La Defensa Pasiva y su división médica de emergencia / Passive Defense and its emergency medical division / Passive Defence e sua divisão médica de emergência

Durante la Segunda Guerra Mundial el gobierno de Uruguay intentó prepararse para una eventual defensa militar del territorio y la defensa de la población civil en caso de sufrir ataques aéreos. La Defensa Pasiva, fue la estructura gubernamental que junto a la voluntad en todas las clases sociales, funcionó en todo el territorio nacional con la finalidad de proteger a la población civil de los ataques aéreos y guerra química, generando un espíritu de solidaridad a través de su División Médica de Emergencia.

During the Second World War, the government of Uruguay tried to prepare for an eventual military defense of the territory and the defense of the civilian population in case of air raids. The Passive Defense was the governmental structure that, together with the will of every social class, operated throughout the national territory with the purpose of protecting the civilian population from air raids and chemical weapons, generating a spirit of solidarity through its Emergency Medical Division.

Durante a Segunda Guerra Mundial, o governo uruguaio tentou se preparar para uma eventual defesa militar do território e para a defesa da população civil em caso de ataques aéreos. A Defesa Passiva era a estrutura governamental que, juntamente com a vontade de todas as classes sociais, operava em todo o território nacional com o objetivo de proteger a população civil de ataques aéreos e da guerra química, gerando um espírito de solidariedade por meio de sua Divisão Médica de Emergência.

Consecuencias de los conflictos armados en la salud mental de niños y adolescentes: revisión de revisiones de la literatura / Mental health consequences of armed conflicts in children and adolescents: An overview of literature reviews

Resumen Introducción. Los conflictos armados dejan consecuencias evidentes en la salud mental de la población infantil y adolescente. En ese marco, se ha documentado una serie de situaciones que tienen como factor común la vulnerabilidad de esta población y las afectaciones biopsicosociales significativas. Objetivo. Determinar y sintetizar las diferentes consecuencias de los conflictos armados en la salud mental de la población infantil y adolescente. Materiales y métodos. Se realizó una búsqueda sistemática exhaustiva de revisiones bibliográficas hasta julio de 2019 en las bases de datos MEDLINE (Ovid), EMBASE, Cochrane Central Register of Controlled Trials, LILACS y otras. Se seleccionaron los artículos y se analizaron de forma narrativa sus características, objetivos y consecuencias en salud mental en tres momentos: antes del conflicto, durante el conflicto y en el posconflicto. Resultados. De un total de 587 artículos potencialmente relevantes, se seleccionaron 72. En los estudios sobre el periodo anterior al conflicto, se detallaron experiencias psicológicas y síntomas somáticos anticipatorios. Durante el conflicto, se evidenciaron síntomas regresivos, conductuales y cognitivos, como enuresis, miedo, tristeza, agresión, hiperactividad e inatención, entre otros. Además, se establecieron consecuencias directas, como trastornos de adaptación, depresión, ansiedad y, en mayor medida, estrés postraumático. Por último, en el posconflicto, se recopiló la información sobre los procesos de transmisión de las consecuencias y la resiliencia. Por otro lado, se profundizó en las consecuencias potenciales en el desarrollo biopsicosocial, la moralidad, la identidad, el contexto, la cultura, la educación y la sociedad. Conclusiones. Las consecuencias de los conflictos armados en la salud mental se inscriben en un proceso complejo que se expresa en función de la etapa evolutiva de la exposición, del tiempo del conflicto armado y de los factores contextuales.

Abstract Introduction: Armed conflicts affect the mental health of children and adolescents. Their outcomes in these populations have been documented identifying vulnerability and significant biopsychosocial damage as the most common factors. Objective: To identify and synthesize the mental health consequences of armed conflicts in children and adolescents. Materials and methods: We carried out a comprehensive and systematic search of reviews published until July 2019 in the MEDLINE (Ovid), EMBASE, Cochrane Central Register of Controlled Trials, and LILACS databases, as well as in additional sources. The information was retrieved and analyzed narratively by describing the characteristics and objectives of the studies and the mental health consequences of armed conflicts in three periods of time: pre-armed conflict, during the armed conflict, and post-conflict. Results. Out of 587 potentially relevant studies, we finally selected 72. In the pre-armed conflict period, we described in detail the psychological experiences and the anticipatory somatic symptoms. During the conflict, we identified regressive, behavioral, and cognitive symptoms such as enuresis, fear, sadness, aggression, hyperactivity, and inattention, among others. Direct mental health consequences such as adjustment disorders, depression, anxiety, and post-traumatic stress were also identified. Finally, in the post-conflict period, we referred to the transmission of mental health consequences and resilience processes. On the other hand, we reviewed in depth the potential consequences of armed conflicts on biopsychosocial development, morality, identity, culture, education, and society. Conclusion. The development of mental health consequences due to the exposure to armed conflicts in these populations is a complex process that depends on the stage of the exposure, the length of the conflict, and contextual factors.

Eficacia de los agentes hemostáticos para el control de hemorragias externas en sanidad militar / Effectiveness of hemostatic agents to control external bleeding in military health

Introducción: Es creciente el uso de nuevos agentes hemostáticos para controlar la hemorragia en entornos militares. Objetivos: Sintetizar y analizar la evidencia disponible sobre la eficacia de diferentes agentes hemostáticos utilizados en ambientes tácticos, transportados por los combatientes del ejército. Desarrollo: Se realizó una revisión narrativa de artículos publicados en inglés y español, en las bases de datos Medline (PubMed), Cochrane, Web of Science y en revistas, protocolos, libros y manuales del ámbito de urgencias y emergencias en el campo de batalla, que analizaron el fenómeno de estudio y cumplieron los criterios de inclusión y exclusión. Tras la búsqueda y selección de los estudios, 7 artículos fueron incluidos en la síntesis narrativa. En los estudios se utilizaron los siguientes agentes hemostáticos QuikClot®, HemCon®, Celox® y el ChitoGauze HemCon®; en la mayoría de los estudios, los agentes hemostáticos tuvieron una eficacia superior al 88 por ciento para detener, disminuir y controlar la hemorragia externa en víctimas de combate, sobre todo en zonas de unión (articulaciones) y para reducir la morbilidad y mortalidad. Solo QuikClot® tuvo efectos secundarios negativos, al provocar quemaduras. El correcto manejo de los agentes hemostáticos requiere de formación previa, lo que evita errores de administración. Conclusiones: Los agentes hemostáticos son eficaces para el abordaje de la hemorragia externa y aumentan la supervivencia en víctimas de combate. Es necesario formar a los profesionales para evitar errores en su manejo. Futuros estudios deben indagar cuál de estos agentes es más eficaz(AU)

Introduction: The use of new hemostatic agents to control hemorrhage in military environments is growing. Objectives: To synthesize and analyze the available evidence about the effectiveness of the different hemostatic agents utilized in tactical environments that are transported by army fighters. Development: A narrative review of articles published in English and Spanish, in Medline (PubMed), Cochrane and Web of Science, and magazines, protocols, books, and manuals in the field of emergency and battlefield emergencies, who analyzed the study phenomenon and met the inclusion and exclusion criteria. After searching and selecting the studies, 7 articles were included in the narrative synthesis. In the studies, the following hemostatic agents were used QuikClot®, HemCon®, Celox®, and ChitoGauze HemCon®, in most studies, hemostatic agents were more than 88 percent effective in stopping, reducing, and controlling external hemorrhage in combat victims, especially in union areas, also decreasing morbidity and mortality. Only QuikClot® had negative side effects causing burns. The correct handling of hemostatic agents requires prior training, which avoids administration mistakes. Conclusions: Hemostatic agents are effective for treating external hemorrhage in combat victims and increasing their survival. It is necessary to train professionals to avoid mistakes in their handling. Future studies should investigate which of these agents is more effective(AU)

Trauma urbano moderno en Caracas / Modern urban trauma in Caracas

A principios del nuevo milenio surgió el concepto del "Trauma urbano moderno", sustentando en la experiencia de varios conflagraciones en zonas densamente pobladas. Fue definido como un conflicto violento, cerrado, con heridas destructivas y de difícil acceso para su evacuación. Su manejo incluyo el cuestionamiento de viejos dogmas y la incorporación de nuevas estrategias. El motín del reten "La Planta", el incremento en las detonaciones por granadas fragmentarias y los graves enfrentamientos entre bandas delictivas o contra cuerpos de seguridad, en diversas zonas de Caracas indican el establecimiento de una modalidad mas agresiva de violencia. Los cirujanos capitalinos se enfrentan con más frecuencia a lesiones severas y múltiples. El personal medico requiere la adecuada comprensión y preparación para afrontar este nuevo tipo de heridas. La reciente enfermedad Covid 19 representa un desafió agregado en el abordaje de los pacientes con traumatismos(AU)

The experience in many combats in densely populated urban areas, determined the new concept of "Modern urban warfare" in the beginning of the new millennium. This definition is a warfare violent, close-quarter, with destructive injuries and the delayed of evacuation. New innovations were incorporate. The revolt in the "La Planta" prison, the increase of grenades explosions and engagement between criminal organized, in many zones of Caracas, illustrated this new definition. The venezuelans surgeons attended many severe and multiple injuries. The surgical personal need understand this new kind of injuries. The new disease Covid 19 represents a challenge in the attention of these patients(AU)

Desafíos nacionales frente a la ciberseguridad en el escenario global: un análisis para Colombia / National Challenges for Cybersecurity on a Global Level: an Analysis for Colombia / Desafios nacionais da cibersegurança no cenário global: uma análise para a Colômbia

Resumen En este artículo se aborda el tema de la seguridad de la información frente a amenazas cibernéticas en un contexto global, haciendo una revisión de la situación actual en Colombia. Mediante una investigación cualitativa, teórica, documental y descriptiva, se hace un recorrido histórico sobre la ciberseguridad (ciberguerra, ciberdefensa, delitos informáticos), particularmente en el componente de seguridad de la información, y se trabajan diversos aspectos al respecto (contextos, análisis de riesgos, sistemas de gestión y estándares de calidad) mientras se muestran los riesgos para las empresas, la sociedad y los países, evidenciados con la pandemia del coronavirus (COVID-19). Para el caso colombiano se revisaron datos sobre las acciones gubernamentales ante estas amenazas y se indagó sobre sus políticas de seguridad informática y estándares de calidad. Al final del artículo se muestran los retos que tiene Colombia frente a las amenazas cibernéticas, en cuanto a la seguridad de la información.

Abstract This article covers the topic of information security in light of cybersecurity threats in a global context, reviewing the current situation in Colombia. A historical walk-through on cybersecurity was performed through qualitative, theoretical, documentary and descriptive research (cyberwar, cyberdefense, computer crime), particularly in the component of information security. In addition, various aspects in that regard were worked on (contexts, risk analyses, management systems and quality standards), while risks to businesses, society and countries are shown, demonstrated with the coronavirus (COVID-19) pandemic. In the case of Colombia, data on government action in light of these threats were reviewed and its information security policies and quality standards were researched. Colombia's challenges from cybersecurity threats, in terms of information security, are shown at the end of the article.

Resumo Este artigo aborda o tema da segurança da informação contra ameaças cibernéticas em um contexto global, fazendo uma revisão da situação atual na Colômbia. Através de uma pesquisa qualitativa, teórica, documental e descritiva, faz-se um percurso histórico sobre a cibersegurança (ciberguerra, ciberdefesa, crimes informáticos), particularmente no componente de segurança da informação, e trabalham-se vários aspectos a este respeito (contextos, análise de riscos, sistemas de gestão e padrões de qualidade), enquanto mostram-se os riscos para as empresas, a sociedade e os países, evidenciados pela pandemia de coronavirus (COVID-19). No caso colombiano, foram revisados dados sobre as ações do governo diante dessas ameaças e foi feita uma pesquisa sobre as políticas de segurança informática e padrões de qualidade. Os desafios que a Colômbia enfrenta diante das ameaças cibernéticas, em termos de segurança da informação, são mostrados ao final deste artigo.

Mulheres em tempos de pandemia: um ensaio teórico-político sobre a casa e a guerra / Mujeres en tiempos pandémicos: un ensayo teórico-político sobre la casa y la guerra / Women in a pandemic context: a theoretical-political essay about house and warfare

Resumo Nesse ensaio, objetivamos pensar a pandemia a partir da situação das mulheres. Para tanto, analisamos o modo como a crise sanitária aciona teórico-politicamente noções sobre a casa e a guerra, tomadas como dispositivos de análise. A casa tenciona fronteiras entre público e privado, principalmente ao olharmos para a violência contra mulheres e para o trabalho doméstico. A guerra, estratégia que tem sido usada para pensar o combate ao coronavírus, aciona masculinidades afastando as mulheres dos espaços de decisões políticas para enfrentamento da pandemia, apesar de estarem na linha de frente como trabalhadoras da saúde e em outros serviços essenciais. Entretanto, a gramática bélica também possibilita a denúncia de ataques às mulheres em tempos de crise. Nos usos destes dispositivos, identificamos modos de direcionar a comoção social e hierarquizar vidas. Atentamos para a importância de transversalizar a perspectiva de gênero na construção de políticas públicas durante e pós-pandemia.

Resumen En este ensayo, nuestro objetivo es pensar la pandemia desde la situación de las mujeres. Con este fin, analizamos la forma en que la crisis de salud desencadena nociones teóricas y políticas sobre la casa y la guerra, tomadas como dispositivos de análisis. La casa tiene la intención de establecer límites entre lo público y lo privado, especialmente cuando se analiza la violencia contra las mujeres y el trabajo doméstico. La guerra, una estrategia para pensar en combatir el coronavirus, desencadena las masculinidades al alejar a las mujeres de los espacios de toma de decisiones políticas para enfrentar la pandemia, a pesar de estar en primera línea como trabajadoras de la salud y en otros servicios esenciales. Sin embargo, la gramática de la guerra también permite denunciar los ataques contra las mujeres en tiempos de crisis. En los usos de estos dispositivos, hemos identificado formas de dirigir la conmoción social y jerarquizar vidas. Señalamos la importancia de incorporar la perspectiva de género en la construcción de políticas públicas durante y después de la pandemia.

Abstract In this essay, we aim to think about the pandemic from the women's situation, by analyzing how the health crisis theoretically and politically operates the concepts of house and warfare. The house tenses borders between public and private spheres, especially when considering the issue of violence against women and the domestic work. As the strategy that has been used to combat coronavirus, warfare triggers concepts of masculinity. That withdraws women from political decision-making spaces, even though they are at the forefront fighting the pandemics as health workers and among other essential services. However, the warfare discourse also enables to expose attacks against women during a period if crisis. These devices are being used to direct social commotion and create a hierarchy over which lives matter. Thus, we highlight the importance of reading gender relations as a transversal issue in the construction of public policies during and after the pandemic.

Naturaleza del acceso a los servicios de salud mental de la población adulta víctima del conflicto armado en Colombia / Access to mental health services by the adult population victim of the armed conflict in Colombia / Natureza do acesso a serviços de saúde mental da população adulta vítima do conflito armado na Colômbia

Introducción. La salud es un derecho fundamental que, además de jugar un papel muy importante por su valor, cumple una función significativa en el desarrollo humano y social. En Colombia, la población víctima del conflicto armado es considerada vulnerable en este aspecto, pues tiene una alta probabilidad de padecer problemas mentales, los cuales, según sugieren algunos estudios, están asociados a determinantes individuales, organizacionales y sociales; además, el acceso a los servicios de salud mental en esta población es limitado. Objetivo. Realizar una revisión documental de la naturaleza del acceso a los servicios de salud mental en la población adulta víctima del conflicto armado en Colombia.Discusión. Los factores asociados al acceso a los servicios de salud mental de la población adulta víctima del conflicto armado pueden abordarse de acuerdo con tres dimensiones: disposición de los servicios de salud, barreras de acceso a los servicios de salud mental y resultados en materia de salud. Los principales hallazgos del presente estudio revelan que, a diferencia de la población general, las víctimas del conflicto armado presentan mayores dificultades en las barreras personales y económicas para acceder a los servicios de salud mental, barreras que incluyen el desconocimiento de los servicios de salud y la dificultad en la articulación intersectorial. Conclusiones. El acceso a los servicios de salud mental en la población general continúa mostrando dificultades debido a barreras de diferente orden: personales, económicas, geográficas, organizacionales y socioculturales, barreras que de igual forma se exacerban en población víctima del conflicto armado.

Introduction: Health is a fundamental right that in addition to playing a very important role for its own value, plays a significant role in human and social development. In Colombia, the population victim of the conflict is considered vulnerable and has a high probability of suffering from mental problems. Access to mental health services in this population is limited and studies are based on their individual, organizational and social determinants. Objective: Make a documentary review of the nature of access to mental health services for the adult population victim of armed conflict.Discussion: The factors associated with access to mental health services for the adult population victim of the armed conflict can be addressed according to the following dimensions: Disposition of health services, barriers to access to mental health services and results in health matter. The main findings reveal that, unlike the general population, victims of the armed conflict have greater difficulties in personal and economic barriers, which include ignorance about health services and, difficulty in the articulation of actions among organizations. Conclusions: Access to mental health services in the general population continues to show difficulties due to barriers of different order: personal, economic, geographical, organizational and sociocultural. These barriers are exacerbated in the population victim of the armed conflict.

Introdução. A saúde é um direito fundamental que, além de desempenhar um papel muito importante, desempenha um papel significativo no desenvolvimento humano e social. Na Colômbia, a população vítima do conflito armado é considerada vulnerável a esse respeito, visto que possui alta probabilidade de sofrer problemas mentais, associados a determinantes individuais, organizacionais e sociais. Porém, o acesso aos serviços de saúde mental nessa população é limitado. Objetivo. Realizar uma revisão documental do acesso a serviços de saúde mental na população adulta vítima do conflito armado na Colômbia.Discussão. Os fatores associados ao acesso a serviços de saúde mental da população adulta vítima do conflito armado podem ser abordados a partir de três dimensões: prestação de serviços de saúde, barreiras ao acesso a serviços de saúde mental e resultados de saúde. Os principais achados deste estudo revelam que, diferentemente da população em geral, as vítimas do conflito armado apresentam maiores dificuldades nas barreiras pessoais e econômicas ao acesso aos serviços de saúde mental, barreiras que incluem o desconhecimento dos serviços de saúde e a dificuldade institucional da articulação intersetorial.Conclusões. O acesso aos serviços de saúde mental na população em geral continua mostrando dificuldades devido a barreiras dpo tipo: pessoal, econômica, geográfica, organizacional e sociocultural (2,3), barreiras que são igualmente exa-cerbadas na população vítima do conflito armado.

Early Detection of Bacillus anthracis From Saliva in Anticipation of a Bioterrorism Attack

Objective: To assess potential for early detection of oral infection by B. anthracis spores for preparedness of a bioterrorism attack. Material and Methods: The laboratory study used saliva with a range of initial anthrax concentrations, to compare detection by direct observation from conventional blood agar culture and by anthrax-specific PCR after a shorter culture in BHI broth. Three types of saliva were collected: stimulated saliva, unstimulated/whole saliva, and unstimulated/whole saliva with antibiotic treatment (for negative control). Using bivariate Kruskal-Wallis and Mann-Whitney tests for statistical analysis for factors that could affecting anthrax detection, significant differences between the test groups was assumed at p<0.05. Results: From unstimulated whole saliva heat shock treated at 62.50C, B. anthracis growth was detected with both methods. PCR detection from a BHI broth culture could shorten the time to diagnosis in comparison to conventional culture in blood agar. Conclusion: Saliva can provide useful samples for diagnosis of oropharyngeal anthrax. In comparison to conventional culture on blood agar, shorter-term culture in BHI broth provides potential for earlier detection and diagnosis.

La guerra biológica: un desafío para la humanidad / Biological warfare: a challenge for humanity

RESUMEN Fundamento: el control de enfermedades transmisibles contribuye al empleo ilegítimo de los agentes biológicos, de manera inicial con fines bélicos o criminales y en la actualidad con fines terroristas. Objetivo: describir la problemática del empleo de las armas biológicas, sus diferentes aristas y en su forma actual con fines terroristas y los aspectos que prohíben su uso según la normativa internacional vigente. Métodos: se realizó una revisión bibliográfica con el método de análisis bibliográfico con una búsqueda realizada entre los años 2000 al 2017, donde se consultaron bases de datos especializadas y se seleccionaron 31 publicaciones científicas sobre el tema. Desarrollo: se realizó un análisis del tema de la guerra biológica basado en los agentes utilizados y la amenaza que constituye su empleo, pues provocan enfermedades y causan la muerte al afectar la salud de los seres vivos y el medio ambiente. Son dañinas e incluyen conocimientos de ciencia, tecnología, ingeniería e involucran otras áreas, como la economía, el derecho, el marco jurídico que limita o no la obtención de materiales y los aspectos psicológicos ante tales ataques. Los avances tecnológicos en Biología e Ingeniería genética de las últimas décadas posibilitan modificar y crear nuevos microorganismos más resistentes al tratamiento y en particular en la búsqueda de inoculación de enfermedades como el cáncer. La biodefensa es el conjunto de medidas para la prevención y actuación frente a una alerta sanitaria donde está implicado el uso de los agentes biológicos con fines bélicos. Conclusiones: los agentes biológicos se utilizan como armas para ocasionar daños en circunstancias de guerra biológica y bioterrorismo, por ser de forma potencial el arma más destructiva conocida por la humanidad que implica aspectos políticos, económicos, científico-tecnológicos, jurídicos y psicológicos, por lo que la biodefensa protege a las personas y el medio ambiente con el uso de medidas sanitarias contra dichos agentes.

ABSTRACT Background: the control of transmittable diseases contributes to the illegitimate use of biological agents, initially for war or criminal purposes and currently for terrorist purposes. Objective: to describe the problem of the use of biological weapons, its different edges and in its current form for terrorist purposes and the aspects that prohibit its use according to current international regulations. Methods: a bibliographic review was made with the bibliographic analysis method with a search conducted between 2000 and 2017, where specialized databases were consulted and 31 scientific publications on the subject were selected. Development: an analysis on the issue of biological warfare was made based on the agents used and the threat that constitutes their use, since they cause diseases and cause death by affecting the health of living beings and the environment. They are harmful and include knowledge of science, technology, engineering and involve other areas, such as economics, law, the legal framework that limits or not the obtaining of materials and the psychological aspects of such attacks. The technological advances in Biology and Genetic engineering of recent decades make it possible to modify and create new microorganisms that are more resistant to treatment and in particular in the search for the inoculation of diseases such as cancer. The biodefense is the set of measures for the prevention and action facing a sanitary alert where the use of the biological agents with war aims is implied. Conclusions: biological agents are used as weapons to cause damage in circumstances of biological warfare and bioterrorism, as it is potentially the most destructive weapon known to humanity that involves political, economic, scientific-technological, legal and psychological aspects, which is why biodefense protects people and the environment with the use of sanitary measures against above-mentioned agents.

War is not healthy: political violence and infant health outcomes in Colombia / La guerra no es saludable: violencia politica y sus efectos en la salud infantil en Colombia

ABSTRACT Objectives To establish and quantify the effect of the internal armed conflict in Colombia on infant health, particularly birth weight. Methods This document explores time differences in relation to the impact of the internal armed conflict in Colombia, measured by municipal homicide rates, on infant health, quantified as infant mortality and birth weight. Based on individual data from the 1995 and 2000 Colombian National Demographic and Health Surveys, along with annual municipal data on violence and economic performance, results obtained from two biological siblings are compared using a maternal fixed logistic regression, as one was born in a violent era and the other during a peaceful moment. Results Political violence negatively affected infant health outcomes during the peak of violence experienced by Colombia in the 1990s, with worse outcomes for male infants than for females. Controlling fixed maternal effects shows a three times greater probability of being born with low birth in infants born during increased violence, compared to their siblings born in more peaceful times. Conclusions These results make visible all the effects of intense and long-lasting armed conflicts, as is the case of Colombia, since not only direct actors involved in conflict are affected, but also infants who show worse health outcomes. These results allows targeting policies for reducing the effects on populations in conflict or during the reconstruction period; in this case, the provision of maternal care during the gestational period and special care for newborns in areas under high violence levels should be a priority.(AU)

RESUMEN Objetivos Establecer y cuantificar el efecto del conflicto armado interno en Colombia en la salud infantil, particularmente en el peso al nacer. Métodos Este documento explora las diferencias en el tiempo de la intensidad del conflicto armado interno en Colombia, medido por las tasas de homicidios municipales, sobre la salud infantil, cuantificado como mortalidad infantil y peso al nacer. Mediante el uso de datos individuales de las encuestas nacionales de demografía y salud de Colombia de 1995 y 2000, combinados con datos anuales de nivel municipal sobre violencia y desempeño económico, se confrontan los resultados entre dos hermanos biológicos, uno nacido en una era violenta y otro en un momento pacífico utilizando una regresión logística de control materno. Resultados La violencia política afecta negativamente la salud infantil, lo que se pudo cuantificar durante el pico de violencia que experimentó Colombia en los años 90, con peores resultados para los bebés varones que en sus contrapartes. El control de los efectos fijos maternos muestra una probabilidad significativa tres veces mayor de nacer con bajo peso al nacer para los bebés nacidos durante el aumento de la violencia, en comparación con sus hermanos nacidos en épocas más pacíficas. Conclusiones Estos resultados hacen visibles la totalidad de los efectos de conflictos armados intensos y duraderos, como es el caso colombiano, en donde no sólo los actores directos involucrados en el mismo se ven afectados, sino que también los recién nacidos muestran peores resultados de salud. Los resultados de este estudio permiten focalizar políticas en la reducción de los efectos en poblaciones en conflicto o durante el período de reconstrucción, en este caso se sugiere la provisión de cuidado materno durante el período gestacional y cuidado especial para recién nacidos en áreas de altos niveles de violencia como una prioridad.(AU)

Epigenómica social y conflicto armado: ¿por qué apostarle a la paz? / Social epigenomics and armed conflict: ¿why rooting for peace? / Epigenómica social e conflito armado: o porquê apostar à paz?

This paper presents a summary of the scientific evidence that accounts for the epigenetic effects and their phenotypic ex-pression of exposure to chronic stress environments, typical of populations exposed to armed conflict, considering also the potential implications for the achievement of wellbeing.Materials and methods. A narrative review of the literature of the last 10 years was conducted in Medline, Science Direct and Lilacs databases and repositories of journals such as: Scie-lo and BIREME. An initial filter was carried out through titles and abstracts according to the inclusion and exclusion criteria. Afterwards, full text reading was performed in the selected ar-ticlesResults. 33 articles were obtained for full text reading. Among the main documented effects, the alteration of gene expression to stress was reported through neuronal activation (hypothala-mic-pituitary-adrenal axis) with greater sensitivity to glucocor-ticoids, leading to chronic stress and increased prevalence of non-transmittable chronic diseases.

O presente trabalho apresenta um resumo da evidencia cien-tífica que dá conta dos efeitos epigenéticos e a sua expressão fenotípica da exposição a ambientes de estrese crónico, pró-prios de populações expostas ao conflito armado, consideran-do além das implicações potenciais para atingir um bom viver.Materiais e Métodos. Realizou-se uma revisão narrativa de li-teratura dos últimos 10 anos nas bases de dados Medline e Science Direct e repositórios como SciELO e BIREME. Foram filtrados artigos a traves de critérios de inclusão e exclusão, posteriormente foi realizada uma leitura completa dos tex-to selecionados.Resultados. Foram lidos 33 artigos para leitura de texto com-pleto. Entre os principais efeitos documentados foram repor-tados a alteração da expressão genética ao estresse a través da activação neuronal (eixo hipotálamo -pituitaria- suprarenal) com maior sensibilidade aos glucocorticoides, conducente ao estrese crónico e aumento da prevalência de doenças crónicas não transmissíveis.

El presente trabajo presenta un resumen de la evidencia científica que da cuenta de los efectos epigenéticos y la expresión fenotípica, de la expo-sición a ambientes de estrés crónico, propios de poblaciones expuestas al conflicto armado; considerando, además, las implicaciones potenciales para el logro de un buen vivir.Materiales y métodos. Se hizo una revisión narrativa de la literatura cien-tífica de los últimos 10 años, en bases de datos Medline y Science Direct y repositorios de revistas como SciELO y BIREME. Se llevó a cabo un filtro inicial mediante títulos y resúmenes, de acuerdo con los criterios de inclu-sión y exclusión. Posteriormente, se hizo la lectura del texto completo en los artículos seleccionados.Resultados. Se obtuvieron 33 artículos para lectura de texto completo. Entre los principales efectos documentados, se reportó la alteración de la expresión génica al estrés mediante activación neuronal (eje hipotála-mo-hipófiso-suprarrenal) con mayor sensibilidad a los glucocorticoides, conducente a estrés crónico y aumento de prevalencia de enfermedades crónicas no transmisibles.

Analysis of combat casualties admitted to the emergency department during the negotiation of the comprehensive Colombian process of peace / Análisis de los soldados heridos en combate admitidos al departamento de emergencias durante la negociación del proceso de paz en Colombia

Abstract Aim: Our objective was to describe the variations in casualties admitted to the emergency department during the period of the negotiation of the comprehensive peace agreement in Colombia between 2011 and 2016. Methods: A retrospective study of all hostile military casualties managed at a regional Level I trauma center from January 2011 to December 2016. Patients were subsequently divided into two groups: those seen before the declaration of the process of peace truce (November 2012) and those after (negotiation period). Variables were compared with respect to periods Results: A total of 448 hostile casualties were registered. There was a gradual decline in the number of admissions to the emergency department during the negotiation period. The number of soldiers suffering blast and rifle injuries also decreased over this period. In 2012 there were nearly 150 hostile casualties' admissions to the ER. This number decreased to 84, 63, 32 and 6 in 2013, 2014, 2015 and 2016 respectively. Both, the proportion of patients with an ISS ≥9 and admitted to the intensive care unit were significantly higher in the period before peace negotiation. From August to December/2016 no admissions of war casualties were registered. Conclusion: We describe a series of soldiers wounded in combat that were admitted to the emergency department before and during the negotiation of the Colombian process of peace. Overall, we found a trend toward a decrease in the number of casualties admitted to the emergency department possibly in part, as a result of the period of peace negotiation.

Resumen Objetivo: Describir las variaciones en los soldados heridos en combate admitidos al departamento de emergencias durante el periodo de negociación del proceso de paz colombiano entre el 2011 y el 2016. Métodos: Estudio retrospectivo de todos los soldados heridos en combate que fueron manejados en un centro de trauma desde Enero del 2011 a Diciembre del 2016. Los pacientes se dividieron en dos grupos: aquellos que ingresaron al departamento de emergencias antes de la tregua del proceso de paz (Noviembre 2012) y aquellos que ingresaron durante la negociación. Los grupos se compararon con respecto a los periodos de tiempo. Resultados: Un total de 448 soldados heridos en combate fueron incluidos. Hubo una disminución gradual en el número de admisiones durante el periodo de negociación. Además, el número de soldados que sufrieron heridas por explosiones y fusiles disminuyó durante este periodo. En el 2012 se registraron 150 soldados heridos en combate. Este número disminuyó a 84, 63, 32 y 6 en los años 2013, 2014, 2015 y 2016 respectivamente. La proporción de pacientes con un ISS ≥9 y la proporción de admitidos a la unidad de cuidado intensivo fueron significativamente mayores en el periodo antes de la negociación. Desde Agosto a Diciembre/2016 no se registraron admisiones. Conclusión: Este estudio describe una disminución gradual en el número de soldados heridos en combate admitidos al departamento de emergencia en un periodo de 6 años. Este fenómeno pudo deberse al periodo de negociación del proceso de paz.

História da Cirurgia Plástica: Sir Harold Gillies, pioneiro da cirurgia plástica reconstrutiva / History of plastic surgery: Sir Harold Gillies, a pioneer of reconstructive plastic surgery

Historicamente, as guerras foram um dos maiores catalisadores para o avanço da Medicina, e especialmente da cirurgia. Sem dúvida, a maior autoridade da Cirurgia Plástica nas primeiras décadas do século XX foi o neozelandês radicado na Inglaterra Sir Harold Delf Gillies, que se destacou pelo tratamento de pacientes com lesões faciais no contexto da I Guerra Mundial. Nosso artigo faz uma análise da vida pessoal e do legado que Gillies deixou para a cirurgia plástica e reconstrutiva moderna; muitos de seus ensinamentos são atemporais e servem de reflexão para cirurgiões da atualidade.

Historically, wars have been among the greatest catalysts for advances in medicine in general, and surgery in particular. Without doubt, the greatest practitioner of plastic surgery in the early decades of the twentieth century was Sir Harold Delf Gillies, a New Zealander living in England, who advocated the treatment of patients with facial injuries in the context of the First World War. This article examines Gillies' personal life and the legacy he left for modern plastic and reconstructive surgery; many of his teachings are timeless and serve as an inspiration for the surgeons of today.

Enzimas degradantes de organofosforados: Base molecular e perspectivas para biorremediação enzimática de agroquímicos / Organophosphorus degrading enzymes: Molecular basis and perspectives for enzymatic bioremediation of agrochemicals

RESUMO Muitos compostos organofosforados (OP) são utilizados até hoje na agricultura como pesticidas e, infelizmente, como agentes de guerra química (ou agentes dos nervos) também. Os pesticidas organofosforados e os agentes dos nervos são moléculas extremamente tóxicas, uma vez que atuam como inibidores da enzima Acetilcolinesterase (AChE). O efeito mais preocupante da exposição a estes compostos é a toxicidade colinérgica aguda, ou seja, a perda de coordenação muscular. Uma vez que o indivíduo se contamina, o processo de intoxicação começa através da ligação do OP no sítio ativo da enzima AChE inativando-a. Os tratamentos atuais para pessoas expostas a baixas doses de OP podem ser realizados com atropina, oximas e benzodiazepínicos. Processos de remediação importantes envolvem o emprego de técnicas de biorremediação utilizando diferentes enzimas degradantes, como a Fosfotriesterase da Agrobacterium radiobacter e SMP-30. Devido ao elevado número de intoxicações anualmente, é crucial buscar métodos de tratamento mais potentes e eficazes, e nesta linha, as técnicas envolvendo biorremediação parecem ser bastante promissoras para este propósito.

ABSTRACT Many organophosphorus compounds (OP) are used until today in agriculture as pesticides and, unfortunately, they are used as chemical warfare agents (or nerve agents) as well. Organophosphorus pesticides and nerve agents are extremely toxic molecules, since they act as Acetylcholinesterase (AChE) inhibitors. The most worrying effect of the exposure to these compounds is the acute cholinergic toxicity, which is the loss of muscle coordination. Once one is contaminated, the intoxication process begins through the binding of the OP in the active site of the AChE enzyme inactivating it. Current treatments for people exposed to low doses of OP can be performed with atropine, oximes and benzodiazepines. Important remediation processes involve the employment of bioremediation techniques using different degrading enzymes, such as the Phosphotriesterase from Agrobacterium radiobacter and SMP-30. Due to the high number of intoxications annually, it is crucial to search for more potent and effective treatment methods, and in this line, the techniques involving bioremediation seem to be quite promising for this purpose.

Paraclinical findings in Iranian veterans exposed to sulfur mustard gas: A literature review / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>Sulfur mustard (SM) causes various systemic disturbances in human beings. This study aimed to assess paraclinical changes caused by exposure to SM gas in Iranian veterans during the war between Iraq and Iran.</p><p><b>METHODS</b>A literature review was carried out in international and national medical databases including ISI, Medline, Scopus, Iranmedex and Irandoc. Both Farsi and English literature were searched.</p><p><b>RESULTS</b>Search of the literature yielded 422 medical articles related to SM poisoning. Among them, 30 relevant articles were thoroughly reviewed. The most important reported complications were leukopenia, neutropenia, lymphopenia, eosinophilia, thrombocytopenia, increased bleeding time, positive C-reactive protein (CRP), rheumatoid factor (RF), antinuclear antibody (ANA), decreased T helper cells, natural killer cells, IL6, and IL8 levels, elevation of serum immunoglobulins, decreased levels of T3, T4 and cortisol, increased level of adrenocorticotropic hormone (ACTH), proteinuria, hematuria, and elevated liver enzymes. Also, there were some changes in chest assessments.</p><p><b>CONCLUSIONS</b>SM causes profound systemic complications in victims, even years after exposure. The paraclinical changes can be observed in hematology, immune system, biochemistry, hormonal profile and some imaging studies.</p>

Santos y beatos de la medicina en las grandes guerras del siglo XX

In the political and social context of World War periods and unstoppable technological advances, health professionals in the early twentieth century tried to orientate the practice of medicine towards a modern anthropological concept close to the biomedical perspective, which defends the dignity of a person. Threatened by the risks represented by collectivism and the meanness of the prevailing repressive governments, a personal struggle for the defense of life aroused, which was socially expressed by the advent of bioethics, psychoanalytic theories and the concept that environment has an important role in peoples health and welfare. And above all, the appearance of a paradoxical claim of religious ideals as support of science in times of overall crisis.

Thirty years of research on toxicant metabolism and toxicokinetics in China / 中国药理学与毒理学杂志

Toxicant metabolism and toxicokinetics are an integrated part of toxicology. They study the absorption,targeted distribution,metabolic detoxicification or bioactivation,excretion and elimination of toxic substances after the body′s exposure via different routes,and also evaluate the effects of various factors on the disposition of poisons. The results of the studies provide essential data on the relation?ships between exposure kinetics and toxicological effect and their mechanisms. They also help to find possible targets of intoxication or detoxicification pathways,which can lead to efficient countermea?sures. In this review,the author summarized the thirty years of progress and features of the research on toxicant metabolism and toxicokinetics in China.

Evolution of forms of warfare promoted by modern biotechnology / 军事医学

Sci-technology is a leading driver of the evolution of warfare forms.If a sci-technology group can promote the evolution of warfare forms, we have to see whether it can lead to changes in new era of economy, boost the transformation of new operational effectiveness, and spawn the emergence of new military philosophy.The rapid development of modern biotechnology has proved to be of high military value and will give impetus to new military reform and promote evolution of warfare forms.The study of the evolution of warfare forms should start with the social basis, material basis, and theoretical basis.This article expounds the mechanism of the evolution of warfare forms, and puts forward some rough notions of forms of biological warfare.It is a prediction and inference on the evolution of warfare forms in future wars.

Characteristics of medical support for modern naval warfare / 第二军医大学学报

Understanding the characteristics of medical support in naval warfare is the premise to determine the principles, requirements and measures of medical support and it is the foundation for organizing and implementing medical support in naval warfare. In this paper, using literature survey and research analysis we summarized the characteristics of medical support in modern naval warfare according to the types of naval warfare, input of army forces, weapons and equipment, war environment and so on. Finally we put forward six characteristics of modern naval warfare from the following perspectives: target, scope, wounding, rescue of the wounded, organizing and commanding, drug supply, and safety of medical support, hoping to provide reference for decision-making for military, logistics and health department.

Research on quantitative index system for factors influencing combat stress attrition during sea warfare / 第二军医大学学报

Objective To investigate the factors influencing the casualties caused by combat stress reaction during sea warfare and their priorities, so as to provide evidence for predicting naval combat stress attrition. Methods The consultation experts of military medical psychology and military health service were selected for a two rounds of expert questionnaire survey; the quantitative index system was established by using Delphi method. Names and meanings of each index were revised according to the experts' suggestions after two rounds of consulting.The weights of each index were also determined by experts' evaluation. Results The recovery rates in the two rounds of questionnaire consultation were both 100%. The level of expert authority was all over 0.8.The index weight system was set up for factors influencing combat stress attrition during sea warfare, including 3 primary indices, 11 second level ones and 51 third level ones; and the weight of each index were also determined. Conclusion The established system in this study may provide a foundation to predict the combat stress attrition during sea warfare and is helpful for more effective medical service.