Computed Tomography Predictors of Vascular Injury in Cranioencephalic Trauma Patients / Preditores tomográficos de lesão vascular em pacientes com traumatismo cranioencefálico

Objective A frequent challenge for the neurosurgeon when treating a patient with cranioencephalic trauma is to determine whether the patient has a vascular lesion, when to suspect it, and what studies to request. In this context, the objective of the present study was to identify the variables on cranial computed tomography (CT) scans that predict vascular injury in digital subtraction angiography in patients with cranioencephalic trauma. ethods We conducted a cross-sectional study of patients with cranioencephalic trauma admitted to the Hospital Universitario del Valle between June 2016 and June 2019. Subjects with available simple CT images of the skull and digital subtraction angiography were included. Results A total of 138 subjects who met the inclusion criteria were identified. The average age was 32 years, 82% were men, and the most frequent mechanism of injury was firearm wound (59%). The variables associated with vascular injury were fracture of the base of the temporal skull and sphenoid fracture. Conclusion The presence of fractures of the base of the temporal skull and sphenoid fractures is associated with vascular injury in patients with cranioencephalic trauma.

Objetivo Um desafio frequente para o neurocirurgião no cuidado de um paciente com traumatismo crânio-encefálico é determinar se o paciente tem lesão vascular, quando suspeitar que tem, e quais estudos pedir. Neste contexto, o objetivo deste estudo foi identificar as variáveis da tomografia computadorizada (TC) de crânio que predizem lesão vascular na angiografia por subtração digital em pacientes com traumatismo crânio-encefálico. Métodos Fez-se um estudo transversal de pacientes com traumatismo crânio-encefálico internados no hospital (cego) entre junho de 2016 e junho de 2019. Foram incluídos também pacientes com imagens de TC simples do crânio e angiografia de subtração digital disponíveis. Resultados Foram identificados um total de 138 sujeitos que cumpriam os critérios de inclusão. A média de idade foi de 32 anos, 82% eram homens, e o mecanismo da lesão mais frequente foi o ferimento por arma de fogo (59%). As variáveis associadas à lesão vascular foram a fratura da base do crânio temporal e a fratura esfenoidal. Conclusão A presença de fraturas da base do crânio temporal e fraturas do esfenoide está associada à lesão vascular em pacientes com traumatismo crânio-encefálico.

COVID-19 and public transport: an overview and recommendations applicable to Latin America / COVID-19 y transporte público: una revisión y recomendaciones aplicables a América Latina

Abstract The article presents a general overview on COVID-19 transmission in the context of public transport, particularly applicable to decision making in Latin America. Based on recent findings on COVID-19 transmission and the relative importance of each factor (droplets, fomites, and aerosol routes) in such transmission, we seek to update the discussion on the topic that has generally been based on social distance as the only parameter for reducing the risk of transmission and broadens the vision to integrate ventilation, users' behavior (mask and eye protection use, silence while in the transport system) and travel distance. Recommendations to improve mobility conditions reducing the risk of COVID-19 contagion are provided.

Resumen El artículo presenta una revisión de transmisión de COVID-19 en el contexto de transporte público, con aplicación particular para toma de decisiones en América Latina. Con base en los hallazgos recientes sobre transmisión de Covid-19 y la importancia relativa de cada factor (gotículas, fómites y rutas de aerosoles) en dicha transmisión, buscamos actualizar la discusión sobre el tema que generalmente se ha basado en la "distancia social" como parámetro único de reducción de riesgo de transmisión y amplía esta visión para integrar la ventilación, el comportamiento de usuarios (uso de mascarilla, protección ocular, silencio), y la distancia de viaje. Se indican al final recomendaciones para mejorar las condiciones de movilidad en general sin aumentar el riesgo de contagio de Covid-19.

Sistemas de alerta temprana con enfoque participativo: un desafío para la gestión del riesgo en colombia / Early warning systems with a participative approach: a challenge for risk management in colombia

La mayor parte de la población colombiana está en condiciones de riesgo debido a factores hidroclimatológicos, fuertemente influenciados por la variabilidad (VC) y el cambio climático (CC). A esto se suma el aumento de la vulnerabilidad por la inadecuada planificación y ocupación del territorio, propia de países en desarrollo. En este sentido, los sistemas de alerta temprana (SAT) facilitan los procesos de adaptación y mitigación de impactos, por lo que se constituyen en uno de los ejes transversales de la gestión del riesgo. En este trabajo se presenta una reflexión de diversos enfoques y experiencias nacionales e internacionales en SAT. A partir de lo anterior, se identificó que muchos SAT no llegan a ser implementados; y una vez en funcionamiento, existe desequilibrio entre sus componentes. Por otro lado, no se ajustan a las necesidades de los territorios como consecuencia de la escasa participación comunitaria, tanto en la etapa de diseño como en la de operación. Por ello, se considera que para obtener resultados eficaces, que promuevan la construcción de resiliencia, son necesarios SAT con enfoque participativo, que fortalezcan las capacidades de las comunidades para enfrentar las condiciones de riesgo de su entorno.

Most of the Colombian population is facing risks due to hydroclimatological factors, strongly influenced by the climate variability (CV) and climate change (CC). Likewise, vulnerability is continuously increasing because of inadequate land planning and occupation, common in developing countries. Therefore, early warning systems (EWS) facilitate the processes of adaptation and mitigation of impacts, which is why they constitute one of the transverse axes in risk management. This study aimed to review approaches to and field experiences with EWS throughout the world, including Colombia. We identified that many EWS are unimplemented; and once in operation, there exists an imbalance among components. On the other hand, some EWS fail to meet the territory needs as a result of poor community participation, both at design and operation stages. Hence, a participative approach in EWS to tackling risks and building up the capacities of the communities should be promoted for obtaining effective results.