Subject(s)
Common Bile Duct , Adult , Humans , Common Bile Duct/pathology , Common Bile Duct/diagnostic imagingABSTRACT
Acute appendicitis in the pediatric population is a pathology of heterogeneous presentation that is currently diagnosed using various criteria or predictive scales, which have proven not to be sufficiently accurate to be standardized, however, methods have been created to establish a more accurate diagnosis, an aspect that has been provided by artificial intelligence, which through different algorithms has the ability to show the patient's condition and the most appropriate intervention for this, thus reducing the rate of unnecessary interventions and therefore possible related complications.
La apendicitis aguda en la población pediátrica es una patología de presentación heterogénea que es diagnósticada actualmente mediante diversos criterios o escalas predictivas, que han demostrado no ser lo suficientemente precisas para ser estandarizadas, sin embargo, se han creado métodos que permitan establecer un diagnóstico más preciso, aspecto que ha sido proporcionado por la inteligencia artificial, la cual mediante diferentes algoritmos cuenta con la capacidad de arrojar cuál es el estado del paciente y la intervención más adecuada para este, disminuyendo así la tasa de intervenciones inecesarias y por ende posibles complicaciones relacionadas.
Subject(s)
Appendicitis , Child , Humans , Child, Preschool , Retrospective StudiesABSTRACT
Introducción. Una fístula es una conexión anormal entre dos superficies epitelizadas. Cerca del 80 % de las fístulas entero-cutáneas son de origen iatrogénico secundarias a cirugía, y un menor porcentaje se relacionan con traumatismos, malignidad, enfermedad inflamatoria intestinal o isquemia. La morbilidad y las complicaciones asociadas pueden ser significativas, como la desnutrición, en la que intervienen múltiples factores. Métodos. Se realizó una búsqueda de la literatura en las bases de datos de PubMed, Google Scholar y SciELO, utilizando las palabras claves descritas y se seleccionaron los artículos más relevantes de los últimos años. Resultados. La clasificación de las fístulas se basa en su anatomía, su gasto o secreción diaria y su localización. Existe una tríada clásica de las complicaciones: sepsis, desnutrición y anomalías electrolíticas. El control del gasto de la fístula, el drenaje adecuado de las colecciones y la terapia antibiótica son claves en el manejo precoz de estos pacientes. Los estudios recientes hacen hincapié en que la sepsis asociada con la desnutrición son las principales causas de mortalidad. Conclusiones. Esta condición representa una de las complicaciones de más difícil y prolongado tratamiento en cirugía abdominal y colorrectal, y se relaciona con importantes tasas de morbilidad, mortalidad y altos costos para el sistema de salud. Es necesario un tratamiento multidisciplinario basado en la reanimación con líquidos, el control de la sepsis, el soporte nutricional y el cuidado de la herida, entre otros factores.
Introduction. A fistula is an abnormal connection between two epithelialized surfaces. About 80% of enterocutaneous fistulas are of iatrogenic origin secondary to surgery, and a smaller percentage are related to trauma, malignancy, inflammatory bowel disease or ischemia. The associated morbidity and complications can be significant, such as malnutrition, in which multiple factors intervene. Methods. A literature search was carried out in the PubMed, Google Scholar and SciELO databases using the keywords described and the most relevant articles from recent years were selected. Results. The classification of fistulas is based on their anatomy, their daily secretion output, and their location. There is a classic triad of complications: sepsis, malnutrition and electrolyte abnormalities. Control of fistula output, adequate drainage of the collections and antibiotic therapy are key to the early management of these patients. Recent studies emphasize that sepsis associated with malnutrition are the main causes of mortality. Conclusions. This condition represents one of the most difficult and prolonged complications to treat in abdominal and colorectal surgery, and is related to significant rates of morbidity, mortality and high costs for the health system. Multidisciplinary treatment based on fluid resuscitation, sepsis control, nutritional support, and wound care, among other factors, is necessary.
Subject(s)
Humans , Surgical Procedures, Operative , Cutaneous Fistula , Nutritional Status , Morbidity , Intestinal Fistula , Rectal FistulaABSTRACT
The Astyanax mexicanus complex includes two different morphs, a surface- and a cave-adapted ecotype, found at three mountain ranges in Northeastern Mexico: Sierra de El Abra, Sierra de Guatemala and Sierra de la Colmena (Micos). Since their discovery, multiple studies have attempted to characterize the timing and the number of events that gave rise to the evolution of these cave-adapted ecotypes. Here, using RADseq and genome-wide sequencing, we assessed the phylogenetic relationships, genetic structure and gene flow events between the cave and surface Astyanax mexicanus populations, to estimate the tempo and mode of evolution of the cave-adapted ecotypes. We also evaluated the body shape evolution across different cave lineages using geometric morphometrics to examine the role of phylogenetic signal versus environmental pressures. We found strong evidence of parallel evolution of cave-adapted ecotypes derived from two separate lineages of surface fish and hypothesize that there may be up to four independent invasions of caves from surface fish. Moreover, a strong congruence between the genetic structure and geographic distribution was observed across the cave populations, with the Sierra de Guatemala the region exhibiting most genetic drift among the cave populations analysed. Interestingly, we found no evidence of phylogenetic signal in body shape evolution, but we found support for parallel evolution in body shape across independent cave lineages, with cavefish from the Sierra de El Abra reflecting the most divergent morphology relative to surface and other cavefish populations.
ABSTRACT
Sustainability may be at risk in a population that has altered health, according to Sustainable Development Goal 3 (SDG 3): Health and well-being. The ongoing conflict between Russia and Ukraine could jeopardize SDG 3, specifically the mental health of the population. The present study sought to determine the association between severe anxiety, depression and stress in population of 13 Latin American countries according to fear about the war conflict. It was a cross-sectional, analytical and multicenter study. Anxiety, depression and stress were measured with the DASS-21 test (Cronbach's Alpha: 0.97) and fear due to an armed crisis with a questionnaire already validated in Latin America (Cronbach's Alpha: 0.92), which was also adjusted for sex, age, education level and country of residence. Descriptive and analytical statistics were obtained. Of the 2,626 respondents, the main fear was that weapons of mass destruction would be used. In the multivariate models, strong associations were found between fear of a possible world-scale armed conflict and having severe or very severe levels of anxiety (aPR: 1.97; 95% CI: 1.64-2.36; value of p <0.001), depression (aPR: 1.91; 95% CI: 1.54-2.36; value of p <0.001) or stress (aPR: 2.05; 95% CI: 1.63-2.57; value of p <0.001). Sustainability linked to SDG 3, specifically mental health, is affected by this type of significant events, given the possible global war crisis that could trigger major events, even more so if added to the deterioration already experienced by COVID-19 in the Latin American region, insecurity and constant political uncertainty.
Subject(s)
Humans , Research , Research Groups , Research Design , General Surgery , Ethics, ResearchSubject(s)
Humans , Cholelithiasis , Antibiotic Prophylaxis , Postoperative Care , General Surgery , CholecystectomyABSTRACT
Coronary microvascular disease or dysfunction (CMVD) has been associated with adverse cardiovascular outcomes. Despite a growing prevalence, guidelines on definitive treatment are lacking. Proposed mechanisms of endothelial dysfunction and resultant inflammation have been demonstrated as the underlying cause. Imaging modalities such as echocardiography, cardiac MRI, PET, and in some instances CT, have been shown to be useful in diagnosing CMVD mainly through assessment of coronary blood flow. Invasive measurements through thermodilution and pressure sensor-guided Doppler microcatheters have also been utilized. Treatment options are directed at targeting inflammatory pathways and angina. In our review, we highlight the current literature on the background of CMVD, diagnostic modalities, and management of this disease.
ABSTRACT
The conventional wet electrode for recording biosignals poses many inconveniences, as it requires an electrolytic gel that dries over time changing its electrical characteristics. The skin typically needs to be abraded when the electrode is applied to record high-quality signals, requiring assistance of trained personnel for the placement of the wet electrode. Alternative electrode designs to overcome these challenges often have difficulties recording small amplitude signals or their fabrication methods are complex and expensive. This research proposes a novel design and a simple fabrication method for a dry microneedle electrode for biosignal monitoring. The electrode can record electroencephalogram and electrocardiogram signals from a human subject without electrolytic gel and it does not require skin preparation such as abrasion, making it suitable for long term measurements as opposed to the wet electrode. When applied to the skin of a human subject with an impact inserter, the electrode has a lower impedance at the skin-electrode interface yielding better signal recording compared to application by hand. The selected electrode materials provides microneedles stiff enough to cross the outmost layer of the skin, while the flexible backing of the electrode has been designed to improve the conformation of the electrode to the rounded shape of the body. The proposed fabrication method for the electrode is based on a simple mold casting process that enables batch production while also reducing the time spent in a cleanroom and the use of expensive machinery.
Subject(s)
Electrocardiography , Needles , Electric Impedance , Electrodes , Humans , SkinABSTRACT
Nature's contributions to people (NCP) may be both beneficial and detrimental to humans' quality of life. Since our origins, humans have been closely related to wild ungulates, which have traditionally played an outstanding role as a source of food or raw materials. Currently, wild ungulates are declining in some regions, but recovering in others throughout passive rewilding processes. This is reshaping human-ungulate interactions. Thus, adequately understanding the benefits and detriments associated with wild ungulate populations is necessary to promote human-ungulate co-existence. Here, we reviewed 575 articles (2000-2019) on human-wild ungulate interactions to identify key knowledge gaps on NCP associated with wild ungulates. Wild ungulate research was mainly distributed into seven research clusters focussing on: (1) silvicultural damage in Eurasia; (2) herbivory and natural vegetation; (3) conflicts in urban areas of North America; (4) agricultural damage in Mediterranean agro-ecosystems; (5) social research in Africa and Asia; (6) agricultural damage in North America; (7) research in natural American Northwest areas. Research mostly focused on detrimental NCP. However, the number of publications mentioning beneficial contributions increased after the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services conceptual framework was implemented. Human-ungulate interactions' research was biased towards the Global North and Cervidae, Suidae and Bovidae families. Regarding detrimental NCP, most publications referred to production damage (e.g. crops), followed by biodiversity damage, and material damage (e.g. traffic collisions). Regarding beneficial NCP, publications mainly highlighted non-material contributions (e.g. recreational hunting), followed by material NCP and regulating contributions (e.g. habitat creation). The main actions taken to manage wild ungulate populations were lethal control and using deterrents and barriers (e.g. fencing), which effectiveness was rarely assessed. Increasing research and awareness about beneficial NCP and effective management tools may help to improve the conservation of wild ungulates and the ecosystems they inhabit to facilitate people-ungulate co-existence in the Anthropocene.
Subject(s)
Deer , Ecosystem , Animals , Biodiversity , Herbivory , Humans , Quality of Life , Ruminants , SwineABSTRACT
Biofuels represent an energy option to mitigate polluting gases. However, technical problems must be solved, one of them is to improve the combustion process. In this study, the geometry of a piston head for a diesel engine was redesigned. The objective was to improve the combustion process and reduce polluting emissions using biodiesel blends as the fuel. The methodology used was the mechanical engineering design process. A commercial piston (base piston) was selected as a reference model to assess the piston head's redesign. Changes were applied to the profile of the piston head based on previous research and a new model was obtained. Both models were evaluated and analyzed using the finite element method, where the most relevant physical conditions were temperature and pressure. Numerical simulations in the base piston and the new piston redesign proposal presented similar behaviors and results. However, with the proposed piston, it was possible to reduce the effort and the material. The proposed piston profile presents adequate results and behaviors. In future, we suggest continuing conducting simulations and experimental tests to assess its performance.
