of polyphenolic compounds (anthocyanins and flavonoids). The supercritical fluid extraction (SFE) of Vaccinium species has mainly focused on the study of V. myrtillus L. (blueberry). In this work, the SFE of Mortiño fruit from Colombia was studied in a small-scale extraction cell (273 cm³) and different extraction pressures (20 and 30 MPa) and temperatures (313 and 343 K) were investigated. Then, process scaling-up to a larger extraction cell (1350 cm³) was analyzed using well-known semi-empirical engineering approaches. The Broken and Intact Cell (BIC) model was adjusted to represent the kinetic behavior of the low-scale extraction and to simulate the large-scale conditions. Extraction yields obtained were in the range 0.1%-3.2%. Most of the Mortiño solutes are readily accessible and, thus, 92% of the extractable material was recovered in around 30 min. The constant CO2 residence time criterion produced excellent results regarding the small-scale kinetic curve according to the BIC model, and this conclusion was experimentally validated in large-scale kinetic experiments.

Setting Up an ECMO Program in a South American Country: Outcomes of the First 104 Pediatric Patients.

BACKGROUND: Less than 1% of the extracorporeal life support organization (ELSO) registry patients are from South America. Extracorporeal membrane oxygenation (ECMO) is an expensive therapy not only in terms of direct financial cost but also with respect to technical and human resources. Finding a successful ECMO model that developing countries can afford is critical to the expansion of therapy to include the availability of this technology for patients in the developing world. METHODS: We retrospectively studied the first 104 pediatric ECMO patients in the Fundacion Cardiovascular de Colombia between May 2007 and May 2013. We collected the ELSO registry data from electronic medical records to determine the survival rate, mortality risk factors, and complications in pediatric patients who received ECMO support for cardiac failure, respiratory failure, or ECMO for extracorporeal cardiopulmonary resuscitation in the setting of refractory cardiopulmonary resuscitation. We describe our model of ECMO care regarding staff, training process, care protocol, ECMO circuit, and costs. RESULTS: Of 104 patients, 82 were diagnosed with congenital heart disease. Of those, 50 had biventricular and 32 had univentricular physiology, with a significantly higher survival rate at discharge in the biventricular group (44% vs 18.7%, odds ratio [OR] 3.6, 95% confidence interval [CI] = 1.28-10.52, P = .01). Pediatric patients with a cardiac indication had survival rates of 76.3% at weaning and 52.6% at discharge, which is roughly comparable to those reported by the ELSO in 2013. Univentricular physiology, ECPR, severe pre-ECMO acidosis, ECMO-associated renal failure, and duration of ECMO support were factors associated with increased mortality. CONCLUSION: Despite limited availability of technical and economic resources, ECMO therapy can be done successfully in a developing country. A model of care based on nurses as ECMO specialists, supported by a multidisciplinary team, is cost-effective.

Conocimientos sobre prevención y factores de riesgo para cáncer de cuello uterino en un centro de educación técnica / Knowledge about prevention and risk factors for cervical cancer in a technical education center

Introduction: Cervical cancer is a public health problem. Objective: To determine the level of knowledge about prevention and risk factors for cervical cancer in women of a technical institute in the city of Cali, Colombia. Methods: Cross-sectional study with the participation of 131 women enrolled in any of the academic programs of the educational institution, to whom a structured survey was applied. Results: The general average of positive answers was 51.7%. The correct knowledge on prevention was calculated in 86.1%, while the knowledge of risk factors was estimated in 34.6%. Conclusions: We found a high level of knowledge regarding cytology and the vaccine against human papillomavirus in questions of preventive methods, but the knowledge on risk factors for the development of cervical cancer was low. These deficiencies could be related to low socioeconomic and academic levels in the population studied.

Introducción. El cáncer de cuello uterino es un importante problema de salud pública. Objetivo. Determinar el grado de conocimiento sobre prevención y factores de riesgo para cáncer de cuello uterino en mujeres de un instituto de educación técnica de la ciudad de Cali, Colombia. Métodos. Estudio de corte transversal, con la participación de 131 mujeres matriculadas en cualquiera de los programas académicos de la institución educativa, a quienes se les aplicó una encuesta estructurada. Resultados. El promedio general de respuestas positivas fue 51,7%. La media de acierto de las variables de conocimiento sobre prevención se calculó en 86,1%, mientras que el promedio de acierto de las variables sobre factores de riesgo se estimó en 34,6%. Conclusiones. Se encontró un nivel de conocimiento alto respecto a la citología y la vacuna contra el virus del papiloma humano como métodos de prevención, pero el nivel fue bajo cuando se consideraron los factores de riesgo para el desarrollo de cáncer de cuello uterino. Estas deficiencias podrían estar relacionadas con nivel socioeconómico y académico bajos en la población estudiada.

Nivel de conocimiento sobre soporte vital básico del personal no médico de una institución de salud, Pasto- Colombia, 2017 / Level of knowledge about basic life support of non-medical workers of a health institution at Pasto city- Colombia, 2017

Objetivo: el objetivo de la presente investigación es describir el nivel de conocimiento acerca de soporte vital básico, del personal asistencial no médico del servicio de urgencias de una institución de salud, en la ciudad de Pasto-Colombia,en el año 2017. La parada cardiorrespiratoria corresponde a la interrupción brusca, inesperada y potencialmente reversible de la respiración y la actividad mecánica cardíaca; que requiere de la implementación de medidas de reanimación,cuyo éxito depende del nivel conocimiento y habilidades del personal que la lleva a cabo Materiales y métodos: se realizó un estudio descriptivo de corte transversal. El nivel de conocimiento se determinó mediante un cuestionario diseñado para tal fin. Resultados: se reclutaron en total 58 participantes. En 39,65% de los casos el nivel de conocimiento fue aceptable, mientas que se consideró adecuado en un 41,37% de los casos. Los puntajes fueron más altos en el grupo con capacitación en soporte vital básico o avanzado en los dos años previos. Conclusiones: la capacitación continua en soporte vital, representa una estrategia que conlleva a la obtención de mejores niveles de conocimiento en reanimación cardiopulmonar que, posiblemente impacten, en los desenlaces del paro cardíaco intrahospitalario..(AU)

Objective: the aim of the present investigation is to describe the level of knowledge of non-medical workers of the emergency service of a health institution at city of Pasto-Colombia in 2017. Cardiorespiratory arrest is the abrupt, unexpected and potentially reversible interruption of respiration and the mechanical activity of the heart; which requires the implementation of resuscitation measures, whose success depends on the level of knowledge and skill level of the staff that carries it out. Materials and methods: a cross-sectional study was permormed. The level of knowledge was determined through a questionnaire designed for that purpose. Results: a total of 58 participants were recruited. In 39.65% of cases, the level of knowledge was acceptable, while it was considered adequate in 41.37% of the cases. Scores were higher in the group with basic or advanced life support training in the previous two years. Conclusions: continuous training in life support represents a strategy that leads to obtaining better levels of knowledge in cardiopulmonary resuscitation that, possibly, impacts the outcomes of in-hospital cardiac arrest..(AU)

[HIV/AIDS prevalence in Medellin and presumptive test diagnostic accuracy (2006-2012)]. / Prevalencia de VIH/Sida en Medellín y evaluación del desempeño de la prueba presuntiva, 2006-2012.

OBJECTIVE: Determining HIV/AIDS prevalence in Medellin, Colombia, and its association with demographic factors2006-2012,as well as exploring screening test performance. METHODS: This was a cross-sectional study involving 5,851subjects. Descriptive statistics were used to describe the population (i.e. frequencies and summary measures); infection prevalence was calculated and its association with demographic factors identified by using parametric and non-parametric statistical tests, prevalence ratios and odds ratios. Predictive values were calculated, as were the percentage of false results and percentage of subjects correctly diagnosed. RESULTS: Mean age was 27 years old (0 to 94 year range); 70.5% of the population were female. HIV/AIDS prevalence was found to be 1.8% during the study period (0.32% annually). A statistical association was found with gender and age, a higher prevalence being found in males and adults. The false positive rate was 0.7%, negative predictive value100%, positive predictive value 71% and there was 99% overall efficiency. CONCLUSION: HIV/AIDS prevalence found in this study was significantly higher than that found in other studies in the Antioquia department and for Colombia overall. The male and female infection prevalence ratio revealed increased diagnosis in women. The screening test performed well in areas having less than 1% infection prevalence.

Efecto del tiempo de almacenamiento sobre propiedades fisicoquímicas y antioxidantes de productos derivados del fruto agraz (Vaccinium meridionale Swartz) / Effect of storage time on the physicochemical properties and antioxidants of products derived of andean berry (Vaccinium meridionale Swartz)

Antecedentes: Agraz es una baya globosa, de color púrpura intenso cuando está madura. Posee alta capacidad antioxidante comparada con bayas del mismo género, atribuido al contenido de compuestos polifenólicos. Objetivo: Evaluar la composición, actividad antioxidante y algunos parámetros microbiológicos de pulpa de agraz congelada (PAC) y pulpa de agraz liofilizada (PAL) y analizar su comportamiento durante 60 días de almacenamiento. Métodos: Se midieron pH, °Brix, acidez titulable, % humedad, cenizas, grasa, proteína, carbohidratos, calorías totales y actividad acuosa a intervalos de 15 días durante el almacenamiento. En las mismas condiciones se determinó el contenido de fenoles y antocianinas totales mediante Folin-Ciocalteau y método diferencial de pH, respectivamente. La actividad antioxidante mediante FRAP y ORAC. Resultados: no presentaron diferencias estadísticas significativas (p>0,05) durante el almacenamiento en pH, °Brix, aw (liofilizado), % humedad, grasa, cenizas, carbohidratos y calorías totales para PAC y PAL, indicando estabilidad de éstas variables a través del tiempo de almacenamiento. La acidez titulable expresada en mg de ácido cítrico/ml, varió significativamente (p < 0,05) a través del tiempo de almacenamiento para PAC y PAL entre 1,65-1,82 y 4,66-4,79 respectivamente. La proteína varió durante el almacenamiento para PAC y PAL entre 1,25-2,10 g y 4,70-5,20 g, y se observó para ambos un aumento significativo entre el día 15 y 60 de almacenamiento. PAC y PAL presentaron pérdidas significativas del contenido de antocianinas, fenoles totales y valor FRAP durante el almacenamiento; sin embargo la PAL conservó hasta el día 60 alto contenido de fenoles totales: 1046 mg eq de ácido gálico/100g), antocianinas totales: 82,64 (mg eq de cianidin-3-glicosido/100g), capacidad reductora (FRAP): 1032,17 mg de equivalentes de ácido ascórbico/100g y valor ORAC 33935 µmol de equivalentes de Trolox/100g. Conclusión: las variables fisicoquímicas analizadas en la PAL fueron estables y se conservó el contenido de compuestos polifenólicos por mayor tiempo comparado con la PAC. Considerando que el agraz tiene dos temporadas de cosecha al año en Colombia (mayo y diciembre), la liofilización es una estrategia que permitirá al productor abastecimiento constante de la fruta para el mercado.

Background: Andean berry is a globose berry, deep purple when it reaches its highest degree of maturity. It fruit has a high antioxidant capacity compared to other Vaccinum berries, attributed to the content of polyphenolic compounds. Objectives: To evaluate the composition, antioxidant activity and some microbiological parameters of frozen pulp of Andean berry (PAC) and freeze-dried pulp of Andean berry (PAL) and analyze their behavior during 60 days of storage. Methods: the variables pH, ° Brix, titratable acidity, % moisture, ash, fat, protein, carbohydrates, total calories and water activity (lyophilized) were measured at intervals of 15 days during storage. Under the same conditions the content of phenols and total anthocyanins by Folin-Ciocalteu and pH differential method respectively was determined. The antioxidant activity by FRAP and ORAC. Results: There were no significant differences (p>0,05) during storage in pH, ° Brix, Aw (lyophilized), % moisture, fat, ash, carbohydrates and total calories for PAC and PAL indicating stability of these variables over time storage. Titratable acidity expressed in mg citric acid/ ml, varied significantly p (<0.05) over time storage for PAC and PAL between 1.65 to 1.82 and 4.66 to 4.79 respectively. The protein varied during storage for PAC and PAL between 1.25 to 2.10 g and 4.70 to 5.20 g, and was observed for both a significant increase between day 15 and 60 of storage. PAC and PAL showed significant losses of anthocyanins, total phenols and FRAP value during storage; however the PAL retained until day 60 high content of total phenols: 1046 (mg gallic eq/100 g acid), anthocyanins: 82.64 (mg eq of cyanidin-3-glucoside/100g), reducing capacity (FRAP): 1032.17 mg ascorbic acid equivalents /100 g and ORAC value 33935 umol equivalents Trolox/100g. Conclusions: physicochemical variables analyzed in the PAL were stable and content of polyphenolic compounds retained for longer compared to PAC. Whereas Andean berry has two growing seasons a year in Colombia (May and December), freezedried is a strategy that will allow the producer constant supply of fruit on the market.

Programa de rehabilitación integral en pacientes con dolor cronico de espalda: un estudio de caso / Rehabilitation program in patients with chronic back pain: a case study

La utilización de estrategias combinadas para el manejo de pacientes con dolor crónico, ha demos-trado eficacia en su recuperación. Este trabajo tiene como objetivo mostrar la aplicación de abor-dajes psicológicos y fisioterapéuticos en la rehabilitación de un paciente masculino de 62 años con dolor crónico de espalda. Las estrategias fisioterapéuticas aplicadas se basaron en la aplicación de técnicas Tens, Ultrasonido, ejercicios de balonterapia, ejercicios isométricos e isotónicos, medios físicos, técnica de Mckenzy y ejercicios de cadenas cinética, las cuales se suministraron con una duración de 1 hora por cada sesión diaria, durante un periodo de 15 días y el efecto del tratamien-to aplicado se evaluó mediante la valoración de problemas osteomusculares (OM). El tratamiento psicológico de acompañamiento se basó en un entrenamiento cognitivo conductual (ECC) sumi-nistrado con una periodicidad semanal; el nivel de mejora de vida del paciente fue medido con la escala de ansiedad Hamilton, y el cuestionario de estrategias de afrontamiento (CIQ) y Euro-gol. Las valoraciones fisioterapéuticas se aplicaron antes, durante y después del tratamiento, mientras que las valoraciones psicológicas se aplicaron antes y después, y demostraron una rehabilitación integral eficiente; disminuyendo el dolor crónico de espalda, aumentando la movilidad y mejoran-do la calidad de vida al disminuir los índices de dolor a la palpación y al movimiento, medida en escala numérica de Borg. Igualmente se observó disminución en el índice de discapacidad lumbar de Oswestry, disminución en los niveles de ansiedad y recuperación total del paciente lo que de-muestra que la rehabilitación integral del paciente fue eficaz.

The use of combined strategies for the management of patients with chronic pain has shown effectiveness in recovery, so this work shows the application of psychological approaches and physiotherapy in the rehabilitation of a 62 year old male patient with chronic back pain. The applied physiotherapy strategies were based on the application of techniques such as Tens, Ul-trasound, balloon-therapy exercises, isometric and isotonic exercises, physical mediums, the McKenzy technique and kinetic chain exercises, which were provided as one hour long daily session, for a period of 15 days and the effect of the applied treatment was evaluated by assessing musculoskeletal problems (OM). The accompanying psychological treatment was based on a cognitive behavioral training (ECC) that was performed weekly; the level of life improvement of the patients was measured with the Hamilton anxiety scale, the coping strategies questionnaire (CIQ) and Euro-gol. The physiotherapy assessments were applied before, during and after the treatment, while psychological assessments were applied before and after and showed an efficient complete rehabilitation, reducing chronic back pain, increasing mobility and improving quality of life by reducing the indexes of tenderness to pain and movement, with the Borg numerical scale. Furthermore, it was observed that the lumbar disability index of Oswestry also decreased, as well as the anxiety levels and there was a total patient recovery demonstrating that comprehen-sive patient rehabilitation was effective.

Dinámica de nutrientes en plantaciones forestales de Azadirachta indica (Meliaceae) establecidas para restauración de tierras degradadas en Colombia / Nutrient dynamics in forest plantations of Azadirachta indica (Meliaceae) established for resto- ration of degraded lands in Colombia

Azadirachta indica is a tree species which use is steadily increasing for restoration of tropical and subtropical arid and degraded lands throughout the world. The objective of this research study was to evaluate the potential of these plantations as an active restoration model for the recovery of soils under desertification in arid lands of Colombia. Litter traps and litter-bags were installed in twenty 250m² plots. Green leaves and soil samples inside and outside this species plantations were taken, and their elemental concentrations were determined. Litterfall, leaf litter decomposition and foliar nutrient resorption were moni- tored for one year. The annual contributions of organic material, such as fine litterfall, represented 557.54kg/ha, a third of which was A. indica leaves. The greatest potential returns of nutrients per foliar litterfall were from Ca (4.6kg/ha) and N (2.4kg/ha), and the smallest potential returns came from P (0.06kg/ha). A total of 68% of the foliar material deposited in litter-bags disappeared after one year. The greatest release of nutrients was that of K (100%), and the least was that of N (40%). P was the most limiting nutrient, with low edaphic availability and high nutrient use efficiency from Vitousek´s index (IEV=3176) and foliar nutrient resorption (35%). Despite these plantations are young, and that they have not had forestry management practices, as an active restoration model, they have revitalized the biogeochemical cycle, positively modifying the edaphic parameters according to the increases in organic material, P and K of 72%, 31% and 61%, respectively. Furthermore, they improved the stability of aggregates and the microbe respiration rates. The forest plantation model with exotic species has been opposed by different sectors; however, it has been acknowledged that these projects derive many benefits for the restoration of biodiversity and ecosystemic functions. The conditions of severe land degradation demand the initial use of species, such as A. indica, that can adapt quickly and successfully, and progressively reestablish the biogeochemical cycle.

Azadirachta indica A. Juss (Nim) ha sido ampliamente empleada en procedimientos de restauración, por lo tanto se evaluó el potencial de sus plantaciones para restaurar tierras secas degradadas por sobrepastoreo, vía reactivación del ciclo biogeoquímico. En 20 parcelas de 250m², se instalaron trampas de hojarasca y litter-bags. Se tomaron muestras de hojas maduras y de suelos dentro y fuera de las plantaciones, y se determinaron sus contenidos elementales. Fueron monitoreados la caída de hojarasca, la descomposición de hojarasca y la reabsorción de nutrientes foliares durante un año. Los aportes anuales de hojarasca fina representaron 557.54kg/ha (33% hojas de Nim). Los mayores retornos potenciales de nutrientes vía foliar fue- ron de Ca (4.6kg/ha) y N (2.4kg/ha) y los menores de P (0.06kg/ha). El 68% del material se descompuso tras un año. La mayor liberación de nutrientes fue de K (100%) y la menor de N (40%). El P fue el nutriente más limitante, con baja disponibilidad edáfica y alta eficiencia en su uso según el Índice de Vitousek (IEV=3 176) y la reabsorción foliar (35%). Estas plantaciones juveniles demostraron efectividad en la reactivación del ciclo biogeoquímico, que mejoraron parámetros edáficos, según incrementos de materia orgánica, P y K; 72%, 31% y 61%, respectiva- mente. Además mejoraron la estabilidad de agregados y las tasas de respiración microbiana.

Correlación entre la vacunación y lapresencia de anticuerpos protectorescontra el virus de la hepatitis B en personas de la Facultad de Medicina, Universidad Cooperativa de Colombia, Medellín, 2011 / Correlation among vaccination and the presence of protector antibodies anti-hepatitis B virus in the personnel of Universidad Cooperativa de Colombia Medical School-Medellín, 2011

Introducción: El personal de la salud es uno de los principales grupos en riesgo de infeccióncon el virus de la hepatitis B y aunque existe una vacuna recombinante basada en el antígeno desuperficie del virus, no todos los individuos vacunados logran el título de anticuerpos protectores.Objetivo: determinar la relación entre los títulos de anticuerpos contra el antígeno de superficiedel virus de la hepatitis B y el número de dosis de vacuna contra la hepatitis B, en personal dela Facultad de Medicina de la Universidad Cooperativa de Colombia, sede Medellín, en 2011. Materiales y Métodos: se realizó un estudio descriptivo transversal en una muestra probabilísticade 162 personas. La recolección de la información fue a partir de fuente primaria. El análisisestadístico se realizó con base en proporciones, medidas de resumen, estadística paramétrica y noparamétrica. Resultados: el 80% del grupo de estudio presentó anticuerpos en un nivel protector,el promedio del título de anticuerpos fue 396 mUI/mL, éste presentó asociación estadística conel número de dosis y no se observó asociación estadística con el sexo ni la edad. Conclusión: la protección hallada contra el virus de la hepatitis B fue menor a la reportada internacionalmentepara vacunas recombinantes (aproximadamente del 90% al 95% en adultos jóvenes). Esto sepodría atribuir a la inclusión de personas con esquemas de vacunación incompletos o con pobrerespuesta inmunológica a la vacuna, como los hombres, los individuos con alto índice de masacorporal, la edad adulta, la presencia de tabaquismo o los individuos con HLA DR3-DQ2.

Introduction: Health personnel is one of the main risk groups for infection with Hepatitis B virus, andalthough there is a vaccine based on recombinant surface antigen of the virus, not all vaccinatedindividuals reach protective antibody titers. Objective: to establish the relationship between serumtiters of anti-Hepatitis B Virus and the number of doses of vaccine against hepatitis B, in staff of the Medical School at Universidad Cooperativa de Colombia, Medellin, in 2011. Materials and methods:a cross-sectional study in a probability sample of 162 people was conducted. The data collectionwas from primary source. Statistical analysis was made based on proportions, summary measures, parametric and nonparametric statistics. Results: 80% of the study group had protective antibodies, the average antibody titer was 396 mIU/mL, it was statistically associated with the number of doses,and there was no statistical association with sex or age. Conclusion: the protection found againsthepatitis B virus was lower than that reported internationally for recombinant vaccines (approximately 90-95% in young adults). This could be attributed to the inclusion of people with incompletevaccination schedules or poor immune response to the vaccine, such as men, individuals with highbody mass index, adulthood, smoking status, and individuals with HLA DR3-DQ2.