Resistencia bacteriana a antibióticos en ambientes acuáticos: origen e implicaciones para la salud pública

El alarmante incremento de la resistencia bacteriana a los antibióticos a nivel global ha dilucidado otras fuentes diferentes al hospital y la comunidad, donde el agua ha cobrado gran importancia. El ambiente acuático constituye la fuente y el hábitat natural de un gran número de microorganismos, incluyendo bacterias resistentes a antibióticos; así mismo, se considera uno de los principales receptores de antimicrobianos, bacterias resistentes y genes de resistencia a antibióticos provenientes de las actividades humanas. La contaminación del agua con estos contaminantes emergentes tiene implicaciones serias para la salud humana, relacionadas con la diseminación de la resistencia bacteriana y la emergencia de nuevos mecanismos de resistencia. En esta revisión se brinda una descripción global del papel de los ambientes acuáticos en el problema de la resistencia bacteriana, las principales fuentes de contaminación, además del impacto para la salud pública. Ante este panorama, se establece la necesidad de abordar la problemática de la resistencia bacteriana desde la perspectiva de "una salud", donde a la vigilancia tradicional, enfocada a nivel humano y veterinario, se articule la vigilancia epidemiológica ambiental, principalmente basada en aguas residuales.

The alarming increase in bacterial resistance to antibiotics globally has diluted sources other than the hospital and community, where water has taken on great importance. The aquatic environment is the source and natural habitat of a large number of microorganisms, including antibiotic-resistant bacteria, as well as being considered one of the main receptors for antimicrobials, resistant bacteria and antibiotic resistance genes from human activities. Contamination of water with these emerging contaminants has serious implications for human health related to the spread of bacterial resistance and the emergence of new resistance mechanisms. This review provides a global description of the role of aquatic environments in the problem of bacterial resistance, the main sources of contamination, as well as the impact on Public Health. In this context, the need arises to address the problem of bacterial resistance from the perspective of "one health", where traditional surveillance, focused at the human and veterinary level, is articulated with environmental epidemiological surveillance, mainly in wastewater.

O incremento alarmante da resistência bacteriana aos antibióticos no nível global tem revelado outras fontes diferentes do hospital e da comunidade, em que a água tem ganho grande importância. O ambiente aquático constitui a fonte e o hábitat natural de um grande número de microrganismos, incluindo bactérias resistentes a antibióticos; é considerado, também, um dos principais receptores de antimicrobianos, bactérias resistentes e genes de resistência a antibióticos provindos das atividades humanas. A poluição da água com esses poluentes emergentes tem sérias implicações para a saúde humana, relacionadas com a disseminação da resistência bacteriana e a emergência de novos mecanismos de resistência. Nesta revisão oferece-se uma descrição global do papel dos ambientes aquáticos na situação problemática da resistência bacteriana, as principais fontes de poluição, além do impacto para a saúde pública. Diante desse panorama, determina-se a necessidade de abordar a problemática da resistência bacteriana desde a perspectiva de "uma saúde" em que a vigilância tradicional, focada nos níveis humano e veterinário, esteja articulada com a vigilância epidemiológica ambiental, principalmente baseada em águas residuais.

Biofortification of Broccoli Microgreens (Brassica oleracea var. italica) with Glucosinolates, Zinc, and Iron through the Combined Application of Bio- and Nanofertilizers.

There is a severe need to develop a sustainable, affordable, and nutritious food supply system. Broccoli microgreens have attracted attention due to their rich nutritional content and abundant bioactive compounds, constituting an important opportunity to feed the ever-increasing population and fight global health problems. This study aimed to measure the impact of the combined application of biofertilizers and zinc and iron nanofertilizers on plant growth and the biofortification of glucosinolates (GLSs) and micronutrients in broccoli microgreens. Biofertilizers were based on plant growth-promoting (PGP) bacterial consortia previously isolated and characterized for multiple PGP traits. Nanofertilizers consisted of ZnO (77 nm) and γ-Fe2O3 (68 nm) nanoparticles synthesized with the coprecipitation method and functionalized with a Pseudomonas species preparation. Treatments were evaluated under seedbed conditions. Plant growth parameters of plant height (37.0-59.8%), leaf diameter (57.6-81.1%) and fresh weight (112.1-178.0%), as well as zinc (122.19-363.41%) and iron contents (55.19-161.57%), were mainly increased by nanoparticles subjected to the functionalization process with Pseudomonas species and uncapped NPs applied together with the biofertilizer treatment. Regarding GLSs, eight compounds were detected as being most positively influenced by these treatments. This work demonstrated the synergistic interactions of applying ZnO and γ-Fe2O3 nanofertilizers combined with biofertilizers to enhance plant growth and biofortify micronutrients and glucosinolates in broccoli microgreens.

Ecophysiology of neotropical amphibians and reptiles: lessons learned from Colombia.

Ecophysiology and herpetology share a close historical relationship, but earlier work at the interface of these disciplines was carried out in temperate regions. Tropical regions like the Neotropics exhibit the highest species richness for amphibians and reptiles, but the pace for ecophysiological research on tropical herpetofauna has been slower relative to temperate counterparts. We are a group of early-career, Latin American researchers interested in the physiological diversity exhibited by neotropical herpetofauna. As such, we have engaged in the organization of the Symposium on the Ecophysiology of Neotropical Amphibians and Reptiles (ECOPHYSHERP) to integrate the scientific community interested on these topics. ECOPHYSHERP has been held three times already within the Colombian Congress of Herpetology, and collectively it has hosted >60 contributions from researchers at 26 institutions and eight countries. Participation has been diverse in terms of gender, age, and career stage, but most participants have been young undergraduate biology students. This generation of early-career researchers is producing excellent research in a broad range of topics, but difficulties to convert this research into scientific publications may exist. Identifying and contributing in order to solve such problems are priorities for this organizing committee, and also our endeavours towards ECOPHYSHERP 4.0 in Santa Marta in 2025.

Barriers to and Outcomes of Initiating Clinical Research at Two Trauma Centers in Mexico.

INTRODUCTION: Despite efforts to advance clinical research through collaboration between Latin and North American partners, there remains persistent barriers to performing investigative work. To overcome these obstacles, a team of over 100 surgeon-leaders from 18 Latin American countries founded the Asociación de Cirujanos Traumatólogos de las Américas (ACTUAR). One of ACTUAR's first major collaborative projects, initiated in 2018, was a prospective, observational, multicenter study evaluating quality of life after open tibia fracture management. The current study identified common barriers experienced during the initiation of this study, as exemplified through two sites in Mexico. The study aims to identify obstacles to proactively overcome these in future collaborative work. METHODS: Two research assistants from University of California, San Francisco and two research coordinators from Mexico were recruited to share their experiences, identify common barriers experienced during site enrollment and on-boarding for the ACTUAR open tibia study, and discuss possible solutions. RESULTS: Barriers were organized into three categories: structural, logistical, and intrapersonal. Structural barriers included differences in patient populations and resources between private and public hospitals. Logistical barriers included ambiguous ethical review processes, internet availability, and low patient follow-up. Primary enrollment as a resident responsibility led to some intrapersonal barriers. Potential solutions were identified for each barrier and agreed upon by all collaborators. CONCLUSIONS: Multiple barriers were identified by research personnel who initiated a prospective surgical clinical research study in Mexico. Through collaborative approaches, many potential solutions may help overcome these barriers and build locally led research capacity in Latin America.

Concern levels of beta-lactamase-producing Gram-negative bacilli in hospital wastewater: hotspot of antimicrobial resistance in Latin-America.

Hospital wastewater (HWW) discharges are among the main sources of antibiotic-resistant bacteria. This study detected a high frequency of beta-lactamase-producing Gram-negative Bacilli in HWW of different geographical regions of Colombia, even in the presence of the wastewater treatment plant, highlighting the importance of regulating these environments in developing countries.

Presence of Human Papillomavirus DNA in Malignant Neoplasia and Non-Malignant Breast Disease.

Breast cancer is the leading cause of cancer death among women worldwide. Multiple extrinsic and intrinsic factors are associated with this disease's development. Various research groups worldwide have reported the presence of human papillomavirus (HPV) DNA in samples of malignant breast tumors. Although its role in mammary carcinogenesis is not fully understood, it is known that the HPV genome, once inserted into host cells, has oncogenic capabilities. The present study aimed to detect the presence of HPV DNA in 116 breast tissue biopsies and classify them according to their histology. It was found that 50.9% of the breast biopsies analyzed were malignant neoplasms, of which 74.6% were histologically classified as infiltrating ductal carcinoma. In biopsies with non-malignant breast disease, fibroadenoma was the most common benign neoplasm (39.1%). Detection of HPV DNA was performed through nested PCR using the external primer MY09/11 and the internal primer GP5+/6+. A hybridization assay genotyped HPV. HPV DNA was identified in 20.3% (12/59) of malignant neoplasms and 35% non-malignant breast disease (16/46). It was also detected in 27.3% (3/11) of breast tissue biopsies without alteration. However, there are no statistically significant differences between these groups and the existence of HPV DNA (p = 0.2521). Its presence was more frequent in non-malignant alterations than in malignant neoplasias. The most frequent genotypes in the HPV-positive samples were low-risk (LR) HPV-42 followed by high-risk (HR) HPV-31.

Spinal epidural hematoma in antiphospholipid syndrome: case report and review of the literature.

INTRODUCTION: Spinal epidural hematomas are a surgical emergency, the delay in diagnosis can develop devastating sequelae due to its acute and progressive course. If not treated properly, it may lead to death or permanent neurological deficit. It is a rare condition that can occur in patients with hematologic pathology. CASE PRESENTATION: We report a case report and literature review of a patient with antiphospholipid syndrome, who undergoes a diagnostic lumbar puncture for probable fungal meningitis. Developed a spinal acute epidural hematoma with neurological involvement that is evidenced in MRI. Urgent surgical decompression was performed with good results. DISCUSSION: Despite the low incidence of an epidural hematoma in patients who undergo lumbar puncture, it is important to perform a thorough evaluation in any patient with coagulation abnormalities prior and after a lumbar puncture, by reason of the inherent possibility of developing an epidural hematoma at the site of the procedure. In the same way, early diagnosis and aggressive treatment is necessary in patients who develop progressive neurological symptoms to limit the damage and improve the prognosis for neurological recovery.

Resiliencia, optimismo, esperanza y sentido de vida en el adulto mayor con y sin enfermedad crónica de la ciudad de Bogotá / Resilience, Optimism, Hope, and Sense of Life in Older Adults With and Without Chronic Diseases in Bogota

Resumen El padecimiento de enfermedades crónicas impacta la calidad de vida, el bienestar y el funcionamiento de los adultos mayores. De allí la necesidad de potencializar las cualidades y recursos psicológicos que incidan de forma positiva en su calidad de vida. En ese sentido, el objetivo de la investigación fue describir los niveles de resiliencia, optimismo, esperanza y sentido de vida en el adulto mayor con o sin enfermedad crónica. El diseño del estudio fue de tipo descriptivo correlacional, de corte transversal, por encuesta. Participaron 200 personas, 100 que presentaban una enfermedad crónica y 100 que no la presentaban, seleccionadas mediante muestreo no aleatorio de sujetos disponibles, residentes en Bogotá (Colombia). Se utilizaron instrumentos para medir resiliencia (Cuestionario Connor-Davidson Resilience Scale (CD-RISC 10)), optimismo (Escala de Optimismo Disposicional (DIOP)), esperanza (Escala de esperanza para adultos AHS (Adult hope scale)) y propósito vital (Test de Propósito Vital (PIL)). Los resultados indican que los adultos mayores con enfermedad crónica muestran niveles menores de resiliencia, optimismo, esperanza y propósito de vida, en comparación con los adultos mayores sin enfermedades crónicas. Lo anterior, nos permite entender que la condición de enfermedad afecta los recursos psicológicos de la persona, entendidos en esta investigación como resiliencia, optimismo, esperanza y propósito de vida, que a su vez funcionan como factores protectores de la salud mental en los procesos de enfermedad, en los cuales se visualiza la oportunidad de fortalecer o reforzan mediante el establecimiento de programas de intervención.

Abstract Having a chronic disease impacts the quality of life, well-being, and functioning of older adults. Hence the need to potentiate the psychological qualities and resources that positively impact their quality of life. In this sense, the objective of this research was to describe the levels of resilience, optimism, hope, and sense of life in older adults with or without chronic diseases. The study design is descriptive, correlational, cross-sectional, with the use of surveys. A total of 200 people participated, 100 with a chronic disease and 100 without, selected through non-random sampling of available subjects residing in Bogota (Colombia). Instruments were used to assess resilience (Connor-Davidson Resilience Scale Questionnaire [CD-RISC 10]), optimism (Dispositional Optimism Scale [DIOP]), hope (Adult Hope Scale [AHS]), and vital purpose (Vital Purpose Test [PIL]). The results indicate that older adults with chronic diseases have lower levels of resilience, optimism, hope, and life purpose, compared to older adults without chronic diseases. This allows us to understand that having a disease impacts the psychological resources of a person, understood in this research as resilience, optimism, hope, and life purpose, which in turn function as protective factors of mental health. There is an opportunity to strengthen or reinforce these factors through the creation of intervention programs.

Climatological and Epidemiological Conditions Are Important Factors Related to the Abundance of blaKPC and Other Antibiotic Resistance Genes (ARGs) in Wastewater Treatment Plants and Their Effluents, in an Endemic Country.

Several physicochemical and season factors have been related to the abundance of antibiotic resistance genes (ARGs) in wastewater treatment plants (WWTPs), considered hotspots of bacterial resistance. However, few studies on the subject have been carried out in tropical countries endemic for resistance mechanisms such as blaKPC. In this study, the occurrence of ARGs, particularly blaKPC, was determined throughout a WWTP, and the factors related to their abundance were explored. In 2017, wastewater samples were taken from a WWTP in Colombia every 15 days for 6 months, and a total of 44 samples were analyzed by quantitative real-time PCR. sul1, sul2, blaKPC, and ermB were found to be the most prevalent ARGs. A low average reduction of the absolute abundance ARGs in effluent with respect to influent was observed, as well as a greater absolute abundance of ARGs in the WWTP effluent in the rainy season. Factors such as temperature, pH, oxygen, total organic carbon (TOC), chemical oxygen demand (COD), and precipitation were significantly correlated with the absolute abundance of several of the ARGs evaluated. A generalized linear mixed-effects model analysis showed that dissolved oxygen and precipitation in the sampling day were important factors related to the absolute concentration of blaKPC over time. In conclusion, the abundance of ARGs in the WWTP could be influenced by endemic conditions and physicochemical and climatological parameters. Therefore, it is necessary to continuously monitor clinical relevant genes in WWTPs from different global regions, even more so in low-income countries where sewage treatment is limited.

MERTK on mononuclear phagocytes regulates T cell antigen recognition at autoimmune and tumor sites.

Understanding mechanisms of immune regulation is key to developing immunotherapies for autoimmunity and cancer. We examined the role of mononuclear phagocytes during peripheral T cell regulation in type 1 diabetes and melanoma. MERTK expression and activity in mononuclear phagocytes in the pancreatic islets promoted islet T cell regulation, resulting in reduced sensitivity of T cell scanning for cognate antigen in prediabetic islets. MERTK-dependent regulation led to reduced T cell activation and effector function at the disease site in islets and prevented rapid progression of type 1 diabetes. In human islets, MERTK-expressing cells were increased in remaining insulin-containing islets of type 1 diabetic patients, suggesting that MERTK protects islets from autoimmune destruction. MERTK also regulated T cell arrest in melanoma tumors. These data indicate that MERTK signaling in mononuclear phagocytes drives T cell regulation at inflammatory disease sites in peripheral tissues through a mechanism that reduces the sensitivity of scanning for antigen leading to reduced responsiveness to antigen.

Metagenomic analysis of urban wastewater resistome and mobilome: A support for antimicrobial resistance surveillance in an endemic country.

In developing countries, where high levels of antimicrobial resistance are observed in hospitals, the surveillance of this phenomenon in wastewater treatment plants (WWTPs) and the environment is very limited, especially using cutting-edge culture-independent methods. In this study, the composition of bacterial communities, the resistome and mobilome (the pool of antibiotic resistance genes (ARGs) and mobile genetic elements (MGEs), respectively) at a WWTP were determined using shotgun metagenomics and culture-based approaches. Wastewater samples were collected at four sampling points of a WWTP in Antioquia, Colombia. A total of 24 metagenomes were analyzed. Specifically, there were marked differences in bacterial community composition, resistome, and mobilome, according to the WWTP sampling points. Bacterial families of clinical importance such as Moraxellaceae, Aeromonadaceae, and Enterobacteriaceae were mainly detected in the WWTP influent and effluent samples. Genes encoding resistance to macrolide-lincosamide-streptogramin, ß-lactams, and those conferring multidrug resistance (e.g., acrB, adeG, and mexD) were the most abundant. Moreover, some clinically important ARGs such as blaKPC-2 and blaCTX-M, and others not reported locally, such as blaTEM-196, blaGES-23, blaOXA-10, mcr-3, and mcr-5 were frequently detected. Co-occurrence network analyses indicated a significant association of ARGs such as blaOXA-58 and blaKPC genes with Aeromonadaceae and Enterobacteriaceae. Among the markers of MGEs, intI1 and ISCR8 were the most frequently detected. Altogether, this work reveals the importance of shotgun metagenomics and culture-based approaches in antimicrobial resistance studies. The findings also support that WWTPs are hotspots for antimicrobial resistance, whose analysis constitutes a powerful tool to predict the impact of antimicrobial resistance in a population.

COVID-19: The outbreak caused by a new coronavirus.

Before the severe acute respiratory syndrome outbreak in 2003, coronaviruses (CoVs) were not considered to be highly pathogenic to humans. However, it was this epidemic that highlighted this group of viruses and included them among the causative agents of emerging epidemic diseases. In addition, in 2012, another new CoV responsible for the Middle East respiratory syndrome was identified. Both infections were considered a threat to global health security. At present, the third epidemic caused by a CoV is being faced. This new CoV, called 2019-nCoV, was originated in the city of Wuhan, China, and has been linked to severe respiratory infections in humans. Thanks to the collaboration of experts worldwide, more information about this virus and its infection is reported each day, which allows modifying the recommendations for its prevention and treatment, without forgetting that the ultimate goal is to control this epidemic. In this review, the important aspects of this new coronavirus, 2019-nCoV, and its disease, COVID-19, have been summarized with the information available up to February 2020.

Previo al brote del síndrome respiratorio agudo grave de 2003, los coronavirus (CoV) no eran considerados como agentes altamente patogénicos para los humanos. Sin embargo, fue dicha epidemia la que destacó este grupo de virus y lo incluyó entre los agentes causantes de enfermedades epidémicas emergentes. Adicionalmente, en 2012 se identificó un nuevo CoV causante del síndrome respiratorio de Oriente Medio. Ambas infecciones fueron consideradas una amenaza para la seguridad sanitaria mundial. Hoy en día se presenta la tercera epidemia causada por un CoV. Este nuevo CoV, llamado 2019-nCoV, se originó en la ciudad de Wuhan, China, y ha sido relacionado con infecciones respiratorias graves en humanos. Gracias a la colaboración de expertos en todo el mundo, cada día se logra obtener más información sobre este virus y la infección que causa, lo cual permite modificar las recomendaciones para su prevención y tratamiento sin olvidar que el fin último es lograr el control de la epidemia. En esta revisión se resumen los aspectos más importantes acerca del nuevo 2019-nCoV y la enfermedad COVID-19, con la información disponible hasta febrero de 2020.

COVID-19: The outbreak caused by a new coronavirus / COVID-19: la epidemia causada por un nuevo coronavirus

Abstract Before the severe acute respiratory syndrome outbreak in 2003, coronaviruses (CoVs) were not considered to be highly pathogenic to humans. However, it was this epidemic that highlighted this group of viruses and included them among the causative agents of emerging epidemic diseases. In addition, in 2012, another new CoV responsible for the Middle East respiratory syndrome was identified. Both infections were considered a threat to global health security. At present, the third epidemic caused by a CoV is being faced. This new CoV, called 2019-nCoV, was originated in the city of Wuhan, China, and has been linked to severe respiratory infections in humans. Thanks to the collaboration of experts worldwide, more information about this virus and its infection is reported each day, which allows modifying the recommendations for its prevention and treatment, without forgetting that the ultimate goal is to control this epidemic. In this review, the important aspects of this new coronavirus, 2019-nCoV, and its disease, COVID-19, have been summarized with the information available up to February 2020.

Resumen Previo al brote del síndrome respiratorio agudo grave de 2003, los coronavirus (CoV) no eran considerados como agentes altamente patogénicos para los humanos. Sin embargo, fue dicha epidemia la que destacó este grupo de virus y lo incluyó entre los agentes causantes de enfermedades epidémicas emergentes. Adicionalmente, en 2012 se identificó un nuevo CoV causante del síndrome respiratorio de Oriente Medio. Ambas infecciones fueron consideradas una amenaza para la seguridad sanitaria mundial. Hoy en día se presenta la tercera epidemia causada por un CoV. Este nuevo CoV, llamado 2019-nCoV, se originó en la ciudad de Wuhan, China, y ha sido relacionado con infecciones respiratorias graves en humanos. Gracias a la colaboración de expertos en todo el mundo, cada día se logra obtener más información sobre este virus y la infección que causa, lo cual permite modificar las recomendaciones para su prevención y tratamiento sin olvidar que el fin último es lograr el control de la epidemia. En esta revisión se resumen los aspectos más importantes acerca del nuevo 2019-nCoV y la enfermedad COVID-19, con la información disponible hasta febrero de 2020.

Seasonal variations in serum concentrations of testosterone, testicular volume and neck circumference of fallow deer (Dama dama) kept ex situ in a tropical region.

The fallow deer (Dama dama) is a species of Cervidae commonly kept in captivity, either in commercial farms or in zoos. The reproductive seasonality of this species is well known in the northern hemisphere, where photoperiod is a decisive factor in androgenic activity and, consequently, in the development of secondary sexual characteristics among male adults. The maintenance of this species in tropical regions has been successful, but there are no studies that demonstrate the maintenance of reproductive seasonality under these climatic conditions, which was the objective of the present study. To do so, the present investigation involved 27 fallow deer (D. dama) specimens, of which 14 were adults and 13 prepubescent (<8 months) individuals, all assessed during and outside (December-February) the reproductive season (June-August). The serum concentrations of testosterone, testicular volume, and neck circumference were analyzed among all animals during both seasons. The reproductive season was marked by expressive hormonal concentrations, increasing neck circumference and testicular volume, differing significantly between adults and prepubescent individuals outside the season. Positive correlations were observed among all analyzed variables: mean testicular volume and neck circumference (r = 0.92, p < 0.0001), testicular volume and testosterone concentrations (r = 0.79, p < 0.0001) and between neck circumference and testosterone concentrations (r = 0.67, p < 0.0001). Given the results found, the conclusion is that even under tropical climate conditions the reproductive seasonality of the fallow deer is well defined and may be related to photoperiod.

Model of chronic kidney disease care in primary health care / Modelo de atención de la enfermedad renal crónica en la atención primaria de la salud

Multidisciplinary attention models include the joined and coordinated participation of different professionals within the health team (physicians, nurses, social workers, dietitians, physical trainers, among others). A multidisciplinary approach facilitates and improves management of patients from early chronic kidney disease (CKD) in the primary health-care setting. This approach is a strategy for improving comprehensive care, initiating and maintaining healthy behaviors, promoting teamwork, eliminating barriers to achieve goals and improving the processes of care. A multidisciplinary intervention may include educational processes guided by health professional, use of self-help groups and the development of a CKD management plan. The complex and fragmented care management of patients with CKD, associated with poor outcome, enhances the importance of implementing a multidisciplinary approach in the management of this disease from the early stages. Multidisciplinary strategies should focus on the needs of patients and should be adapted to the resources and health systems; its systematic implementation can help to improve patient care and prevent/slow the progression of CKD.

Los modelos de atención multidisciplinaria incluyen la participación conjunta y coordinada de diferentes profesionales miembros del equipo de salud (médicos, enfermeras, trabajadoras sociales, nutriólogas, entrenadores físicos, entre otros). Un abordaje multidisciplinario facilita y mejora el manejo de los pacientes con enfermedad renal crónica (ERC) en el primer nivel de atención médica. Este abordaje es una estrategia para mejorar el cuidado de una forma más completa, iniciando y manteniendo conductas saludables, promoviendo el trabajo en equipo, eliminando barreras para alcanzar objetivos y mejorando los procesos de la atención. Una intervención multidisciplinaria puede incluir procesos educativos guiados por profesionales, el empleo de grupos de autoayuda y el desarrollo de un plan de manejo de la ERC. La atención actual de los pacientes con ERC, fragmentada y compleja, asociada con los malos resultados frecuentemente observados, pone de manifiesto la importancia de la implementación de un abordaje multidisciplinario desde las etapas más tempranas de la enfermedad. Las estrategias multidisciplinarias deben enfocarse en las necesidades de los pacientes y deben ser adaptadas a los recursos disponibles en los sistemas de salud; su implementación sistematizada podrá ayudar a mejorar el cuidado del paciente y prevenir y/o retrasar el avance de la ERC.

El costo de ignorar el signo de Carnett: Reporte de caso y revisión de la literatura / The Cost Of Ignoring Carnett’s Sign: A Case Report and Literature Review

El dolor abdominal crónico es un motivo frecuente de consulta externa y de urgencias. Los médicos tradicionalmente consideran que el origen del mismo son las estructuras intraabdominales, incluido el tracto gastrointestinal. Rara vez tienen en cuenta la pared abdominal como la causa de la molestia y someten a los pacientes a numerosos e interminables procedimientos diagnósticos, como laparoscopias y cirugías, entre otros. Por lo menos el 50% de estos pacientes tiene dolor de la pared abdominal por lesión del nervio cutáneo anterior y el diagnóstico se hace identificando el signo de Carnett. Se presenta un caso típico con esta patología, cuyo enfoque inicial ilustra los errores y altos costos en el abordaje de esta patología

Chronic abdominal pain is a frequent cause of outpatient and emergency visits. Doctors traditionally consider that its origin is in intra-abdominal structures, including the gastrointestinal tract. They rarely take into account the abdominal wall as a cause of discomfort and subject patients to numerous and endless diagnostic procedures, including laparoscopy and surgery. At least 50% of these patients have abdominal wall pain due to injuries to the anterior cutaneous vein the diagnosis of which is made by identifying Carnett’s sign. A typical case of this pathology is here. The initial approach illustrates the errors and high costs that can be involved in the approach to this pathology

Maternal Deaths Databases Analysis: Ecuador 2003-2013.

Background: Maternal mortality ratio in Ecuador is the only millennium goal on which national agencies are still making strong efforts to reach 2015 target. The purpose of the study was to process national maternal death databases to identify a specific association pattern of variable included in the death certificate. Design and methods: The study processed mortality databases published yearly by the National Census and Statistics Institute (INEC). Data analysed were exclusively maternal deaths. Data corresponds to the 2003-2013 period, accessible through INEC's website. Comparisons are based on number of deaths and use an ecological approach for geographical coincidences. Results: The study identified variable association into the maternal mortality national databases showing that to die at home or in a different place than a hospital is closely related to women's socioeconomic characteristics; there was an association with the absence of a public health facility. Also, to die in a different place than the usual residence could mean that women and families are searching for or were referred to a higher level of attention when they face complications. Conclusions: Ecuadorian maternal deaths showed Patterns of inequity in health status, health care provision and health risks. A predominant factor seems unclear to explain the variable association found processing national databases; perhaps every pattern of health systems development played a role in maternal mortality or factors different from those registered by the statistics system may remain hidden. Some random influences might not be even considered in an explanatory model yet.

FGFR1 Amplification in Squamous Cell Carcinoma of the Lung with Correlation of Primary and Metastatic Tumor Status.

BACKGROUND: The FGFR1 gene can be amplified in squamous cell carcinoma of the lung (SqCC). The aim of this study was to compare FGFR1 status with stage and matched primaries with metastases. METHODS: Cases with FGFR1 fluorescence in situ hybridization (FISH) testing performed from 2000 to 2013 were evaluated for amplification status and clinicopathologic features. RESULTS: Of the 336 cases tested by FGFR1 FISH, 52 (15%) were positive for amplification. Eight (13%) of 60 N0 cases and eight (17%) of 46 N1 or N2 cases were amplified, with no statistically significant difference. Of the 24 cases with matched primary and metastatic tumors, 22 (92%) were synchronous and one (4%) had discordant amplification. CONCLUSIONS: Frequency of FGFR1 amplification is similar in SqCC with and without lymph node metastases, but status in metastatic sites may be discordant from the primary in a small subset of cases, which may affect the decision to perform testing of metastatic SqCCs.