Social and clinical predictors of perianal colonisation by multidrug-resistant bacteria for geriatric patients in the internal medicine service.

BACKGROUND: Colonisation by multidrug-resistant (MDR) bacteria is a global health issue. The identification of patients with a higher risk of colonisation is essential. Patients admitted to internal medicine services might represent a vulnerable population with a high risk of colonisation. This study was the first to assess social and clinical variables associated with a higher risk of perianal colonisation by MDR bacteria in a Spanish cohort of patients admitted to internal medicine service. METHODS: Patients admitted to an internal medicine service during 12 months of recruitment (1 March 2022 to 1 March 2023) were included in the study. Perianal swabs were performed at admission to identify the presence of MDR bacteria. Social and clinical variables were collected following a directed acyclic graph. A cluster analysis was performed to identify clinical profiles of higher risk. Bivariate analyses and multivariable logistic regression models were fitted to identify potential predictors of MDR bacteria colonisation. RESULTS: A total of 245 patients, according to the required sample size, were included. Of them, 46 (18.8%) were colonised by MDR bacteria in perianal swabs. Female sex, age > 80 years, dependency on activities of daily living, cognitive deterioration and living in long-term care facilities constituted the highest risk clinical profile. After adjustments, living in long-term care facilities and malnutrition remained the main risk factors identified. CONCLUSION: Patients admitted to internal medicine services presented a high frequency of perianal colonisation by MDR bacteria. Social and clinical variables associated with bio-psycho-social susceptibility were associated with colonisation. Special surveillance is needed in internal medicine services to control the transmission.

Characteristics and clinical outcome in 312 patients with moderate to severe pneumonia due to SARS-COV-2 and hyperinflammation treated with anakinra and corticosteroids: A retrospective cohort study.

OBJECTIVE: To assess the clinical outcome (death and/or Intensive Care Unit (ICU) admission) based on the time from hospital admission to the administration of anakinra and the possible usefulness of a "simplified" SCOPE score to stratify the risk of worse prognosis in our cohort of patients with moderate/severe SARS-CoV-2 pneumonia, both vaccinated and unvaccinated, that received anakinra and corticosteroids. In addition, the clinical, analytical, and imaging characteristics of patients at admission are described. METHODS: Retrospective cohort study of 312 patients admitted to Hospital Clínico San Cecilio in Granada for moderate/severe pneumonia caused by SARS-CoV-2 that received anakinra and corticosteroids between March 2020 and January 2022. Clinical and analytical data were collected as well as the patient outcome at 30 and 60 days after admission. Three treatment groups were established according to the time from hospital admission to administration of anakinra: early (1st-2nd day), intermediate (3rd-5th day), and late (after the 5th day). RESULTS: The median age was 67.4 years (IQR 22-97 years) and 204 (65.4%) were male. The most common comorbidity was hypertension (58%). The median time from the start of symptoms to anakinra administration was 6 days (IQR 5-10) and the SaFi (SaO2/FiO2) was 228 (IQR 71-471). The cure rate was higher in the early-onset anakinra group versus the late-onset group (73% vs 56.6%). The latter had a higher percentage of deaths (27.4%) and a greater number of patients remained hospitalized for a month (16%). On admission, the patients had elevated C-reactive protein (CRP), ferritin, and D-dimer values and decreased total lymphocytes. Analytical improvement was observed at both 72 hours and one month after treatment. 42 (13.5%) required ICU admission, and 23 (7.3%) orotracheal intubation. At 60 days, 221 (70.8%) were discharged, 87 (27.8%) had died and 4 (1.4%) remained hospitalized. The mean dose of anakinra was 1000 mg (100-2600 mg) with differences found between the dose administered and the clinical outcome. There were no differences in the primary outcome based on vaccination. A simplified SCOPE score at the start of anakinra administration was lower in patients with better clinical evolution. CONCLUSIONS: Early treatment with anakinra and corticosteroids was associated with a better outcome regardless of vaccination status. A simplified SCOPE was found to be a good prognostic tool.

Diagnóstico de adenocarcinoma pulmonar primario a partir de metástasis coroidea. Reporte de caso / Diagnosis of primary lung adenocarcinoma from choroidal metastasis. Case report

En la actualidad se cuenta con escasos reportes de casos clínicos de pacientes con metástasis coroidea sintomática como la presentación inicial de cáncer de pulmón. En este reporte describimos el caso de una paciente con adenocarcinoma de pulmón, la cual fue diagnosticada por síntomas iniciales oculares consistentes en pérdida visual progresiva y presencia de escotomas en ambos ojos, por lo que se le realizaron exámenes adicionales que llevaron al diagnóstico de cáncer de pulmón con metástasis coroidea. El pronóstico de estos pacientes es pobre, en la mayoría de los casos se trata de tumores en estadios avanzados de la enfermedad.

Currently there are few clinical case reports of patients with symptomatic choroidal metastasis as the initial presentation of lung cancer. In this report, we describe the case of a female patient with lung adenocarcinoma, who was diagnosed due to initial ocular symptoms consisting of progressive visual loss and the presence of scotomas in both eyes, so additional tests were performed leading to the diagnosis of lung cancer with choroidal metastasis.

Tumor de músculo liso uterino de potencial maligno incierto (STUMP): reporte de caso y revisión de la literatura / Uterine smooth muscle tumor of uncertain malignant potential (STUMP): case report and literature review

Myometrial smooth muscle neoplasms are the most common gynecologic tumors with a prevalence of 70-80% at age 50. Among women undergoing hysterectomy or myomectomy for a suspected diagnosis of leiomyoma, 0.01% receive a diagnosis of STUMP. Clinically, the average age of presentation is between 41-48 years. Tumors ranging from 3 to 30 cm have been described. Signs and symptoms are similar to leiomyomas, such as abnormal uterine bleeding, anemia, dysmenorrhea, pelvic pain, pelvic mass, infertility or other types of pain secondary to compression of adjacent organs. Due to the limited literature available, there is no definite management consensus, and treatment and follow-up options are limited to observational studies. The standard treatment is total hysterectomy with or without bilateral salpingo-oophorectomy; if fertility has already been completed, there is no role for adjuvant hormonal therapy or chemotherapy. The overall 5-year survival is 92-100%. A case of a 31-year-old woman with STUMP is presented.

Physico-Chemical and Microbiological Control of the Composting Process of the Organic Fraction of Municipal Solid Waste: A Pilot-Scale Experience.

The aim of this work was to carry out a pilot experiment to monitor OFMSW (organic fraction of municipal solid waste) composting processes using different types of installations (automatic reactor, aerated static pile and turned pile). To carry out the process, pruning waste was used as structuring material (SM), in a 1:1 and 1:2, v:v, OFMSW:SM ratio. Monitoring was carried out through the control of physico-chemical and microbiological parameters, such as temperature, pH, humidity, Rottegrade, Solvita tests, the presence of Salmonella sp. and Escherichia coli, total coliform, and Enterococcus sp. concentrations. After carrying out the tests, it can be affirmed that the three types of installations used worked correctly in terms of the monitoring of physico-chemical parameters, giving rise to a compost of sufficient stability and maturity to be applied on agricultural soil. In all cases the bacterial concentrations in the final compost were lower than those detected in the mixture of initial components for its preparation, thus complying with the requirements established in RD 506/2013 and RD 999/2017RD on fertilizer products. However, it cannot be affirmed that one of the three types of installation used produces a greater bacterial inactivation than the others. When composting with different types of facilities, it is of interest to optimize the irrigation and aeration system in order to have a better control of the process and to study the possible temperature gradients in the piles to ensure good sanitization without the risk of bacterial proliferation a posteriori. Finally, the different initial mixtures of OFMSW and SM used in this study did not have a significant influence on the functioning of the composting process or on the microbiological quality during the process. The irrigation water can provide a bacterial contribution that can lead to increases in concentration during the composting process. This study is part of the Life-NADAPTA project (LIFE16 IPC/ES/000001), an integrated strategy for adaptation to Climate Change in Navarra, where NILSA participates in water action and collaborates in agricultural action, which includes among its objectives the development of new soil amendments from different organic waste.

Anisakidae parasites in frozen fish fillets intended for human consumption. / Parásitos anisákidos en filetes de pescado congelado destinados a consumo humano

INTRODUCTION: Anisakiasis is a human parasitic disease caused by the consumption of raw fish or shellfish containing larvae of the Anisakidae family. It is currently considered an emerging disease of public health interest. OBJECTIVE: To identify the presence of larvae of the Anisakidae family in samples of frozen raw fish fillets intended for human consumption in markets in Medellín and its metropolitan area in Antioquia, Colombia. MATERIALS AND METHODS: A cross-sectional study was carried out, in which larvae of the Anisakidae family were detected and identified in frozen raw fish fillets from three representative markets in Medellín and its metropolitan area. A total of 384 ready for consumption fillets were analyzed (197 sawfish, 137 salmon, 37 tuna, and 13 hake), using the pressing and ultraviolet light method. Taxonomic keys were used to identify the collected parasites and to establish its genus. Conventional PCR and Sanger sequencing was performed to determine the species. RESULTS: Four larvae were found in 4 of the 384 (1.04%) fillets (CI95% 1.04 ± 1.01%). The species of fish in which the larvae were found was sawfish (Scomberomorus spp.) and the genus and species of the larvae was established as Anisakis pegreffii. CONCLUSIONS: According to the study, the presence of Anisakis parasites in frozen raw fish fillets in the influence area is evident.

Introducción. La anisakiasis es una infección producida por parásitos de la familia Anisakidae, transmitida a los humanos por el consumo de pescado o mariscos crudos. En la actualidad, se considera una enfermedad emergente de interés en salud pública. Objetivo. Identificar la presencia de larvas de la familia Anisakidae en muestras de filetes de pescado crudo congelado destinados a consumo humano, en mercados de Medellín y su área metropolitana en Antioquia (Colombia). Materiales y métodos. Se realizó un estudio transversal, en el cual se buscó la presencia de larvas de la familia Anisakidae en filetes de pescado crudo congelado de tres mercados representativos de Medellín y su área metropolitana. Se analizaron 384 filetes listos para el consumo (197 sierras, 137 salmones, 37 atunes y 13 merluzas). Cada filete fue analizado mediante el método de prensado y luz ultravioleta. Los parásitos recolectados se identificaron a partir de claves taxonómicas para establecer el género, así como PCR convencional y posterior secuenciación Sanger, para determinar la especie. Resultados. Se encontraron 4 larvas en 4 de los 384 filetes (1,04 %) (IC95% 1,04 ± 1,01 %). Las larvas encontradas fueron identificadas como Anisakis pegreffi y el tipo de pescado en el cual se encontraron fue la sierra (Scomberomorus spp.). Conclusiones. De acuerdo con el estudio realizado, se evidencia la presencia de parásitos anisákidos en filetes de pescado crudo congelado en el área de influencia.

Anisakidae parasites in frozen fish fillets intended for human consumption / Parásitos anisákidos en filetes de pescado congelado destinados a consumo humano

Introduction: Anisakiasis is a human parasitic disease caused by the consumption of raw fish or shellfish containing larvae of the Anisakidae family. It is currently considered an emerging disease of public health interest. Objective: To identify the presence of larvae of the Anisakidae family in samples of frozen raw fish fillets intended for human consumption in markets in Medellín and its metropolitan area in Antioquia, Colombia. Materials and methods: A cross-sectional study was carried out, in which larvae of the Anisakidae family were detected and identified in frozen raw fish fillets from three representative markets in Medellín and its metropolitan area. A total of 384 ready for consumption fillets were analyzed (197 sawfish, 137 salmon, 37 tuna, and 13 hake), using the pressing and ultraviolet light method. Taxonomic keys were used to identify the collected parasites and to establish its genus. Conventional PCR and Sanger sequencing was performed to determine the species. Results: Four larvae were found in 4 of the 384 (1.04%) fillets (CI95% 1.04 ± 1.01%). The species of fish in which the larvae were found was sawfish (Scomberomorus spp.) and the genus and species of the larvae was established as Anisakis pegreffii. Conclusions: According to the study, the presence of Anisakis parasites in frozen raw fish fillets in the influence area is evident.

Introducción. La anisakiasis es una infección producida por parásitos de la familia Anisakidae, transmitida a los humanos por el consumo de pescado o mariscos crudos. En la actualidad, se considera una enfermedad emergente de interés en salud pública. Objetivo. Identificar la presencia de larvas de la familia Anisakidae en muestras de filetes de pescado crudo congelado destinados a consumo humano, en mercados de Medellín y su área metropolitana en Antioquia (Colombia). Materiales y métodos. Se realizó un estudio transversal, en el cual se buscó la presencia de larvas de la familia Anisakidae en filetes de pescado crudo congelado de tres mercados representativos de Medellín y su área metropolitana. Se analizaron 384 filetes listos para el consumo (197 sierras, 137 salmones, 37 atunes y 13 merluzas). Cada filete fue analizado mediante el método de prensado y luz ultravioleta. Los parásitos recolectados se identificaron a partir de claves taxonómicas para establecer el género, así como PCR convencional y posterior secuenciación Sanger, para determinar la especie. Resultados. Se encontraron 4 larvas en 4 de los 384 filetes (1,04 %) (IC95% 1,04 ± 1,01 %). Las larvas encontradas fueron identificadas como Anisakis pegreffi y el tipo de pescado en el cual se encontraron fue la sierra (Scomberomorus spp.) Conclusiones. De acuerdo con el estudio realizado, se evidencia la presencia de parásitos anisákidos en filetes de pescado crudo congelado en el área de influencia.

Uncovering commercial activity in informal cities.

Knowledge of the spatial organization of economic activity within a city is a key to policy concerns. However, in developing cities with high levels of informality, this information is often unavailable. Recent progress in machine learning together with the availability of street imagery offers an affordable and easily automated solution. Here, we propose an algorithm that can detect what we call visible establishments using street view imagery. By using Medellín, Colombia as a case study, we illustrate how this approach can be used to uncover previously unseen economic activity. By applying spatial analysis to our dataset, we detect a polycentric structure with five distinct clusters located in both the established centre and peripheral areas. Comparing the density of visible establishments with that of registered firms, we infer that informal activity concentrates in poor but densely populated areas. Our findings highlight the large gap between what is captured in official data and the reality on the ground.

Calcium Oxalate Crystals in Leaves of the Extremophile Plant Colobanthus quitensis (Kunth) Bartl. (Caryophyllaceae).

The presence of calcium oxalate (CaOx) crystals has been widely reported in the plant kingdom. These structures play a central role in various physiological functions, including calcium regulation, metal detoxification, and photosynthesis. However, precise knowledge about their possible roles and functions in plants is still limited. Therefore, the present work aims to study the ecotypic variability of Colobanthus quitensis, an extremophile species, concerning CaOx crystal accumulation. The CaOx crystals were studied in leaves of C. quitensis collected from different provenances within a latitudinal gradient (From Andes mountains in central Chile to Antarctica) and grown under common garden conditions. Polarized light microscopy, digital image analysis, and electron microscopy were used to characterize CaOx crystals. The presence of CaOx crystals was confirmed in the four provenances of C. quitensis, with significant differences in the accumulation among them. The Andean populations presented the highest accumulation of crystals and the Antarctic population the lowest. Electron microscopy showed that CaOx crystals in C. quitensis are classified as druses based on their morphology. The differences found could be linked to processes of ecotypic differentiation and plant adaptation to harsh environments.

Experience of clinical screening for COVID-19 among patients undergoing elective orthopedic surgeries: an alternative proposal.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic is the largest global event in recent times, with millions of infected people and hundreds of thousands of deaths worldwide. Colombia has also been affected by the pandemic, including by the cancellation of medically necessary surgical procedures that were categorized as nonessential. The objective of this study was to show the results of the program implemented in two institutions in Bogotá, Colombia, in April 2020 to support the performance of elective essential and nonessential low- and medium-complexity orthopedic surgeries during the mitigation phase of the COVID-19 pandemic, which involved a presurgical clinical protocol without serological or molecular testing. METHODS: This was a multicenter, observational, retrospective, descriptive study of a cohort of patients who underwent elective orthopedic surgery at two institutions in the city of Bogota, Colombia, in April 2020. We implemented a preoperative clinical protocol that did not involve serological or molecular tests; the protocol consisted of a physical examination, a survey of symptoms and contact with confirmed or suspected cases, and presurgical isolation. We recorded the types of surgeries, the patients' scores on the medically necessary, time-sensitive (MeNTs) scale, the presence of signs, symptoms, and mortality associated with COVID-19 developed after the operation. RESULTS: A total of 179 patients underwent orthopedic surgery. The average age was 47 years (Shapiro-Wilk, P = 0.021), and the range was between 18 and 81 years. There was a female predominance (61.5%). With regard to the types of surgeries, 86 (48%) were knee operations, 42 (23.5%) were hand surgeries, 34 (19%) were shoulder surgeries, and 17 (9.5%) were foot and ankle surgeries. The average MeNTs score was 44.6 points. During the 2 weeks after surgery, four patients were suspected of having COVID-19 because they developed at least two symptoms associated with the disease. The incidence of COVID-19 in the postoperative period was 2.3%. Two (1.1%) of these four patients visited an emergency department where RT-PCR tests were performed, and they tested negative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). No patients died or were hospitalized for symptoms of COVID-19. CONCLUSION: Through the implementation of a presurgical clinical protocol consisting of a physical examination; a clinical survey inquiring about signs, symptoms, and epidemiological contact with suspected or confirmed cases; and presurgical isolation but not involving the performance of molecular or serological diagnostic tests, positive results were obtained with regard to the performance of low- and medium-complexity elective orthopedic surgeries in an early stage of the COVID-19 pandemic. LEVEL OF EVIDENCE: IV.

OXA-48 Carbapenemase-Producing Enterobacterales in Spanish Hospitals: An Updated Comprehensive Review on a Rising Antimicrobial Resistance.

Carbapenemase-producing Enterobacterales (CPE) are significant contributors to the global public health threat of antimicrobial resistance. OXA-48-like enzymes and their variants are unique carbapenemases with low or null hydrolytic activity toward carbapenems but no intrinsic activity against expanded-spectrum cephalosporins. CPEs have been classified by the WHO as high-priority pathogens given their association with morbidity and mortality and the scarce number of effective antibiotic treatments. In Spain, the frequency of OXA-48 CPE outbreaks is higher than in other European countries, representing the major resistance mechanism of CPEs. Horizontal transfer of plasmids and poor effective antibiotic treatment are additional threats to the correct prevention and control of these hospital outbreaks. One of the most important risk factors is antibiotic pressure, specifically carbapenem overuse. We explored the use of these antibiotics in Spain and analyzed the frequency, characteristics and prevention of CPE outbreaks. Future antibiotic stewardship programs along with specific preventive measures in hospitalized patients must be reinforced and updated in Spain.

Photoactivation and photoregeneration of TiO2/PAC mixture applied in suspension in water treatments: approach to a real application.

The process TiO2/PAC/UV-vis has been under study and compared with the isolated treatments of adsorption and photocatalysis determining possible synergies between adsorption and photocatalysis of target antibiotics: amoxicillin, enrofloxacin, sulfadiazine, and trimethoprim. The characterization of the TiO2/PAC mixture was carried out via FESEM and FTIR. Moreover, a kinetic study has been performed. The effect of UV-vis radiation and the type of matrix was analyzed in TiO2/PAC/UV-vis process. The performance of this treatment has been monitored during three cycles, evaluating also the regeneration of TiO2/PAC mixture by UV-vis light. TiO2/PAC/UV-vis process allowed the removal of the antibiotics in the range 90-100% (an average removal of 93% of the initial concentration) after 60 min of treatment. However, only amoxicillin showed a significant synergy applying TiO2/PAC/UV-vis process. Regarding matrix effect, no influence of the matrix type (ultrapure water or treated wastewater) was observed. Since PAC tends to be deactivated gradually, the TiO2/PAC/UV-vis process performance decreases after each cycle in a 15% average. Finally, regeneration via UV-vis light started to be effective after a total of 4 h of regeneration.

Antibiotics removal from aquatic environments: adsorption of enrofloxacin, trimethoprim, sulfadiazine, and amoxicillin on vegetal powdered activated carbon.

This study addresses the growing concern about the high levels of antibiotics in water, outlining an alternative for their removal. The adsorption of four representative antibiotics from commonly used families (fluoroquinolones, ß-lactams, trimethoprim, and sulfonamides) was performed over vegetal powdered activated carbon. The evolution of the adsorption was studied during 60 min for different initial antibiotic concentrations, not only individually but also simultaneously to determine competitive adsorption. Moreover, this research studied the adsorption isotherms and kinetics of the process, as well as the pH influence; FTIR of the activated carbon before and after adsorption was carried out. Trimethoprim and sulfadiazine showed more affinity for the adsorbent than amoxicillin and enrofloxacin. This trend might be attributed to their structure, capable of stablishing stronger π-π interactions with the adsorbent, which showed high affinity for the active sites of the adsorbent via FTIR. In addition, the sorption isotherms of trimethoprim followed a Langmuir type isotherm, amoxicillin followed a Freundlich type isotherm, and enrofloxacin and sulfadiazine followed both. The antibiotics followed pseudo-second-order kinetics. Sulfadiazine and amoxicillin gave better performances in acidic conditions. By contrast, the sorption of trimethoprim was favored in basic environments. Variations of pH had a negligible effect on the removal of enrofloxacin.

Study of Evolution of Microbiological Properties in Sewage Sludge-Amended Soils: A Pilot Experience.

Large amounts of sewage sludge are generated in urban wastewater treatment plants and used as fertilizer in agriculture due to its characteristics. They can contain contaminants such as heavy metals and pathogenic microorganisms. The objective of this research work is to study, in real conditions, the evolution of microbial concentration in agricultural soils fertilized by biologically treated sewage sludge. The sludge (6.25 tons Ha-1) was applied in two agricultural soils with different textures and crops. A microbiological (total coliforms, Escherichia coli, Staphylococcus aureus, Enterococcus sp., Pseudomonas sp., Salmonella sp. and total mesophylls) and physical-chemical characterization of the sludge, soils and irrigation water were carried out. The evolution of these parameters during sowing, growth and harvesting of crops was studied. Initially, sewage sludge had a higher concentration of microorganisms than soils. Irrigation water also contained microorganisms, fewer than sewage sludge amendment but not negligible. After amendment, there were no differences in the microbiological evolution in the two types of soil. In general, bacterial concentrations after crop harvest were lower than bacterial concentrations detected before sewage sludge amendment. Consequently, the application of sludge from water treatment processes did not worsen the microbiological quality of agricultural soil in this study at real conditions.

Prevalence of Multi-Resistant Microorganisms and Antibiotic Stewardship among Hospitalized Patients Living in Residential Care Homes in Spain: A Cross-Sectional Study.

Antimicrobial resistance is a growing global health problem. Patients living in care homes are a vulnerable high-risk population colonized by multidrug-resistant organisms (MDRO). We identified a case series of 116 residents of care homes from a cohort of 540 consecutive patients admitted to the internal medicine service of our hospital. We performed early diagnostic tests of MDRO through anal exudates in our sample. The prevalence of MDRO colonization was 34.5% of residents and 70% of them had not been previously identified in the clinical records. Previous hospitalizations and in-hospital antibiotic administration were significantly associated with the presence of MDRO. Our results emphasize the need to consider care homes in the planning of regional and national infection control measures and for implementing surveillance systems that monitor the spread of antimicrobial resistance in Spain. Systematic early testing upon admission to hospital services with a high prevalence of patients with MDRO colonization (e.g., internal medicine) could contribute to the adoption of adequate prevention measures. Specific educational programs for care home staff should also be implemented to address this increasing problem.

Performance comparison of commercial TiO2: separation and reuse for bacterial photo-inactivation and emerging pollutants photo-degradation.

This research aims to compare the disinfection and degradation effectiveness in water of a commercial suspension of nano-TiO2 (TiO2Levenger) with the standard TiO2Degussa P25. Photo-inactivation and photo-degradation experiments were conducted with UVA-vis light. Concerning the disinfection, the effects of TiO2 dose (0-2 g/l), water matrix, bacterium type (Gram-positive or Gram-negative), and bacterial regrowth after the photo-treatments were studied for each catalyst. The experimental results show that Enterococcus sp. (Gram-positive) was more resistant to the photo-treatments than Escherichia coli (Gram-negative) for both catalyst; however, postirradiation trends showed similar behavior for both bacteria, favoring regrowth for short-treated cells and decay for longer-treated ones. Caffeine was selected as a model substance of pharmaceuticals and personal care products. In terms of caffeine removal, the effects of TiO2 dose (0-2 g/l) and water matrix were analyzed. Besides, the comparison between mechanical coagulation-flocculation-decantation and simple decantation of TiO2 was carried out. The results show that simple decantation allowed the recovery of 97.5% of TiO2 Degussa P25 and TiO2 Levenger within 1 day of simple decantation, while applying the proposed mechanical coagulation-flocculation decantation 99.7% of recovery of both catalysts was achieved in 2 hours. Finally, the subsequent reuse of both catalysts was proved with little loss of efficiency in terms of photo-disinfection during the four cycles. Nevertheless, the standard TiO2 Degussa P25 photo-degradation efficiency of caffeine decreases considerably as compared to commercial suspension of TiO2 Levenger concerning the reutilization.

Recomendaciones para el uso racional de la prueba 25-hidroxivitamina D Resumen de política

está disponible en el texto completo

The exponential increase in the request for laboratory tests of 25-Hydroxyvitamin D or [25 (OH) D has ignited the alarms and generated a strong call for attention, since it may reflect deficiencies in the standardization of clinical practice and in the use non-systematic scientific evidence for decision-making in real life, which allows to analyze the indications of the test, its frequency, interpretation and even to assess the impact for health systems, especially when contrasted with the minimum or almost. No effects of the strategy of screening or supplying indiscriminately to the general population, without considering a comprehensive clinical assessment of risks and needs of people. From a purely public health impact point of view, the consequence of massive and unspecified requests is affecting most of the health systems and institutions at the global level. The primary studies that determined average population intake values have been widely used in the formulation of recommendations in Clinical Practice Guidelines, but unfortunately misinterpreted as cut points to diagnose disease and allow the exaggerated prescription of nutritional substitution. The coefficient of variation in routine tests to measure blood levels of 25 (OH) D is high (28%), decreasing the overall accuracy of the test and simultaneously, increasing both the falsely high and falsely low values. The most recent scientific evidence analyzes and seriously questions the usefulness and the real effect of the massive and indiscriminate practice of prescribing vitamin D without an exhaustive risk analysis. The available evidence is insufficient to recommend a general substitution of vitamin D to prevent fractures, falls, changes in bone mineral density, incidence of cardiovascular diseases, cerebrovascular disease, neoplasms and also to modify the growth curve of mothers' children. They received vitamin D as a substitute during pregnancy. The recommendations presented in the document are based on the critical analysis of current evidence and the principles of good clinical practice and invite to consider a rational use of 25 (OH) D tests in the context of a clinical practice focused on people and a comprehensive assessment of needs and risks. The principles of good practice suggest that clinicians may be able to justify that the results of the 25 (OH) D test strongly influence and define clinical practice and modify the outcomes that interest people and impact their health and wellness. Currently there is no clarity on how to interpret the results, and the relationship between symptoms and 25 (OH) D levels, which may not be consistent with the high prevalence of vitamin D deficiency reported. For this reason, it is suggested to review the rationale of the request for tests for systematic monitoring of levels of 25 (OH) D or in all cases where substitution is performed. Consider the use of 25 (OH) D tests within the comprehensive evaluation of people with suspicion or confirmation of the following conditions: rickets, osteomalacia, osteoporosis, hyper or hypoparathyroidism, malabsorption syndromes, sarcopenia, metabolic bone disease.

Hallazgos neuropsicológicos de una muestra de niños con epilepsias focales de etiología genética y desconocida / Neuropsychological Discoveries in a Sample of Children with Focal Epilepsies of Genetic and Unkown Etiologies / Descobertas neuropsicológicas de uma amostra de crianças com epilepsias focais de etiologia genética e desconhecida

Resumen Objetivo. Caracterizar el perfil cognitivo de un grupo de niños con epilepsias focales de etiología genética y desconocida y control de crisis epilépticas. Método. Se realizó una evaluación neuropsicológica con subpruebas de la batería Evaluación Neuropsicológica Infantil (ENI), a 35 niños entre los 7 y los 15 años de edad, con diagnóstico de epilepsias focales de etiología genética o desconocida, tratamiento farmacológico y coeficiente intelectual ≥ 80. Resultados. El grupo de pacientes evidenció déficit significativo en atención auditiva, al comparar su desempeño con los datos normativos de la ENI para población colombiana. No se encontraron diferencias significativas en el desempeño de pacientes con o sin crisis epilépticas durante el último año, etiología genética o desconocida, foco epiléptico en región cerebral frontal o centro-temporal, con o sin diagnóstico previo de trastorno por déficit con o sin hiperactividad (TDAH/TDA). Conclusión. La dificultad atencional observada puede requerir mayor manejo terapéutico, al plantearles una mayor susceptibilidad para desatender a los contenidos de clase que requieren una focalización rápida y efectiva, implicando también tareas de conteo numérico auditivo (como dictados y operaciones matemáticas sencillas), que dependen del adecuado funcionamiento de la atención auditiva.

Abstract Objective. Characterize the cognitive profile of a group of children with focal epilepsies of genetic and unknown etiologies and control of epileptic seizures. Method. This study carried out a neuropsychological assessment using tests from the Evaluación Neuropsicológica Infantil (Neurspsychological Infantile Assessment) (ENI) battery to 35 children between 7 and 15 years old, diagnosed with focal epilepsies of genetic or unknown etiology, pharmacological treatment, and intelligence quotient ≥ 80. Results. Comparing their performance to normative ENI values for the Colombian population and using the percentiles assessment parameters of the test, the group of patients showed a significant deficit in auditory selective attention. No relevant differences were found in the performance of patients with or without seizures during the last year, genetic or unknown etiology, epileptic activity on frontal or centro-temporal brain regions, and the presence or absence of a previous diagnosis of Attention Deficit with or without Hyperactivity (ADHD/ADD). Conclusion. It is possible that this deficit requires more therapeutic management and has negative effects over scholar performance for the assessed children, who demonstrate a greater susceptibility to neglect class contents that require fast and effective attentional focalization, including auditory numeric counting tasks (like dictation and simple mathematic operations).

Resumo Escopo. Caracterizar o perfil cognitivo de um grupo de crianças com epilepsias focais de etiologia genética e desconhecida e controle de crises epilépticas. Metodologia. Foi feita uma avaliação neuropsicológica com sub provas da bateria Avaliação Neuropsicológica Infantil (ANI), a 35 crianças entre os 7 e os 15 anos de idade, com diagnóstico de epilepsias focais de etiologia genética ou desconhecida, tratamento farmacológico e coeficiente intelectual ≥ 80. Resultados. O grupo de pacientes evidenciou déficit significativo em atenção auditiva, ao comparar seu desempenho com os dados normativos da ANI para população colombiana. Não foram achadas diferencias significativas no desempenho de pacientes com ou sem crises epilépticas durante o último ano, etiologia genética ou desconhecida, foco epiléptico em região cerebral frontal ou centro-temporal, com ou sem diagnóstico prévio de Transtorno por Déficit com ou sem Hiperatividade (TDAH/TDA). Conclusão. A dificuldade de atenção observada pode requerer maior gestão terapêutica, ao abordar uma maior susceptibilidade para desatender aos conteúdos de classe que requerem uma focalização rápida e efetiva, implicando também tarefas de contar números de forma auditiva (como ditados e operações matemáticas simples), que dependem do adequado funcionamento da atenção auditiva.