Potencial dendrocronológico de tres especies de Podocarpáceas de la Cordillera de los Andes / Dendrochronological potential of three Podocarpaceae species from the Andean Cordillera

Resumen Introducción: Poco se conoce del potencial dendrocronológico de las Podocarpáceas en el trópico. Objetivo: Explorar el potencial dendrocronológico de tres especies de podocarpáceas: Retrophyllum rospigliosii, Podocarpus oleifolius y Prumnopitys harmsiana. Métodos: De plantaciones no manejadas localizadas en los Andes colombianos, se muestrearon y analizaron 88 árboles: 30 muestras de R. rospigliosii provenientes de secciones transversales, 30 y 28 muestras de P. oleifolius y P. harmsiana, respectivamente, provenientes de núcleos de madera extraídos con barreno de incrementos. Las muestras se procesaron siguiendo las técnicas dendrocronológicas estándar. Resultados: En general, las características anatómicas de los anillos de crecimiento son similares para las tres especies, con una anatomía simple de traqueidas alineadas radialmente por tratarse de coníferas. Dado que la edad conocida de la plantación coincide con el número de anillos se considera una fuerte evidencia de la frecuencia anual de su formación en R. rospigliosii y P. oleifolius, las cuales presentaron buena sincronización (cofechado) con una inter-correlación promedio de 0.55 (r-Pearson). Para P. harmsiana no fue posible concretar series de ancho de anillos de las muestras recolectadas. Las series estandarizadas de R. rospigliosii y P. oleifolius mostraron una relación con los registros instrumentales de precipitación y temperatura, indicando que estas especies pueden ser promisorias para estudios adicionales. Conclusión: La investigación dendrocronología con especies de Podocarpáceas podría realizarse exitosamente con R. rospigliosii y P. oleifolius, pero no con P. harmsiana.

Abstract Introduction: Little is known about the dendrochronological potential of Podocarpaceaes in the tropics. Objective: To explore the dendrochronological potential of three Podocarpaceae species: Retrophyllum rospigliosii, Podocarpus oleifolius, and Prumnopitys harmsiana. Methods: From a non-managed plantation in the Andean cordillera in Colombia, a total of 88 trees were analyzed: 30 samples of cross-sections of R. rospigliosii, and 30 and 28 samples of P. oleifolius and P. harmsiana, respectively, obtained with an increment borer. Samples were processed according to standard dendrochronological methods. Results: The anatomical characteristics of the growth rings of the three species are similar, with a simple conifer anatomy with radially oriented tracheids. Since the known age of the plantation coincides with the number of tree rings this is strong evidence of annual tree-ring frequency of R. rospigliosii and P. oleifolius which also showed a satisfactory cross-dating with an average inter-correlation of 0.55 (r-Pearson). For P. harmsiana, it was not possible to build a tree-ring series from the collected samples. R. rospigliosii and P. oleifolius standardized ring-width chronologies showed a relationship with the instrumental records of rainfall and temperature, indicating these species may be promising further studies. Conclusions: Dendrochronological research with Podocarpaceae species could be carried out successfully with R. rospigliosii and P. oleifolius but not with P. harmsiana.

Impact of Bariatric Surgery on the Incidence of Various Cancers. Narrative Review

Obesity is a global epidemic. According to the World Health Organization (WHO), it is an abnormal or excessive accumulation of fat that can harm health. Its incidence is increasing alarmingly in developing countries. It is also a significant risk factor for developing chronic diseases such as type 2 diabetes mellitus, arterial hypertension, coronary disease, non-alcoholic fatty liver disease, and musculoskeletal disorders such as osteoarthritis. Furthermore, associations have been found between obesity and the development of prostate, liver, gallbladder, kidney, colon, endometrial, breast, and ovarian cancer. Bariatric and metabolic surgery is the most effective treatment for morbid obesity and its comorbidities. This surgery can reduce general mortality by 40% at ten years due to cardiovascular outcomes, diabetes, or cancer and improve metabolic diseases such as type 2 diabetes.

La obesidad es una epidemia global, según la Organización Mundial de la Salud (OMS) se define como una acumulación anormal o excesiva de grasa que puede ser perjudicial para la salud, su incidencia está aumentando de forma alarmante en los países en desarrollo. Asimismo, es un factor de riesgo importante para el desarrollo de enfermedades crónicas como la diabetes mellitus tipo 2, hipertensión arterial, enfermedad coronaria, enfermedad del hígado graso no alcohólico y trastornos musculoesqueléticos como la osteoartritis; además, se han encontrado asociaciones entre la obesidad y el desarrollo del cáncer de próstata, hígado, vesícula biliar, riñón, colon, endometrio, mama y ovarios. La cirugía bariátrica y metabólica es el tratamiento más eficaz para la obesidad mórbida y sus comorbilidades, esta cirugía puede reducir la mortalidad general en un 40% a los diez años por desenlaces cardiovasculares, diabetes o cáncer, como también mejorar enfermedades metabólicas como la diabetes tipo 2.

Cannabis recreativo: Perfil de los cannabinoides presentes en muestras de marihuana suministradas por población consumidora / Recreational cannabis: Profile of cannabinoids present in marijuana samples supplied by the consuming population

RESUMEN El cannabis o marihuana es una de las sustancias psicoactivas más consumida en todo el mundo, por lo que conocer la composición y el tipo de cannabis que se comercializa en los entornos urbanos es un insumo necesario para el diseño de políticas en salud pública sustentadas en la evidencia científica. Este estudio caracterizó los principales fitocannabinoides de muestras de marihuana (cigarrillos o cogollos) obtenidas en áreas urbanas y rurales de la ciudad Medellín, en octubre de 2021. Se realizó un muestreo no probabilístico a conveniencia en el que se recolectaron 87 muestras de marihuana donadas por consumidores en diferentes puntos de recolección en toda la ciudad, aplicando las técnicas de cromatografía de gases masas e ionización de llama para la caracterización de los fitocanabinoides. Se encontró el tetrahidrocannabinol como el constituyente principal de la marihuana circulante en Medellín, donde el 67,8% de las muestras presentaba un rango toxicológico alto o superior para THC; lo anterior en un contexto donde el mercado desregulado limita la posibilidad que tienen los consumidores en la práctica de calibrar o decidir la concentración de cannabinoides en sus dosis.

ABSTRACT As cannabis/marijuana is one of the most consumed psychoactive substances in the world, knowing the composition and type of cannabis sold in urban environments is a necessary input for the design of public health policies based on scientific evidence. This study characterized the main phytocannabinoids of marijuana samples (cigarettes or buds) obtained in urban and rural areas of the city of Medellín in October 2021. Non-probabilistic convenience sampling was carried out in which 87 marijuana samples donated by consumers were collected at different collection points throughout the city, and gas chromatography-mass spectrometry and flame ionization techniques were employed for the characterization of phytocannabinoids. Tetrahydrocannabinol (THC) was found to be the main constituent of circulating marijuana in Medellín, where 67.8% of the samples had a high or higher toxicological range for THC; the foregoing in a context where the deregulated market in practice limits the possibility that consumers have to calibrate or decide the concentration of cannabinoids in their doses.

Fishes from Yarinacocha lake: an emblematic Amazonian ecosystem in the lower Ucayali River basin, Pucallpa, Peru / Peixes do lago Yarinacocha: um ecossistema amazônico emblemático na bacia do baixo rio Ucayali, Pucallpa, Peru

The Yarinacocha lake is an emblematic ecosystem of the Peruvian Amazon, representing the main point of fish landing and a tourist attraction in the city of Pucallpa. The wide fauna diversity in this area has made it the target of various studies, although for fish species most of them were focused on commercial species. In this work, we carried out the first ichthyofauna species inventory of the Yarinacocha lake, sampling throughout the entire lake during the rainy and dry seasons and considering also all previously recorded species deposited in the Ichthyological Collection of the MUSM with the same locality. A total of 164 fish species were recorded, representing 10 orders (plus Eupercaria), 34 families and 116 genera. Characiformes was the order with more species (68 spp., 41.5%) followed by Siluriformes (59 spp., 36%), Cichliformes (17 spp., 10.5%), and Gymnotiformes (8 spp., 4.9%). The most highly represented families, including almost 55.5% of the total diversity obtained, were Characidae (23 spp., 14%), followed by Cichlidae (17 spp., 10.4%), Loricariidae (14 spp., 8.5%), Pimelodidae (13 spp., 7.9%), Doradidae (13 spp., 7.4%) and Anostomidae (12 spp., 7.3%). From the total fish species recorded in this study, only 22 are considered protected species following the IUCN criteria and 109 species have commercial importance, including 90 ornamental species (54.8%). Our results contribute to the knowledge of the ichthyofauna of the Yarinacocha lake and can be used as a starting point for its conservation and sustainable management over time.

O lago Yarinacocha é um ecossistema emblemático da Amazônia peruana, representando o principal ponto de desembarque de peixes e também uma atração turística da cidade de Pucallpa. A grande diversidade faunística nesta área a tornou alvo de vários estudos, embora para as espécies de peixes a maioria deles tenha sido focada em espécies comerciais. Neste trabalho, realizamos o primeiro inventário da ictiofauna do lago Yarinacocha, amostrando todo o lago durante as estações chuvosa e seca, e também considerando todas as espécies depositadas na Coleção Ictiológica do MUSM dessa localidade. Um total de 164 espécies de peixes foram registradas, representando 10 ordens (mais Eupercaria), 34 famílias e 116 gêneros. Characiformes foi a ordem com mais espécies (68 espécies, 41,5%), seguida por Siluriformes (59 espécies, 36%), Cichliformes (17 espécies, 10,5%) e Gymnotiformes (8 espécies, 4,9%). As famílias mais representadas, incluindo quase 55,5% da diversidade total obtida, foram Characidae (23 spp., 14%), seguido por Cichlidae (17 spp., 10,4%), Loricariidae (14 spp., 8,5%), Pimelodidae (13 spp., 7,9%), Doradidae (13 spp., 7,4%) e Anostomidae (12 spp., 7,3%). Do total de espécies de peixes registradas neste estudo, apenas 22 são consideradas espécies protegidas seguindo os critérios da IUCN e 109 espécies têm importância comercial, incluindo 90 espécies ornamentais (54,8%). Nossos resultados contribuem para o conhecimento da ictiofauna do lago Yarinacocha e podem ser utilizados como ponto de partida para sua conservação e manejo sustentável ao longo do tempo.

Tratamento de siringomas periorbitários: revisão da literatura científica nos últimos 5 anos / Treatment of periorbital syringomas: review of scientific literature in the last 5 years

Introdução: O siringomas são tumores anexais benignos com caraterísticas histopatológicas decorrentes dos ductos écrinos, em forma de pápulas amareladas ou cor da pele, de 1-3 mm, comumente na região periorbitária inferior, podendo causar problemas cosméticos importantes. O objetivo do tratamento é melhorar a aparência, através da destruição completa do tumor usando métodos minimamente invasivos e inclusa cirurgia. Existem na literatura múltiplas opções de tratamento com vários graus de sucesso, porém pouco se conhece sobre a eficácia. Em geral, a remoção completa não é bem-sucedida, e têm sido descritos efeitos colaterais, sendo a recorrência o mais frequente. Métodos: Trata-se de uma revisão narrativa de literatura, de publicações científicas no período de 2014-2019. Resultados: Após revisar 45 artigos, e identificar os publicados nos últimos cinco anos que tiveram registro de número de pacientes, descrição de tratamento, escalas de avaliação dos resultados e acompanhamento, foram selecionados seis artigos. Do número total de seis artigos, foram encontrados: uma revisão sistemática, e cinco estudos retrospectivos, sendo um comparativo. Foi designado um número para cada artigo analisado, e coletados o número de pacientes incluídos, tratamento realizado, escalas de avaliação e resultados, complicações e conclusões. Conclusões: Os siringomas periorbitários ainda são um desafio terapêutico, e até agora nenhum tratamento demostrou ser consistentemente eficaz. O laser CO2 continua sendo a primeira escolha de tratamento quando usado fracionado, e a eletrocoagulação intralesional representa uma segunda alternativa com resultados moderados e menor risco de complicações. Novos tratamentos como Laser Erbium Laser Erbium Yttrium Aluminum Garnet, Neodymium-Doped Yttrium Aluminum Garnet e monoterapia com toxina botulínica A poderiam ser boas alternativas. Estudos prospetivos comparativos são necessários.

Introduction: Syringomas are benign adnexal tumors with histopathological characteristics arising from the eccrine ducts, in yellowish or skin-colored papules, 1-3 mm, commonly in the lower periorbital region, which can cause important cosmetic problems. The goal of treatment is to improve appearance by destroying the tumor using minimally invasive methods and including surgery. There are multiple treatment options in the literature with varying degrees of success, but little is known about their effectiveness. Complete removal is unsuccessful, and side effects have been described, recurrence being the most frequent. Methods: This is a narrative review of the literature of scientific publications in the period 2014-2019. Results: After reviewing 45 articles and identifying those published in the last five years that had a record of the number of patients, treatment description, scales of evaluation of results and follow-up, six articles were selected. Of the total number of six articles, we found: a systematic review and five retrospective studies, one being a comparative one. A number was assigned to each article analyzed, and the number of patients included, treatment performed, assessment scales and results, complications and conclusions were collected. Conclusions: Periorbital syringomas are still a therapeutic challenge, and so far, no treatment is consistently effective. The CO2 laser remains the first choice of treatment when used fractionally, and intralesional electrocoagulation represents a second alternative with moderate results and a lower risk of complications. New treatments such as Laser Erbium Laser Erbium Yttrium Aluminum Garnet, Neodymium-Doped Yttrium Aluminum Garnet and botulinum toxin A monotherapy could be good alternatives. Comparative prospective studies are needed.

El impacto de la pandemia de COVID-19 en la salud mental de los trabajadores de la salud en Chile: datos iniciales de The Health Care Workers Study / Impact of COVID-19 pandemic on the mental health of healthcare workers

Background: Healthcare workers' mental health was affected by SARS-CoV-2 pandemic. Aim: To evaluate healthcare workers' mental health and its associated factors during the pandemic in Chile. Material and Methods: An online self-reported questionnaire was designed including the Goldberg Health Questionnaire, the Patient Health Questionnaire, (PHQ-9), and the Columbia-Suicide Severity Rating Scale among other questions. It was sent to 28,038 healthcare workers. Results: The questionnaire was answered by 1,934 participants, with a median age of 38 years (74% women). Seventy five percent were professionals, and 48% worked at a hospital. Fifty nine percent of respondents had a risk of having a mental health disorder, and 73% had depressive symptoms. Significant associations were found with sex, workplace, and some of the relevant experiences during the pandemic. Fifty one percent reported the need for mental health support, and 38% of them received it. Conclusions: There is a high percentage of health workers with symptoms of psychological distress, depression, and suicidal ideas. The gender approach is essential to understand the important differences found. Many health workers who required mental health care did not seek or received it.

Integrative taxonomy reveals a new species of Neotropical headstanding fish in genus Schizodon (Characiformes: Anostomidae)

Abstract Schizodon encompasses approximately 15 species of Neotropical headstanding fishes. Integrative taxonomy, combining molecular and morphometric analyses with traditional taxonomic methods, was used to investigate Schizodon vittatus and its potential new sister species. Molecular differences between the two species in the barcode are greater than intra-specific variation recovered in species of Schizodon, and the two species represent distinct lineages for approximately one million years. The two species are morphologically very similar, and the meristic data showed great overlap. Morphometric analyses also showed overlap among the putative species but indicated differences in caudal-peduncle depth, orbital diameter, and length of anal-fin rays. Color pattern seems to provide a clear diagnostic feature for the two species. Schizodon vittatus usually has four dark brown transversal bars on body, and its sister species has three conspicuous bars, with the fourth, if present, inconspicuous and dorsal to the lateral line. Schizodon vittatus is redescribed based on the type and recently collected specimens, its type locality is revisited, and its known distribution restricted to the Araguaia and Tocantins drainages. The new species, sister to S. vittatus, distributed in the Xingu and Tapajós drainages, is described. A key for the identification of the Amazon clade species of Schizodon is provided.

Resumo Schizodon engloba aproximadamente 15 espécies de peixes neotropicais. A taxonomia integrativa, combinando análises moleculares e morfométricas com métodos taxonômicos tradicionais, foi utilizada para investigar Schizodon vittatus e sua potencial espécie irmã. As diferenças moleculares (DNA barcoding) entre as duas espécies são maiores do que a variação intraespecífica observada em espécies congêneres, e as duas espécies representam linhagens distintas por aproximadamente um milhão de anos. As duas espécies são morfologicamente muito similares e os dados merísticos mostram grande sobreposição. As análises morfométricas também mostraram sobreposição entre as duas espécies, mas indicaram diferenças na altura do pedúnculo caudal, no diâmetro interorbital, e no comprimento dos raios da nadadeira anal. O padrão de colorido parece fornecer uma característica diagnóstica clara para as duas espécies. Schizodon vittatus normalmente possui quatro faixas escuras transversais no corpo e sua espécie irmã tem três faixas, com a quarta, se presente, inconspícua e dorsal à linha lateral. Schizodon vittatus é redescrita com base no tipo e em espécimes coletados recentemente; sua localidade tipo é revisitada e a sua distribuição conhecida é restringida às drenagens do Araguaia e Tocantins. A nova espécie, irmã de S. vittatus e distribuída nas drenagens do Xingu e Tapajós, é descrita. Uma chave para a identificação das espécies do clado amazônico de Schizodon é apresentada.

Uso y percepción del personal de salud sobre una aplicación móvil para la valoración geriátrica integral / Healthcare personnel use and perception of a mobile application for a comprehensive geriatric assessment / Uso e percepção do pessoal de saúde de um aplicativo móvel para avaliação geriátrica ampla

Introducción. Existe poca evidencia que sustente la utilidad del uso de aplicaciones móviles en la atención del adulto mayor. GeriatriApp es una aplicación creada para dispositivos Android que busca facilitar al profesional de salud la realización de la valoración geriátrica integral (VGI) e integra la evaluación funcional, nutricional, cognitivo, emocional, farmacológico, fragilidad y sarcopenia. El objetivo del presente estudio es evaluar la utilidad percibida entre los usuarios de la App al momento de realizar la VGI, así como el efecto en la toma de decisiones y evaluar posibles diferencias entre el personal de salud. Metodología. Estudio descriptivo de corte trasversal, tipo encuesta entre usuarios de GeriatriApp, se indaga por aspectos demográficos, educativos y de percepción de utilidad de la App. Resultados. Se analizaron 228 encuestas. El 29% fueron médicos especialistas, 18% médicos generales, 17% estudiantes de medicina y 12% médicos residentes. El grupo de edad con mayor frecuencia de uso de la App se encuentra entre 20 y 30 años (39%). El principal escenario de práctica profesional fue el hospitalario (40.1%), seguido de atención primaria (31.6%). El 63% utilizó la App entre 1 y 5 veces por semana. Durante el análisis estadístico no se encontró diferencia significativa en la frecuencia de uso según la edad (p = 0.631), ni el nivel de formación (p = 0.749). Para el 98% de los encuestados la App facilitó la práctica clínica profesional y la toma de decisiones, y en el 99% permitió identificar problemas en el adulto mayor en menor tiempo. Discusión. La aplicación estudiada tuvo un alcance internacional, lo que demuestra el potencial de este tipo de tecnologías. La mayor cantidad de usuarios fueron menores de 30 años, posiblemente explicado por su mayor contacto y experiencia con la tecnología móvil. No se encontraron diferencias en la frecuencia de uso según la edad, un hallazgo inesperado respecto a otros estudios. La percepción favorable de la aplicación parece estar secundada por su gratuidad, la utilidad de sus herramientas y una interfaz de uso sencilla. Conclusiones. GeriatriApp tiene una percepción favorable de utilidad entre el personal de la salud, permite realizar una valoración geriátrica en corto periodo de tiempo, facilita atención y toma de decisiones en el adulto mayor. Los resultados sugieren su utilidad en escenarios hospitalarios, atención primaria, centros de rehabilitación y hogares geriátricos.

Introduction. There is little evidence supporting the usefulness of mobile applications in senior care. GeriatriApp is an application created for Android devices to assist health professionals in performing the comprehensive geriatric assessment (CGA). It integrates functional, nutritional, cognitive, emotional, pharmacological, frailty, and sarcopenia assessment. The aim of the present study is to evaluate the perceived usefulness of the App by its users when performing the CGA, as well as its effect on decision-making and to evaluate possible differences among healthcare personnel. Methodology. This survey-type descriptive cross-sectional study surveys GeriatriApp users, considering aspects like demographics, education, and the App's perceived usability. Results. A total of 228 surveys were analyzed, of which 29% involved specialist physicians, 18% general practitioners, 17% medical students, and 12% resident physicians. The age group with the highest frequency of App use was between 20 and 30 years old (39%). The main professional practice setting was the hospital (40.1%), followed by primary care (31.6%). Sixty-three percent of the surveyed used the App between 1 and 5 times per week. The statistical analysis showed no significant difference in the frequency of use according to age (p = 0.631) or education level (p = 0.749). For 98% of the respondents, the App facilitated professional clinical practice and decision making, and, for 99%, it allowed identifying problems in the seniors in less time. Discussion. The application studied has an international scope, demonstrating this technology's potential. The largest number of users were under 30, possibly because of their greater interaction and experience with mobile technology. No differences were found in the frequency of use according to age, an unexpected finding regarding other studies. The application's favorable perception seems to rely on the fact that it is free of charge, the tool's usability, and its user-friendly interface. Conclusions. GeriatriApp has a favorable perception of usefulness among health personnel, allows a geriatric assessment in a shorter period, and facilitates care and decision-making regarding seniors. The results suggest its usefulness in hospital settings, primary care, rehabilitation centers, and nursing homes.

Introdução. Existem poucas evidências para apoiar a utilidade do uso de aplicativos móveis no atendimento dos idosos. GeriatriApp é um aplicativo criado para dispositivos Android que visa facilitar ao profissional de saúde a realização da avaliação geriátrica ampla (AGA) e integra a avaliação funcional, nutricional, cognitiva, emocional, farmacológica, fragilidade e sarcopenia. O objetivo deste estudo é avaliar a utilidade percebida pelos usuários do App no momento da realização da AGA, bem como o efeito na tomada de decisão, também avaliar possíveis diferenças entre os profissionais de saúde. Metodologia. Estudo transversal descritivo, tipo enquete entre usuários do GeriatriApp, consultando aspectos demográficos, educacionais e de percepção de utilidade do App . Resultados. Foi analisado um total de 228 enquetes. 29% eram médicos especialistas, 18% clínicos gerais, 17% estudantes de medicina, e 12% residentes. O grupo etário com maior frequência de utilização do App tem entre 20 e 30 anos (39%). O principal cenário de prática profissional foi o hospital (40.1%), seguido da atenção básica (31.6%). De outro lado, 63% usaram o aplicativo entre 1 e 5 vezes por semana. Durante a análise estatística, não foi encontrada diferença significativa na frequência de uso em função da idade (p = 0.631), nem do nível de educação (p = 0.749). Para 98% dos entrevistados, o App facilitou a prática clínica profissional e a tomada de decisões, e para 99% permitiu identificar problemas nos idosos em menos tempo. Discussão. O aplicativo estudado teve um alcance internacional, o que mostra o potencial desse tipo de tecnologia. O maior número de usuários tinha menos de 30 anos, possivelmente explicado pelo maior contato e experiência com a tecnologia móvel. Não foram encontradas diferenças na frequência de uso de acordo com a idade, uma descoberta inesperada em comparação com outros estudos. A percepção favorável do aplicativo parece apoiar-se na sua gratuidade, na utilidade das suas ferramentas e numa interface amigável. Conclusões. O GeriatriApp tem uma percepção favorável de utilidade entre os profissionais de saúde, permite uma avaliação geriátrica em um curto período de tempo, facilita a tomada de decisão e o atendimento ao idoso. Os resultados sugerem sua utilidade em ambientes hospitalares, atenção básica, centros de reabilitação e lares geriátricos.

IPACK block: emerging complementary analgesic technique for total knee arthroplasty / Bloqueo IPACK: Complemento analgésico emergente en artroplastia de rodilla

Abstract Introduction: Pain control in total knee arthroplasty (TKA) is a determining factor in the patient's rehabilitation process. With conventional peripheral blocking techniques for the posterior compartment, foot drop, and distal motor deficit have been reported. The infiltration between popliteal artery and capsule of the knee (IPACK) block is a promising emerging analgesic technique. Objective: To describe analgesic control, opioid consumption, and mobility of patients scheduled for TKA using IPACK block as adjunct analgesic to the femoral block. Methods: We conducted a prospective observational cohort study over a 6-month period in adults taken to TKA. Sociodemographic and anthropometric characteristics, laterality, postoperative pain, and opioid consumption, patient and surgeon satisfaction (Likert), postoperative nausea and vomiting, and walk in the first 24hours, were evaluated and reported with a descriptive analysis. Results: Twenty-seven patients taken to TKA received an IPACK block. The pain score remained in a mild level during the 48 hours of evaluation. In 73% of the cases, an opioid rescue dose was not required; 81% of the patients managed to walk in the first 24 hours. Conclusion: The IPACK block, combined with femoral block and neuraxial anesthesia, turn out to be an excellent analgesic strategy for TKA, achieving adequate pain management, prompt rehabilitation, and early ambulation of the patient.

Resumen Introducción: El control del dolor en artroplastia total de rodilla (ATR) es determinante en el proceso de rehabilitación del paciente. Con las técnicas convencionales de bloqueo periférico para el compartimiento posterior se ha reportado pie caído y déficit motor distal. Por lo anterior, se decidió evaluar en una cohorte las cualidades analgésicas del bloqueo IPACK como una técnica emergente prometedora. Objetivo: Describir el control analgésico, consumo de opioides y movilidad de pacientes programados para ATR usando bloqueo IPACK como adyuvante analgésico al bloqueo femoral. Métodos: Se realizó un estudio de cohorte prospectivo, en adultos llevados a ATR, durante 6 meses. Se evaluaron las características sociodemográficas, antropométricas, lateralidad, dolor postopera torio y consumo de opioides, satisfacción del paciente y del cirujano, náuseas y vómito postoperatorio, caminata en las primeras 48 h. Se informar los resultados de forma descriptiva. Resultados: En total, 27 pacientes a quienes se les realizó ATR obtuvieron bloqueo IPACK. La puntuación del dolor se mantuvo en una escala leve en un rango de 1-3 durante las 48 horas de seguimiento. En el 73% de los casos no se requirió una dosis de opioide de rescate. El 81% de los pacientes logró caminar en las primeras 24 horas. Conclusión: El IPACK, combinado con el bloqueo femoral y la anestesia neuroaxial, resultan ser una excelente estrategia analgésica para logar un adecuado control del dolor en ATR, pronta rehabilitación y deambulación temprana del paciente.

Identificación molecular y relaciones evolutivas de Pomacea nobilis, base para la autenticación específica del churo negro de la Amazonia peruana / Molecular identification and evolutionary relationships of Pomacea nobilis, basis for the specific authentication of the black apple snail from Peruvian Amazonia

Resumen En la Amazonia Peruana los caracoles dulceacuícolas de la familia Ampullariidae son conocidos como churos y originalmente han sido descritas para Perú alrededor de 20 especies. Aunque son muy usadas para alimentación, medicina tradicional y objeto de muchos estudios para su cultivo e industrialización, solamente es mencionada en la literatura la especie Pomacea maculata. Se llevó a cabo la identificación molecular sobre la base del marcador mitocondrial COI, de individuos de churos negros (Pomacea) comercializados en los mercados de Iquitos, así como los usados en platos a la carta en la ciudad de Lima, contrastados con otros individuos de procedencia de su hábitat natural. Se encontró que estos especímenes expendidos corresponden a la especie Pomacea nobilis (Reeve, 1856). El análisis filogenético molecular mostró que P. nobilis es especie hermana de P. guyanensis, en el grupo de P. glauca, distantemente relacionada de P. maculata. Las distancias no corregidas encontradas entre ellas, para el marcador mitocondrial COI, fueron de 11.33% a 13.17%, mientras que con P. maculata fueron de 13.67% a 15.33%. Estos resultados demostraron la eficacia del código de barras de ADN para la identificación y autenticación de la especie, lo que le da un valor agregado para su eventual comercio de exportación.

Abstract In the Peruvian Amazon, freshwater snails of the Ampullariidae family are known as churos, and around 20 species have originally been described for Peru. Although they are widely used for food, traditional medicine and the object of many studies for their cultivation and industrialization, only the species Pomacea maculata is mentioned in the literature. Molecular identification was carried out based on the mitochondrial marker COI of individuals of "churo negro" apple snails (Pomacea) commercialized in the markets of Iquitos, as well as those used in restaurant dishes in the city of Lima, and contrasted with specimens from their natural habitat. It was found that these specimens, correspond to the species Pomacea nobilis (Reeve, 1856). The molecular phylogenetic analysis showed P. nobilis as the sister species of P. guyanensis, in the P. glauca group, distantly related to P. maculata. The uncorrected distances found between them, for the mitochondrial marker COI, were from 11.33% to 13.17%, while with P. maculate were from 13.67% to 15.33%. These results demonstrated the effectiveness of the DNA barcode for the identification and authentication of the species, which gives it added value for its eventual export trade.

Prevalencia de embarazo ectópico en el Hospital Carlos Andrade Marín, 2017 a 2019 / Prevalence of ectopic pregnancy in the Carlos Andrade Marín Hospital, 2017 a 2019

RESUMEN: Objetivos: 1) Determinar la prevalencia de embarazo ectópico en el Servicio de Alto Riesgo Obstétrico del Hospital Carlos Andrade Marín. 2) Identificar los factores de riesgo asociados con esta patología. Métodos: se realizó un estudio descriptivo, de corte transversal, retrospectivo, tomando en cuenta a las pacientes ingresadas con diagnóstico de Embarazo Ectópico al Servicio de Alto Riesgo del Hospital Carlos Andrade Marín, en el periodo del 1 de enero del 2017 al 31 de mayo del 2019. Resultados: durante el período comprendido entre el 1 de enero de 2017 y el 31 de mayo de 2019, se registró un total de 7.596 nacimientos en el Servicio de Alto Riesgo Obstétrico del Hospital Carlos Andrade Marín; de ellos, hubo 117 pacientes diagnosticadas de embarazo ectópico. La prevalencia del embarazo ectópico en el Hospital Carlos Andrade Marín, entre los años 2017 y 2019, fue de 1,5%; la tasa de embarazo ectópico es de 15,40 / 1.000 gestaciones. Conclusiones: el análisis de los datos obtenidos de las historias clínicas evidenció que la tasa de prevalencia de embarazo ectópico en el Servicio de Alto Riesgo Obstétrico del Hospital Carlos Andrade Marín es similar a la reportada por diferentes estudios realizados alrededor del mundo.Palabras claves: embarazo ectópico, prevalencia, trompa de falopio, factores de riesgo

ABSTRACT: Objective: To determine the prevalence of ectopic pregnancy in the high-risk obstetric service of the Carlos Andrade Marín Hospital and to know the associated risk factors. Methods: A descriptive, cross-sectional, retrospective study was carried out, taking into account patients admitted with a diagnosis of ectopic pregnancy to the high-risk service of the Carlos Andrade Marín Hospital, from January 1, 2017 to May 31 of 2019. Results: During the period from January 1, 2017 to May 31, 2019, a total of 7596 births were recorded in the High Obstetric Risk Service of Hospital Carlos Andrade Marín. Of all of them, a total of 117 patients were registered diagnosis of ectopic pregnancy. The prevalence of ectopic pregnancies in the Hospital Carlos Andrade Marín in a period between 2017 and 2019 was 1.5%, with an ectopic pregnancy rate of 15.40 per 1000 pregnancies. Conclusions: When performing an analysis of the data obtained from the medical records it was possible to obtain similar results of prevalence rates of ectopic pregnancy in the High Risk Obstetric Service of the Hospital Carlos Andrade Marín in relation to the data obtained by different studies conducted around of the world.Keywords:ectopic pregnancy, prevalence, fallopian tube, risk factors

Selective BuChE inhibitory activity, chemical composition, and enantiomer content of the volatile oil from the Ecuadorian plant Clinopodium brownei

ABSTRACT This paper describes the chemical composition and the enantiomer content of the volatile oil hydrodistilled from Clinopodium brownei (Sw.) Kuntze, Lamiaceae. The plant was collected in the South of Ecuador. Thirty one components were identified by GC-MS, which accounted for the 96.15% of the volatile oil. The major components were pulegone (48.44%), menthone (34.55%) and β-acorenol (3.41%). Oxygenated monoterpenes (86.06%), followed by oxygenated sesquiterpenes (5.36%) constituted the most abundant fractions. The enantiomeric compositions of β-pinene, sabinene, 3-octanol, menthone, pulegone and menthyl acetate were determined by enantioselective GC-MS. (-)-Menthone showed the highest enantiomeric excess (ee = 83.4%). In in vitro tests, the volatile oil showed high selective inhibitory activity for butyrylcholinesterase with an IC50, 13.4 ± 1.8 µg/ml. In contrast, it was weakly active against acetylcholinesterase with an IC50 >250 µg/ml.

Inmunopatología del dengue: importancia y participación de los monocitos y sus subpoblaciones / Dengue immunopathology: Importance and participation of monocytes and their subsets

RESUMEN El dengue es una infección viral aguda transmitida por la picadura de mosquitos del género Aedes, la cual produce hasta 100 millones de infecciones anuales en el mundo. Una gran proporción de individuos infectados con el virus presentan infecciones asintomáticas. Sin embargo, de los individuos que desarrollan la enfermedad, el 95 % presentan signos y síntomas similares a una virosis común, que por lo general se autoresuelven (dengue con y sin signos de alarma). El 5 % restante puede evolucionar a manifestaciones graves, caracterizadas por hemorragias, daño orgánico, choque hipovolémico e incluso la muerte (dengue grave). Los monocitos son uno de los blancos principales de la infección producida por el virus del dengue (DENV), los cuales participan en la replicación del mismo y en la producción de una gran variedad de citoquinas que contribuyen con el daño de diferentes tejidos y órganos en respuesta a la infección. Los monocitos se dividen en tres subpoblaciones: clásica (CD14++CD16-), no clásica (CD14+CD16++) e intermedia (CD14++CD16+), las cuales poseen respuestas funcionales contrastantes en diferentes procesos inflamatorios, en cuanto a la producción de mediadores solubles e interacción con el endotelio. Los monocitos no clásicos parecen ser los principales productores de mediadores inflamatorios como el TNF-α y la IL-1β en respuesta a la infección por DENV. Por lo tanto, se propone que cada subpoblación de monocitos debe tener un papel diferencial en la inmunopatología de la enfermedad. En esta revisión se recopilan los principales aspectos de la replicación viral y la inmunopatología del dengue, así como los principales hallazgos referentes al papel de los monocitos en esta infección y además, se propone un papel potencial y diferencial de las subpoblaciones de monocitos.

SUMMARY Dengue is an acute viral infection transmitted by the bite of the mosquito belonging to the genus Aedes, which produce until 100 millions of infections worldwide per year. A high proportion of infected individuals develop an asyntomatic infection. Nevertheless, among patients that develop a clinical disease, 95 % of them show clinical signs and symptoms similar to common virosis, that in the most of the cases can recover by themselves (dengue with and without alarm signs); the remaining 5 % can evolve to severe manifestations, characterized for hemorrhages, organic damage, hypovolemic shock and death (severe dengue). Monocytes are one of the main targets of the infection by dengue virus (DENV), supporting the viral replication, contributing to the production of high levels of cytokine and the damage of different tissues and organs in response to the infection. Monocytes are divided in 3 subsets: classical (CD14++CD16-), non-classical (CD14+CD16++) and intermediate (CD14++CD16+); which have differential functional responses in the inflammatory process, regarding the production of inflammatory mediators and the interaction with the endothelium. The non-classic monocytes seem to be the main producers of inflammatory mediators such as TNF-α and IL-1β in response to DENV infection. Therefore, it is proposed that each monocyte subset may have a different role in the disease immunopathology. This review collect the main evidence regarding the viral replication and the immunopathology of dengue, also it shows the most important findings about the role of monocytes in this infection and proposes a potential differential involvement of monocytes subsets.

Intervención multidisciplinaria en paciente diagnosticado con el síndrome de Prader-Will / Interdisciplinary intervention in a pacient diagnosed with Prader-Willi síndrome

Introducción: El síndrome de Prader-Willi es una enfermedad genética, causada por deleciones de novo en la región 15q11q13 en el cromosoma paterno. Se caracteriza por falta de saciedad que conduce a obesidad mórbida, trastornos del comportamiento, discapacidad intelectual, baja estatura e hipogonadismo. Objetivo: Describir los resultados obtenidos del análisis e intervención multidisciplinar realizados en paciente diagnosticado con el síndrome de Prader-Willi. Presentación del caso: Análisis de caso clínico en menor de 8 años, sexo masculino, diagnosticado con síndrome de Prader-Willi, a través de intervención multidisciplinaria realizado en tres momentos: evaluación, diagnóstico e intervención con enfoque cognitivo conductual. Conclusiones: Las estrategias adoptadas generaron cambios significativos en el contexto familiar y social, entre ellas, apropiación de las recomendaciones suministradas, adopción de factores protectores, identificación de roles y optimización en la adherencia farmacológica. La atención a estas consideraciones proporciona mejoras, que apuntan a la calidad de vida y clínica del paciente(AU)

Introduction: Prader-Willi syndrome is a genetic disease caused by de novo deletions in the 15q11q13 region in the paternal chromosome. It is characterized by lack of satiety leading to morbid obesity, behavioral disorders, intellectual disability, short height and hypogonadism. Objective: To describe the results obtained from the multidisciplinary analysis and intervention performed in a patient diagnosed with Prader-Willi syndrome. Presentation of the clinical case: Clinical case analysis in an 8 years old child, male sex, diagnosed with Prader-Willi syndrome through a multidisciplinary intervention performed in three moments: assessment, diagnosis and intervention with cognitive behavioral approach. Conclusions: The strategies adopted generated significant changes in the social and family context, family´s appropriation of the recommendations provided, adoption of protective factors, roles identification and improving of adherence to treatment. By taking into account this considerations, improvements lead to clinic and life quality of the patient(AU)

Presión arterial media: ¿importa el uso de escaleras? / Mean arterial pressure: does the use of stairs matter?

Objetivo: Determinar si el uso diario de escaleras se relaciona con valores de presión arterial media, en un grupo de habitantes de un conjunto residencial con edificios de 4 pisos. Materiales y métodos:Estudio descriptivo, transversal. Se tomó la presión arterial a 125 sujetos sanos (50,4% mujeres) residentes en los 4 pisos de cada uno de los 4 edificios de un conjunto residencial. Se compararon los valores de presión arterial media según el piso de residencia mediante ANOVA de un factor y prueba de Bonferroni, y se estratificó el análisis según edad, sexo, obesidad, fumar, beber alcohol con frecuencia y actividad física. Resultados: Se encontró relación significativa (p<0,05) entre el promedio de presión arterial media y el piso de residencia, siendo marcadas las diferencias especialmente entre el piso uno y el cuatro (p<0,05). Se encontró significancia estadística (p<0,05) al estratificar los valores de presión arterial media según sexo masculino, obesidad abdominal y fumar. Conclusión: En los adultos sanos, participantes en el estudio, hubo un efecto benéfico en el uso diario de escaleras con respecto a los valores de presión arterial media.Palabras clave: Actividad física, presión arterial media, escaleras, obesidad, fumar

Objective:To determine if the daily use of stairs is related to values of mean arterial pressure, in a group of inhabitants of a residential complex with buildings of 4 floors.Materials and methods:Descriptive, cross-sectional study. Blood pressure was taken to 125 healthy subjects (50.4% women) living in the 4 floors of each of the 4 buildings of a residential complex. The values of mean arterial pressure were compared according to the residence floor by means of one-way ANOVA and Bonferroni test, and the analysis was stratified according to age, sex, obesity, smoking, frequent alcohol drinking and physical activity.Results:A significant relationship was found (p <0.05) between the meanarterialpressure average and the residence floor, the differences being marked especially between floor one and four (p <0.05). Statistical significance was found (p <0.05) when stratifying mean arterialpressure values according to male sex, abdominal obesity and smoking.Conclusion: In healthy adults, participants in the study, there was a beneficial effect in the daily use of stairs with respect to the values of mean arterial pressure.

Latent tuberculosis infection in patients with rheumatic diseases / Infecção latente por tuberculose em pacientes com doenças reumatológicas

ABSTRACT Most people infected by Mycobacterium tuberculosis (Mtb) do not have any signs or disease symptoms, a condition known as latent tuberculosis infection (LTBI). The introduction of biological agents, mainly tumor necrosis factor (TNF) inhibitors, for the treatment of immune-mediated diseases such as Rheumatoid Arthritis (RA) and other rheumatic diseases, increased the risk of reactivation of LTBI, leading to development of active TB. Thus, this review will approach the aspects related to LTBI in patients with rheumatologic diseases, especially those using iTNF drugs. For this purpose it will be considered the definition and prevalence of LTBI, mechanisms associated with diseases and medications in use, criteria for screening, diagnosis and treatment. Considering that reactivation of LTBI accounts for a large proportion of the incidence of active TB, adequate diagnosis and treatment are crucial, especially in high-risk groups such as patients with rheumatologic diseases.

RESUMO A maioria das pessoas infectadas por Mycobacterium tuberculosis (Mtb) não possui sinais ou sintomas da doença, quadro conhecido como infecção latente por tuberculose (ILTB). A introdução de agentes biológicos, sobretudo inibidores do fator de necrose tumoral (iTNF), para o tratamento de doenças imunomediadas, como artrite reumatoide (AR) e outras doenças reumatológicas, aumentou o risco de reativação de ILTB, levando ao desenvolvimento de tuberculose (TB) ativa. Assim, esta revisão abordará os aspectos relacionados à ILTB em pacientes com doenças reumatológicas, especialmente naqueles em uso de medicamentos iTNF. Para tanto, serão considerados a definição e a prevalência de ILTB, os mecanismos associados às doenças e às medicações em uso, bem como os critérios para rastreamento, diagnóstico e tratamento da ILTB. Como a reativação da ILTB é responsável pela grande proporção de casos de TB ativa, o diagnóstico e o tratamento adequados são cruciais, principalmente em grupos de alto risco, como os pacientes com doenças reumatológicas.

Oferta de frutas y verduras en instituciones educativas de un municipio del caribe colombiano / Offer of fruits and vegetables in educational institutions of a municipality of the Colombian Caribbean

Resumen Introducción: Frente al creciente problema de obesidad infantil, en Colombia se han realizado avances en el marco legislativo, como la ley 1355 de 2009, la cual indica que las instituciones educativas deben ofertar frutas y verduras a los escolares. Objetivo: Describir la aplicación de la ley 1355 de 2009 frente a la oferta de frutas y verduras en instituciones educativas del municipio de Soledad-Atlántico. Materiales y métodos: Estudio descriptivo, transversal. Se encuestaron 18 directivos docentes: 12 coordinadores y 6 directores, mediante un formulario estructurado, y se hizo observación directa de la disponibilidad de frutas y verduras en las tiendas escolares, contrastando ambos aspectos. Resultados: 8/18 encuestados manifestó conocer la ley 1355; 11/18 indicaron que en su escuela existe un encargado de liderar programas relacionados con alimentación saludable; en 50% de las Instituciones se han adelantado programas de alimentación saludable; 15/18 (83,3%) respondieron que sí hay disponibilidad de frutas y verduras en las tiendas escolares, pero esto se evidenció solamente en una de las 18 Instituciones (5,6%). Conclusión: Se debe mejorar la disponibilidad de frutas y verduras en las tiendas escolares y lograr un empoderamiento de directivos, docentes, padres de familia y estudiantes, en aras de disminuir las cifras de obesidad.

Abstract Introduction: In response to the growing problem of childhood obesity, progress has been made in Colombia in the legislative framework; for instance, the law 1355 of 2009, which indicates that educational institutions should offer fruits and vegetables to school children. Objective: To describe the application of the law 1355 of 2009 facing the supply of fruits and vegetables in educational institutions in the municipality of Soledad, Atlántico. Materials and methods: A descriptive, transversal study was made. Twelve coordinators and six directors were surveyed through a structured form, and a direct observation was made of the availability of fruits and vegetables in the school stores, contrasting both aspects. Results: 8/18 respondents said they know law 1355; 11/18 indicated that there is a leader in their school to lead programs related to healthy eating, which have been advanced in 50% of the institutions; 15/18 (83.3%) responded that there is availability of fruits and vegetables in school stores, but this was only evident in one of the 18 institutions (5.6%). Conclusion: The availability of fruits and vegetables in school stores should be improved as well as the empowerment of managers, teachers, parents and students in order to reduce obesity numbers.

Carnosol from Lepechinia mutica and tiliroside from Vallea stipularis: Two promising inhibitors of BuChE

Abstract Lepechinia mutica (Benth.) Epling, Lamiaceae, and Vallea stipularis L.f., Elaeocarpaceae, are the object of the present study. These plants are endemic to the Andean region and have attracted our attention on the basis of interesting results obtained in a preliminary anticholinesterase screening. Actually, carnosol and tiliroside, isolated from L. mutica and V. stipularis, respectively, have shown a promising selective inhibitory activity against butyrylcholinesterase. Specifically, the anti-butyrylcholinesterase activity of carnosol was 5.15 µM and that of tiliroside was 52.9 µM, compared to 8.568 ± 0.570 µM of the positive control Donepezil. Carnosol and tiliroside were purified chromatographically from the ethyl acetate extract of L. mutica and V. stipularis, respectively. Spectrophotometric methods were used for enzymatic studies.

Polimorfismos de un solo nucleótido representativos para los alelos clásicos del antígeno leucocitario humano en familias antioqueñas con diabetes mellitus tipo 1 / Classical HLA alleles tag SNP in families from Antioquia with type 1 diabetes mellitus

Resumen Introducción. La región del antígeno leucocitario humano (Human Leukocyte Antigen, HLA) se ha asociado claramente con enfermedades autoinmunitarias, como la diabetes mellitus de tipo 1. Los polimorfismos representativos de un solo nucleótido (tag Single Nucleotide Polymorphism, tag SNP) constituyen una forma alternativa de evaluar los alelos clásicos del HLA. En la población europea se ha reportado un grupo de tag SNP para múltiples alelos clásicos relacionados con la predisposición o la resistencia frente a dicha enfermedad. Objetivo. Validar la metodología basada en los tag SNP enfocada en la inferencia de alelos HLA clásicos, y evaluar su asociación con la diabetes mellitus de tipo 1 en una muestra de familias antioqueñas. Materiales y métodos. Se estudió una muestra de 200 familias antioqueñas con uno a dos hijos afectados por diabetes mellitus de tipo 1. Se genotipificaron 13 SNP mediante el ARMS-PCR (Amplification Refractory Mutation System-Polymerase Chain Reaction) con cuatro iniciadores, o mediante la PCR-RFLP (PCR-Restriction Fragment Length Polymorphism). Además, se evaluó la validez de los tag SNP de 1.000 genomas reportados en europeos en una muestra de 60 individuos de la población colombiana de Medellín. Se hicieron las pruebas de desequilibrio de la transmisión, de desequilibrio de ligamiento y de equilibrio de Hardy-Weinberg. Resultados. En la población de estudio no se encontró suficiente desequilibrio de ligamiento entre los SNP y los alelos clásicos evaluados, por lo cual no fue posible inferir los alelos clásicos del HLA para el conjunto de familias con diabetes mellitus de tipo 1. El estudio de asociación evidenció que esta región aporta factores tanto de riesgo como de protección para el desarrollo de la enfermedad. Los tag SNP apropiados para la muestra de estudio se determinaron usando los SNP ubicados en la región HLA en la base de datos del 1000 Genomes Project en la mencionada población. Conclusiones. Los patrones de desequilibrio de ligamiento en la población estudiada fueron diferentes a los reportados para la población europea. A pesar de esto, se encontró evidencia clara sobre el papel de la región HLA en el riesgo de padecer diabetes mellitus de tipo 1 en la población de estudio.

abstract Introduction: The HLA region strongly associates with autoimmune diseases, such as type 1 diabetes. An alternative way to test classical HLA alleles is by using tag SNP. A set of tag SNP for several classical HLA alleles has been reported as associated with susceptibility or resistance to this disease in Europeans. Objective: We aimed at validating the methodology based on tag SNP focused on the inference of classical HLA alleles, and at evaluating their association with type 1 diabetes mellitus in a sample of 200 families from Antioquia. Materials and methods: We studied a sample of 200 families from Antioquia. Each family had one or two children with T1D. We genotyped 13 SNPs using tetra-primer ARMS-PCR or PCRRFLP. In addition, we tested the validity of the tag SNP reported for Europeans in 60 individuals from a population of Colombians living in Medellín (CLM) from the 1000 Genomes Project database. Statistical analyses included the Hardy-Weinberg equilibrium, the transmission disequilibrium and the linkage disequilibrium tests. Results: The linkage disequilibrium was low in reported tag SNP and classical HLA alleles in this CLM population. Association analyses revealed both risk and protection factors to develop type 1 diabetes mellitus. Appropriate tag SNPs for the CLM population were determined by using the genotype information available in the 1000 Genome Project database. Conclusions: Although linkage disequilibrium patterns in this CLM population were different from those reported in Europeans, we did find strong evidence of the role of HLA in the development of type 1 diabetes mellitus in the study population.