Usefulness of Ultrasonography and Radiography in the Evaluation of Distal Forearm Fractures in Children: A Narrative Review / Utilidad de la ecografía y la radiografía en la evaluación de las fracturas distales del antebrazo en niños: una revisión narrativa

Pediatric fractures, especially distal forearm fractures, represent a significant global medical concern, affecting up to 50% of pediatric fracture cases. This narrative review aims to compare diagnostic modalities to determine which offers higher accuracy, minimizes radiation exposure, and is adaptable to diverse clinical settings. In the choice between ultrasound and X-ray for diagnosing distal forearm fractures in children, each modality has its merits. X-ray provides accuracy and value in wellequipped facilities, while ultrasound, being radiation-free, is effective in resourcelimited areas and is essential for pediatric patients to avoid radiation exposure. Professional training and continual updates are crucial. Moreover, it underscores that alongside diagnostic imaging, comprehensive clinical assessment remains pivotal for making informed medical decisions. The choice of method should consider individual case factors and prioritize patient safety. (AU)

Las fracturas pediátricas, especialmente las fracturas distales del antebrazo, representan una importante preocupación médica mundial y afectan hasta el 50% de los casos de fracturas pediátricas. Esta revisión narrativa tiene como objetivo comparar modalidades de diagnóstico para determinar cuál ofrece mayor precisión, minimiza la exposición a la radiación y es adaptable a diversos entornos clínicos. A la hora de elegir entre ecografía y rayos X para diagnosticar fracturas distales del antebrazo en niños, cada modalidad tiene sus ventajas. Los rayos X proporcionan precisión y valor en instalaciones bien equipadas, mientras que el ultrasonido, al no tener radiación, es eficaz en áreas con recursos limitados y es esencial para que los pacientes pediátricos eviten la exposición a la radiación. La formación profesional y la actualización continua son cruciales. Además, subraya que, junto con el diagnóstico por imágenes, la evaluación clínica integral sigue siendo fundamental para tomar decisiones médicas informadas. La elección del método debe considerar factores de cada caso individual y priorizar la seguridad del paciente. (AU)

Fallo en la regulación de la fertilidad posparto en mujeres en vulnerabilidad social en Colombia / Failured to regulate postpartum fertility in vulnerable women in Colombia

Objetivo: Evaluar la prevalencia de fallo en la regulación de la fertilidad posparto y la asociación con otros factores en un municipio colombiano (2017). Método: Estudio observacional de corte transversal con 148 mujeres. Se aplicó un muestreo no aleatorio para incluir mujeres que hubieran tenido un parto en los últimos 5 años. Se calcularon la prevalencia y las razones de prevalencia. Se exploró la asociación con la prueba χ2 o la prueba exacta de Fisher bajo una significancia estadística de 0,05. Resultados: Se encontró una prevalencia de fallo de la regulación de la fertilidad posparto del 40,5%. La prevalencia se asoció con ejercer oficios del hogar, tener uno o dos hijos, no planificar o no acceder a métodos de planificación y haber tenido un embarazo con periodo intergenésico menor de 2 años (p < 0,05). Conclusiones: Es necesario implementar estrategias para identificar barreras de acceso a la planificación, impactando en el espaciamiento entre embarazos y el acceso a los servicios. Lo anterior para generar múltiples beneficios para la madre, su hijo/a, el sistema de salud y la sociedad.

Objective: To evaluate the prevalence of regulated postpartum fertility failure and possible associated factors in a Colombian municipality (2017). Method: Cross-sectional observational study of 148 women. A non-random sampling method was used to include women who had given birth to a child in the last five years. Prevalence and prevalence ratios were calculated. Associations were examined at 0.05 statistical significance using χ2 test or Fishers exact test. Results: The prevalence of postpartum fertility failure was found to be 40.5%. The prevalence was associated with household work, having one or two children, not planning, or not having access to planning methods, and having a pregnancy with an interval between pregnancies of less than 2 years (p < 0.05). Conclusions: It is necessary to implement strategies to identify barriers to access to planning, which have an impact on the spacing between pregnancies and access to services. This will have multiple benefits for mother, child, health system and society.

Taxonomic and Feeding Trait-Based Analysis of Macroinvertebrates in the Antisana River Basin (Ecuadorian Andean Region).

High-elevation tropical streams are under increasing threat from human activities and climate change. Specifically, Ecuadorian Andean streams require priority actions such as bioassessment (e.g., biodiversity and functional ecology of macroinvertebrates) in order to generate adequate environmental management policies. Therefore, we investigated the distribution and composition of the macroinvertebrate taxa and their functional feeding groups in relation to the environmental variables in the Antisana river basin (Andean-Ecuadorian Region). We sampled macroinvertebrates from 15 locations to assess ecological conditions (ECs), expressed as the Biological Monitoring Working Party Colombia (BMWP-Col) classes, the Andean Biotic Index (ABI) and the Andean-Amazon Biotic Index (AAMBI). Results indicate that dissolved oxygen saturation, elevation, nutrient concentration and conductivity contributed significantly to the composition of the taxa and functional feeding groups (FFGs). Taxa diversity and FFGs were more abundant in the best EC sites. Shredders (SH) were, overall, dominant and abundant at sites with medium-high ECs. Scrapers constituted the second most prevalent assemblage, exerting dominance at moderate ecological conditions (high altitude and high oxygen saturation). Collector-gathers (CGs) are less sensitive to contamination than the previous two groups but were equally abundant at medium-high EC sites. Collector-filterers (CFs) and parasites (PAs) were less abundant, although the presence of the former was slightly related to better environmental conditions. Predators (PRs) were almost absent throughout the study, but they were collected from poor EC sites. CGs, PAs and PRs showed more tolerance to the presence of human disturbances (e.g., hydraulic constructions or slope erosion). The BMWP-Col index seems to be the best fit for this ecosystem, showing a significant difference in FFG between the index classes, compared to the other indices evaluated. The results of this investigation may be regarded as a fundamental starting point and used in future bioassessment work in other similar ecosystems, particularly high-altitude tropical Ecuadorian streams.

Simultaneous quantification of lead, cadmium and zinc in superficial marine sediments using a carbon-fiber microelectrode modified with bismuth film.

Marine sediments are a useful environmental assessment matrix as they naturally trap toxic substances of anthropogenic origin and thus have higher concentrations of these than the surrounding water. Therefore, developing methods for the sensitive, accurate, and inexpensive quantification of these substances is important, as the traditional techniques have various disadvantages. The current study evaluated the effectiveness of an in situ bismuth-modified carbon-fiber microelectrode (voltamperometric sensor) to simultaneously detect Pb, Cd, and Zn in marine sediments from Puerto Jeli in El Oro Province, Ecuador. This site is representative of the contamination levels present along the coast in this province. Differential pulse anodic stripping voltammetry was applied, and the resulting linear regression for the metal quantification ranged from 12 to 50 µg mL-1, with quantification limits for Pb(II), Cd(II), and Zn(II) of 18.69, 12.55, and 19.29 µg mL-1, respectively. Thus, the quantification with the sensor was successful. According to the preliminary results, Cd and Pb values exceeded the permissible limits established by Ecuador (Texto Unificado de la Legislación Secundaria del Ministerio del Ambiente) and the US Environmental Protection Agency, respectively.

Determining Tipping Points and Responses of Macroinvertebrate Traits to Abiotic Factors in Support of River Management.

Although the trait concept is increasingly used in research, quantitative relations that can support in determining ecological tipping points and serve as a basis for environmental standards are lacking. This study determines changes in trait abundance along a gradient of flow velocity, turbidity and elevation, and develops trait-response curves, which facilitate the identification of ecological tipping points. Aquatic macroinvertebrates and abiotic conditions were determined at 88 different locations in the streams of the Guayas basin. After trait information collection, a set of trait diversity metrics were calculated. Negative binomial regression and linear regression were applied to relate the abundance of each trait and trait diversity metrics, respectively, to flow velocity, turbidity and elevation. Tipping points for each environmental variable in relation to traits were identified using the segmented regression method. The abundance of most traits increased with increasing velocity, while they decreased with increasing turbidity. The negative binomial regression models revealed that from a flow velocity higher than 0.5 m/s, a substantial increase in abundance occurs for several traits, and this is even more substantially noticed at values higher than 1 m/s. Furthermore, significant tipping points were also identified for elevation, wherein an abrupt decline in trait richness was observed below 22 m a.s.l., implying the need to focus water management in these altitudinal regions. Turbidity is potentially caused by erosion; thus, measures that can reduce or limit erosion within the basin should be implemented. Our findings suggest that measures mitigating the issues related to turbidity and flow velocity may lead to better aquatic ecosystem functioning. This quantitative information related to flow velocity might serve as a good basis to determine ecological flow requirements and illustrates the major impacts that hydropower dams can have in fast-running river systems. These quantitative relations between invertebrate traits and environmental conditions, as well as related tipping points, provide a basis to determine critical targets for aquatic ecosystem management, achieve improved ecosystem functioning and warrant trait diversity.

Health risk-benefit assessment of the commercial red mangrove crab: Implications for a cultural delicacy.

Mangrove forests, provide vital food resources and are an endangered ecosystem worldwide due to pollution and habitat destruction. A risk-benefit assessment (RBA) was performed on the red mangrove crab (Ucides occidentalis) from the threatened Guayas mangroves in Ecuador. It was aimed to assess the combined potential adverse and beneficial health impact associated with crab consumption and define a recommended safe intake (SI) to improve the diet of the Ecuadoran population while ensuring safe food intake. Target hazard quotients (THQs), benefit quotients (Qs), and benefit-risk quotients (BRQs) were calculated based on the concentrations of the analyzed contaminants (121 pesticide residues, 11 metal(loid)s, antimicrobial drugs from 3 classes) and nutrients (fatty acids, amino acids, and essential nutrients). Except for inorganic arsenic (iAs), the THQ was below 100 for all investigated contaminants, suggesting that the average crab consumer is exposed to levels that do not impose negative non-carcinogenic or carcinogenic health effects in the long and/or short term. Concentrations of iAs (average AsIII: 25.64 and AsV: 6.28 µg/kg fw) were of the highest concern because of the potential to cause negative health effects on long-term consumption. Despite the thriving aquaculture in the Guayas estuary, concentrations of residues of the antimicrobial drugs oxytetracycline (OTC), florfenicol, and nitrofurans still were low. Based on the fact that different risk reference values exist, related to different safety levels, four SI values (0.002, 0.04, 4, and 18 crabs/day) were obtained. The strictest intake values indicate a concern for current consumption habits. In conclusion, the red mangrove crab contains various important nutrients and can be part of a balanced diet for the Ecuadorian population when consumed in limited portions. The present study emphasizes the importance of safeguarding the quality of the environment as a prerequisite for procuring nutritious and safe food.

The nutritional quality of the red mangrove crab (Ucides occidentalis), harvested at two reserves in the Guayas estuary.

Crabs are an outstanding source of many essential nutrients. Little research has been performed on the nutritional quality of the red mangrove crab (Ucides occidentalis). In this research we investigated the proximate composition, fatty acid profile, amino acid composition, and mineral concentrations of red mangrove crabs sampled at two reserves within the Guayas estuary in Ecuador. Furthermore, we evaluated the influence of spatial variation. We found that the red mangrove is a good source of nutrition for a balanced diet and can contribute to the recommended intake of essential nutrients. Also, the red mangrove crab obtained better lipid nutritional quality indices compared to other shellfish species, apart from the EPA + DHA index values. Current research indicated that the final nutritional quality indices of the red crab were not influenced by harvest site. More research into the influence of environmental and ecological factors on the nutritional composition of crabs is suggested.

Total mercury determination in bivalves Anadara tuberculosa sold in open markets from Quito, Ecuador.

This study aimed to quantify the amount of total mercury in bivalves Anadara tuberculosa supplied from Esmeraldas Province and sold in markets in the Metropolitan District of Quito, Ecuador. The determined total mercury concentration was compared to the permissible limits established by the European Commission and World Health Organization-Food and Agriculture Organization and health risk subsequently assessed. Sampling was conducted in five open markets and involved collecting fifteen specimens from each market. Total mercury was measured through cold vapor atomic fluorescence spectrophotometry. Results showed that samples did not exceed the total mercury threshold value (0.5 mg kg-1). However, samples of Anadara tuberculosa from the Ofelia market, which receives fresh products from Eloy Alfaro canton, contained the highest mean levels of mercury contamination, 0.055 mg kg-1. This result could be associated to the influence of illegal mining activity in this area. In addition, methylmercury potential non-carcinogenic risk for consumers exceeded the threshold limit (>1) established by the US Environmental Protection Agency. The daily consumption rate (Rclim) was determined to be 26.61-38.50 g for a child weight of 14.5 kg, and 128.44-185.84 g for an adult weight of 70 kg. Thus, consuming a higher amount of Anadara tuberculosa could negatively affect human health.

From Mangrove to Fork: Metal Presence in the Guayas Estuary (Ecuador) and Commercial Mangrove Crabs.

Mangrove wetlands provide essential ecosystem services such as coastal protection and fisheries. Metal pollution due to industrial and agricultural activities represents an issue of growing concern for the Guayas River Basin and related mangroves in Ecuador. Fisheries and the related human consumption of mangrove crabs are in need of scientific support. In order to protect human health and aid river management, we analyzed several elements in the Guayas Estuary. Zn, Cu, Ni, Cr, As, Pb, Cd, and Hg accumulation were assessed in different compartments of the commercial red mangrove crab Ucides occidentalis (hepatopancreas, carapax, and white meat) and the environment (sediment, leaves, and water), sampled at fifteen sites over five stations. Consistent spatial distribution of metals in the Guayas estuary was found. Nickel levels in the sediment warn for ecological caution. The presence of As in the crabs generated potential concerns on the consumers' health, and a maximum intake of eight crabs per month for adults is advised. The research outcomes are of global importance for at least nine Sustainable Development Goals (SDGs). The results presented can support raising awareness about the ongoing contamination of food and their related ecosystems and the corresponding consequences for environmental and human health worldwide.

Polluted paradise: Occurrence of pesticide residues within the urban coastal zones of Santa Cruz and Isabela (Galapagos, Ecuador).

Although pesticides are frequently used for agriculture in the Galapagos Islands (Ecuador), there are, to date, no investigations of pesticide occurrences in its coastal waters. We examined the presence of pesticide residues in the coastal waters of urban areas in two islands of the Galapagos archipelago using a repeated sampling design. Quantification was performed by solid-phase extraction, followed by chemical analysis using liquid chromatography-tandem mass spectrometry (LC-MS/MS) and gas chromatography-electron capture detector (GC-ECD). The diversity and concentration of pesticide residues in Santa Cruz island were higher compared to Isabela island. In total, sixteen pesticides were detected, including three persistent organic pollutants. Carbendazim (23.93 µg·L-1), cadusafos (4.74 µg·L-1), DDT (2.99 µg·L-1), diuron (1.61 µg·L-1) and aldrin (1.55 µg·L-1) were detected with the highest concentrations between samples. Repetitions in locations show that concentrations of pesticide residues varied considerably in space and time. Comparison with local products indicated agricultural activities on the islands as a possible source. Furthermore, evaluation through ecological risk quotients showed that the observed concentration levels of seven pesticides pose a relatively high risk for three biotic groups (i.e. algae, invertebrates and fishes). Taken together, this study provides insights into the need to regulate, monitor and assess the presence of pesticides in the islands. At a global scale, this study is moreover valuable for the many islands that are facing the same challenges.

Improved Process to Obtain Nanofibrillated Cellulose (CNF) Reinforced Starch Films with Upgraded Mechanical Properties and Barrier Character.

Nowadays, the interest on nanofibrillated cellulose (CNF) has increased owing to its sustainability and its capacity to improve mechanical and barrier properties of polymeric films. Moreover, this filler shows some drawbacks related with its high capacity to form aggregates, hindering its dispersion in the matrix. In this work, an improved procedure to optimize the dispersability of CNF in a thermoplastic starch was put forward. On the one hand, CNF needs a hydrophilic dispersant to be included in the matrix, and on the other, starch needs a hydrophilic plasticizer to obtain a thermoformable material. Glycerol was used to fulfil both targets at once. CNF was predispersed in the plasticizer before nanofibrillation and later on was included into starch, obtaining thin films. The tensile strength of these CNF-starch composite films was 60% higher than the plain thermoplastic starch at a very low 0.36% w/w percentage of CNF. The films showed a noticeable correlation between water uptake, and temperature and humidity. Regarding permeability, a ca. 55% oxygen and water vapor permeability drop was found by nanofiller loading. The hydrolytic susceptibility of the composite was confirmed, being similar to that of the thermoplastic starch.

Distribution of agricultural pesticides in the freshwater environment of the Guayas river basin (Ecuador).

The rapid increase and transition to more intensive agricultural activities in developing nations are often leading to misuse and overuse of pesticides, making their environment vulnerable for pesticide accumulation. In the present study, the Guayas river basin was taken as a representative case study to evaluate pesticide contamination of the Ecuadorean freshwater environment. Pesticide contamination was determined at 181 sampling sites by a multi-residue method using solid phase extraction (SPE) and pesticide residues were linked with agricultural land use activities to identify the main pollution sources. Moreover, the biological water quality status based on macroinvertebrate communities was determined at every location and the relation with the occurrence of pesticide residues was further investigated. Results showed that pesticide contamination of the freshwater environment was widely present in the Guayas river basin with detections at 108 sampling sites (60%). A total of 26 pesticide products were identified. Most frequently detected pesticides included cadusafos (62 locations), butachlor (21 locations) and pendimethalin (21 locations), with concentrations up to 0.081, 2.006 and 0.557 µg·L-1 respectively. Pesticide residues detected in this study did not significantly influence the biological water quality (p = 0.69), but were observed to be positively correlated with ammonium concentrations, supporting the assumed combined application of chemical fertilizers and pesticides in agriculture. These pesticide residues were also associated with one or more agricultural crops, with in particular the banana and rice industries identified as major pollution sources. Both high consumption rates and non-specific application methods, such as aerial spraying of banana plantations and application directly into the water layer of irrigated rice fields, may attribute to pesticide contamination of the freshwater environment of the Guayas river basin. It is therefore suggested that measures, e.g. legal regulations and awareness campaigns, taken to prevent environmental pollution and accumulation of pesticides primarily focus on these industries.

Assessment of groundwater vulnerability in the Daule aquifer, Ecuador, using the susceptibility index method.

The Guayas region in Ecuador is economically very important, producing 68% of the national crops. The main agricultural activities threaten the groundwater therein with nitrate contamination given the large fertiliser and water needs. The present work tests the applicability of the susceptibility index assessment method in evaluating the impact of agricultural activities on groundwater quality, using as a case study an aquifer of the Guayas river basin in Ecuador. The index adapts four parameters of the DRASTIC method and incorporated a new land use parameter. Results show that the areas highly vulnerable to contamination are located in irrigation perimeters of dominant paddy fields associated with the high recharge rates in the alluvial deposits. Respectively, moderately vulnerable and low-vulnerability areas correspond to aquatic environments and forests, semi-natural zones and water bodies. One of the main contributions of the Daule aquifer vulnerability is likely its wide, flat topography. A great part of the aquifer is at high risk of contamination by nitrates if a code of good agricultural practices is not applied. Therefore the implementation of a monitoring network to control the nitrates concentrations is the first step to assure groundwater quality for drinking purposes.

Comparison of the abiotic preferences of macroinvertebrates in tropical river basins.

We assessed and compared abiotic preferences of aquatic macroinvertebrates in three river basins located in Ecuador, Ethiopia and Vietnam. Upon using logistic regression models we analyzed the relationship between the probability of occurrence of five macroinvertebrate families, ranging from pollution tolerant to pollution sensitive, (Chironomidae, Baetidae, Hydroptilidae, Libellulidae and Leptophlebiidae) and physical-chemical water quality conditions. Within the investigated physical-chemical ranges, nine out of twenty-five interaction effects were significant. Our analyses suggested river basin dependent associations between the macroinvertebrate families and the corresponding physical-chemical conditions. It was found that pollution tolerant families showed no clear abiotic preference and occurred at most sampling locations, i.e. Chironomidae were present in 91%, 84% and 93% of the samples taken in Ecuador, Ethiopia and Vietnam. Pollution sensitive families were strongly associated with dissolved oxygen and stream velocity, e.g. Leptophlebiidae were only present in 48%, 2% and 18% of the samples in Ecuador, Ethiopia and Vietnam. Despite some limitations in the study design, we concluded that associations between macroinvertebrates and abiotic conditions can be river basin-specific and hence are not automatically transferable across river basins in the tropics.

Esofaguectomía transhiatal laparoscópica / Transhiatal oesophaguectomy laparoscopic

Se reporta el caso de un paciente operado de esofaguectomía trashiatal por vía laparoscópica, quien era portador de carcinoma epidermoide localizado en tercio distal de esófago, cercano al cardias. El reemplazo del órgano extirpado se efectuó con estómago.