Mixed success for carbon payments and subsidies in support of forest restoration in the neotropics.

Restoration of forests in low- and middle-income countries (LMICs) has the potential to contribute to international carbon mitigation targets. However, high upfront costs and variable cashflows are obstacles for many landholders. Carbon payments have been promoted as a mechanism to incentivize restoration and economists have suggested cost-sharing by third parties to reduce financial burdens of restoration. Yet empirical evidence to support this theory, based on robust, dynamic field sampling is lacking. Here we use large, long-term datasets from Panama to evaluate the financial prospects of three forest restoration methods under different cost-sharing and carbon payment designs where income is generated through timber harvests. We show some, but not all options are economically viable. Further work combining growth and survival data from field trials with more sophisticated financial analyses is essential to understanding barriers and realizing the potential of forest restoration in LMICs to help meet global carbon mitigation commitments.

Salud bucal en la primera infancia: estrategia con agentes educativas y acudientes / Oral health in early childhood: strategy with educational agents and guardians

Introducción: la dentición temporal es esencial para la nutrición, habla y autoestima. Los niños y niñas menores de 5 años no poseen habilidades motoras para efectuar higiene bucal por sí mismos. Objetivo: diseñar e implementar una estrategia educativa para la promoción de la salud bucal en la primera infancia con agentes educativas y acudientes de los niños y niñas que asisten a los hogares comunitarios del Instituto Colombiano de Bienestar Familiar en Santa Rosa de Cabal (Colombia) en el 2019. Materiales y métodos: investigación cualitativa, diseño investigación-acción. Muestreo no probabilístico por conveniencia, participaron 25 agentes educativas y 55 acudientes. Técnicas de investigación empleadas: grupos focales y talleres pedagógicos. Para analizar los datos se usó Análisis Temático. Resultados: se desarrolló en 3 fases. 1) los/as participantes expresaron que tener salud bucal consiste en la adecuada higiene, aunque todos/as conocían la caries, los cuidadores no la comprendían como una patología, las agentes educativas percibieron tener alta capacidad de autoeficacia para contribuir a la salud bucal de los niños/as. 2) En los talleres pedagógicos se resolvieron inquietudes en temas como crecimiento y desarrollo del sistema estomatognático, enfermedades bucales, entre otros. 3) Las agentes educativas aprendieron la relación de la salud bucal con lactancia materna, asimismo las causas y consecuencias de las patologías bucales, y replicaron lo aprendido. Conclusiones: se recomienda el desarrollo de estrategias educativas guiadas por modelos teóricos y con metodologías participativas, adaptadas a las necesidades y contextos de las comunidades, pues se requiere producir conocimiento situado y con aceptabilidad cultural.

Introduction: Primary dentition is essential for nutrition, speech, and self-esteem. Children under the age of 5 do not have the motor skills to perform oral hygiene on their own. Objective: To design and implement an educational strategy to promote oral health in early childhood with educators and parents/guardians of children attending the community homes of the Colombian Family Welfare Institute in Santa Rosa de Cabal (Colombia) in 2019. Materials and methods: Qualitative, action research design. Non-probability convenience sampling was used. Twenty-five educators and 55 parents/guardians participated. Focus groups and pedagogical workshops were the research techniques used. Thematic analysis was performed for data analysis. Results: It was conducted in three phases: 1) Participants expressed that oral health is about proper hygiene. Although all were aware of caries, the caregivers did not understand it as a pathology. The educators perceived that they had high self-efficacy to contribute to children's oral health; 2) in the pedagogical workshops, concerns were resolved on topics such as growth and development of the stomatognathic system, oral diseases, among others, and 3) the educators learned about the relationship between oral health and breastfeeding, as well as the causes and consequences of oral pathologies, and reproduced what they learned. Conclusions: The development of educational strategies based on theoretical models and participatory methods adapted to the needs and contexts of the communities is recommended since it is necessary to produce situated knowledge with cultural acceptance.

Introdução: a dentição temporária é essencial para nutrição, fala e autoestima. Meninos e meninas menores de 5 anos não possuem habilidades motoras para realizar a higiene bucal sozinhos. Objetivo: desenhar e implementar uma estratégia educativa para a promoção da saúde bucal na primeira infância com agentes educativos e responsáveis dos meninos e meninas que frequentam as casas comunitárias do Instituto Colombiano de Bem-Estar Familiar em Santa Rosa de Cabal (Colômbia) em 2019. Materiais e Métodos: pesquisa qualitativa, desenho de pesquisa-ação. Amostragem não probabilística por conveniência, participaram 25 agentes educativos e 55 responsáveis. Técnicas de pesquisa utilizadas: grupos focais e seminários educativos. Para analisar os dados se usou Análises Temático. Resultados: foi desenvolvido em 3 fases. 1) os participantes expressaram que ter saúde bucal consiste em higiene adequada, embora todos soubessem sobre a cárie, os cuidadores não a entendiam como uma patologia, os agentes educativos percebiam que tinham alta capacidade de autoeficácia para contribuir com a saúde bucal das crianças 2) Nos seminários educativos foram sanadas dúvidas sobre temas como crescimento e desenvolvimento do sistema estomatognático, doenças bucais, entre outros. 3) Os agentes educativos aprenderam a relação entre saúde oral e amamentação, bem como as causas e consequências das patologias orais, e replicaram o que aprenderam. Conclusões: Recomenda-se o desenvolvimento de estratégias educativas pautadas em modelos teóricos e com metodologias participativas, adaptadas às necessidades e contextos das comunidades, pois é necessário produzir conhecimento situado com aceitabilidade cultural.

Tree diversity in a tropical agricultural-forest mosaic landscape in Honduras.

Biodiversity decline in the tropics requires the implementation of comprehensive landscape management where agricultural systems are necessarily an integral element of biodiversity conservation. This study evaluates the potential for taxonomic biodiversity conservation within an intensive livestock-agricultural-forest mosaic landscape in Catacamas, Honduras. Tree sampling was performed in 448 plots set up within different forest and agricultural land uses: secondary forests, agroforestry coffee plantations, agriculture, pastures, live fences and riparian forest. All trees with a minimum diameter at breast height of 10 cm were identified and measured. We characterized their tree structure and diversity, and compared tree diversity between the different uses. The results indicate a high degree of tree species diversity: 375 species identified, belonging to 74 families among the 15,096 trees inventoried across 84.2 hectares, including many rare species (40% of the species registered three individuals or fewer). Biodiversity indices for agroforestry coffee were found equivalent to those for natural secondary forests in the Catacamas landscape. Combining biodiversity conservation and agricultural production is possible in human-pressured tropical landscapes through tree cover maintenance. Enrichment practices combining local producers and technical knowledge may improve tree diversity in agricultural landscapes by prioritizing a mix of forest and introduced tree species (rare and with multiple uses).

Robust deep learning optical autofocus system applied to automated multiwell plate single molecule localization microscopy.

We presenta robust, long-range optical autofocus system for microscopy utilizing machine learning. This can be useful for experiments with long image data acquisition times that may be impacted by defocusing resulting from drift of components, for example due to changes in temperature or mechanical drift. It is also useful for automated slide scanning or multiwell plate imaging where the sample(s) to be imaged may not be in the same horizontal plane throughout the image data acquisition. To address the impact of (thermal or mechanical) fluctuations over time in the optical autofocus system itself, we utilize a convolutional neural network (CNN) that is trained over multiple days to account for such fluctuations. To address the trade-off between axial precision and range of the autofocus, we implement orthogonal optical readouts with separate CNN training data, thereby achieving an accuracy well within the 600 nm depth of field of our 1.3 numerical aperture objective lens over a defocus range of up to approximately +/-100 µm. We characterize the performance of this autofocus system and demonstrate its application to automated multiwell plate single molecule localization microscopy.

Many microscopy experiments involve extended imaging of samples over timescales from minutes to days, during which the microscope can 'drift' out of focus. When imaging at high magnification, the depth of field is of the order of one micron and so the imaging system should keep the sample in the focal plane of the microscope objective lens to this precision. Unfortunately, temperature changes in the laboratory can cause thermal expansion of microscope components that can move the focal plane by more than a micron and such changes can occur on a timescale of minutes. This is a particular issue for super-resolved microscopy experiments using single molecule localization microscopy (SMLM) techniques, for which 1000s of images are acquired, and for automated imaging of multiple samples in multiwell plates. It is possible to maintain the sample in the focal plane focus position by either automatically moving the sample or adjusting the imaging system, for example by moving the objective lens. This is called 'autofocus' and is frequently achieved by reflecting a light beam from the microscope coverslip and measuring its position of beam profile as a function of defocus of the microscope. The correcting adjustment is then usually calculated analytically but there is recent interest in using machine learning techniques to determine the required focussing adjustment. Here, we present a system that uses a neural network to determine the required defocus correcting adjustment from camera images of a laser beam that is reflected from the coverslip. Unfortunately, this approach will only work when the microscope is in the same condition as it was when the neural network was trained - and this can be compromised by the same drift of the optical system that causes the defocus needing to be corrected. We show, however, that by training a neural network over an extended period, for example 10 days, this approach can 'learn' about the optical system drifts and provide the required autofocus function. We also show that an optical system utilizing a rectangular slit can make two measurements of the defocus simultaneously, with one measurement being optimized for high accuracy over a limited range (±10 µm) near focus and the other providing lower accuracy but over a much longer range (±100 µm). This robust autofocus system is suitable for automated super-resolved microscopy of arrays of samples in a multiwell plate using SMLM, for which an experiment routinely lasts more than 5 h.

Characterization of NADH fluorescence properties under one-photon excitation with respect to temperature, pH, and binding to lactate dehydrogenase.

Reduced nicotinamide adenine dinucleotide (NADH) is the principal electron donor in glycolysis and oxidative metabolism and is thus recognized as a key biomarker for probing metabolic state. While the fluorescence characteristics of NADH have been investigated extensively, there are discrepancies in the published data due to diverse experimental conditions, instrumentation and microenvironmental parameters that can affect NADH fluorescence. Using a cuvette-based time-resolved spectrofluorimeter employing one-photon excitation at 375 nm, we characterized the fluorescence intensity, lifetime, spectral response, anisotropy and time-resolved anisotropy of NADH in aqueous solution under varying microenvironmental conditions, namely temperature, pH, and binding to lactate dehydrogenase (LDH). Our results demonstrate how temperature, pH, and binding partners each impact the fluorescence signature of NADH and highlight the complexity of the fluorescence data when different parameters produce competing effects. We hope that the data presented in this study will provide a reference for potential sources of variation in experiments measuring NADH fluorescence.

Single-shot phase contrast microscopy using polarisation-resolved differential phase contrast.

We present a robust, low-cost single-shot implementation of differential phase microscopy utilising a polarisation-sensitive camera to simultaneously acquire four images from which phase contrast images can be calculated. This polarisation-resolved differential phase contrast (pDPC) microscopy technique can be easily integrated with fluorescence microscopy.

Application of direct stochastic optical reconstruction microscopy (dSTORM) to the histological analysis of human glomerular disease.

Electron microscopy (EM) following immunofluorescence (IF) imaging is a vital tool for the diagnosis of human glomerular diseases, but the implementation of EM is limited to specialised institutions and it is not available in many countries. Recent progress in fluorescence microscopy now enables conventional widefield fluorescence microscopes to be adapted at modest cost to provide resolution below 50 nm in biological specimens. We show that stochastically switched single-molecule localisation microscopy can be applied to clinical histological sections stained with standard IF techniques and that such super-resolved IF may provide an alternative means to resolve ultrastructure to aid the diagnosis of kidney disease where EM is not available. We have implemented the direct stochastic optical reconstruction microscopy technique with human kidney biopsy frozen sections stained with clinically approved immunofluorescent probes for the basal laminae and immunoglobulin G deposits. Using cases of membranous glomerulonephritis, thin basement membrane lesion, and lupus nephritis, we compare this approach to clinical EM images and demonstrate enhanced imaging compared to conventional IF microscopy. With minor modifications in established IF protocols of clinical frozen renal biopsies, we believe the cost-effective adaptation of conventional widefield microscopes can be widely implemented to provide super-resolved image information to aid diagnosis of human glomerular disease.

Neoplasia endocrina múltiple IIA: feocromocitoma bilateral. A propósito de un caso y revisión de la literatura / Multiple Endocrine Neoplasia IIA: Bilateral Pheochromocytoma. About a Case and Literature Review

Resumen: Presentamos el caso de una paciente del sexo femenino, de 54 años de edad, con antecedente familiar de neoplasia endocrina múltiple tipo II, con estudio genético positivo para NEM 2 IIA EXON 11, c634 CGCIB. Inició padecimiento con cardiopatía hipertensiva y disfunción diastólica, hallazgo to mográfico de tumor suprarrenal bilateral por imagenología, se realizó adrenalectomía convencional transabdominal, se encontró tumor derecho con cápsula correspondiente a feo cromocitoma con un peso de 1,100 g de 14.5 cm de diámetro mayor con invasión a cápsula sin romperla, tumor suprarrenal izquierdo correspondiente a feocromocitoma con un peso de 950 g de 15 cm de diámetro mayor.

Abstract: We present the case of a 54-year-old female patient with a family history of multiple endocrine neoplasia type II, with a genetic study for MEN 2 IIA EXON 11, CG6B c634, onset with hypertensive heart disease and diastolic dysfunction, tomographic finding of bilateral adrenal tumor by imaging. A conventional transabdominal adrenalectomy was performed, finding a right tumor with a capsule corresponding to pheochromocytoma with a weight of 1,100 g of 14.5 cm of greater diameter with invasion of the capsule without breaking it, and a left adrenal tumor corresponding to pheochromocytoma with a weight of 950 g of 15 cm of greater diameter.

Elucidation of mass transfer mechanisms in pellet formation by spheronization.

Previously published mechanisms of pellet formation during extrusion-spheronization include a transfer of material between different granules. This research aimed to specify the origin of this transfered mass, enabling further insight into the extrusion-spheronization process. Granules of various diameters were rounded simultaniously in a spheronizer to ascertain if mass transfer between smaller and larger granules is truly in balance, or if mass transfer from smaller to larger granules is preferred. Granules were also marked with a fluorescent tracer to enable quantification of mass transfer. By using differently sized and shaped granules as starting material, different modes of mass transfer were investigated. Samples were taken after various process durations to investigate the kinetics of the tranfer mechanism. It was found that both small and large granules dispense and receive mass during spheronization. In general, small granules increase their size, while large granules maintain their size or show a slight size decrease, resulting in the particularly narrow monomodal size distribution.

Primary extra-gastrointestinal stromal tumor (EGIST) of the mesentery: Case report and review of literature.

INTRODUCTION: Gastrointestinal stromal tumors (GISTs) represent <1% of all gastrointestinal (GI) tumors. Extra-gastrointestinal stromal tumors (EGISTs) are mesenchymal tissue neoplasm arising outside the GI tract. This rare group comprises only 5% of all GISTs. This case demonstrates a rare entity in a patient with non-specific symptoms, a large tumor size and unremarkable past personal and family history. PRESENTATION OF CASE: We present a 45-year old man with non-specific symptoms who was diagnosed with a primary EGIST arising in the small bowel mesentery after surgery. The tumor was not compromising the GI tract and it was completely resected. The tumor was sent for pathological examination that confirmed the diagnosis. Histological examination revealed a 15 cm in diameter mass, comprised of spindle cells and high mitotic activity. Treatment with imatinib mesylate was initiated. DISCUSSION: There have been only a few previous reports of EGISTs arising from the small bowel mesentery. It is believed that EGISTs originate from cells with similar pathological characteristics and biological behaviour as the intestinal cells of Cajal. Such tumors are associated with poorer prognosis, lager tumor size and younger presentation than their GI counterparts. The preferred treatment is complete surgical resection. The addition of specific tyrosine kinase inhibitors such as imatinib mesylate is recommended for high risk patients. Even though morphological and immunohistochemical similarities between GISTs and EGISTs are described, their pathogenesis, incidence, genetic background, complications and prognosis are not completely known because they are extremely rare. CONCLUSION: EGISTs are very rare tumors which originate from cells outside the GI tract and are associated with a more aggressive biological behavior than their GI counterparts. These tumors may grow without any clinical implications and should be kept in mind in the differential diagnosis for patients presenting with an abdominal mass. Further studies are needed due to lack of large patient cohort studies and long-term follow-up regarding the prognosis and management of this rare pathology.

Pictures Do Influence the Decision to Transfer: Outcomes of a Telemedicine Program Serving an Eight-State Rural Population.

Triaging burn patients is a daunting task because burn injuries are rare; this inexperience leads to uncertainty in treatment and referral algorithms. Our regional burn center's catchment area includes eight states. Outlying facilities consult via telephone through the medical center's transfer center. Referring provider assessments of depth or size of injury infrequently correlates with burn provider's assessments. This causes over- and under-triage of patients managed outside of burn centers. A quality improvement telemedicine project was developed to allow burn providers to review photos with referring providers to determine best management, provide pertinent education, and initiate appropriate and timely resuscitation. Details tracked include date of service, consulting provider, follow-up education offered, and whether the image reviewed changed or confirmed the requested plan of care. Of the 155 cases between January 2017 and August 2018, 24.5% of patient images changed the initial transfer decision, and 75.5% confirmed the initial plan of care. Of the cases requiring change of plan, 60.5% were down-triaged to outpatient care and 39.5% were up-triaged to transfer. Implementation of this telemedicine program has increased efficiency of resource utilization, timely resuscitation, appropriate transfer of patients requiring admission, and real-time education. Findings suggest advanced practice providers' assessments are similar to those of referring physicians. These observations may have significant implications on Emergency Medical Treatment and Labor Act (EMTALA) guidelines defining physician to physician consultation and support efficient use of available resources. Telemedicine facilitates access to specialized care and improves fiscal responsibility.

Experience of oncology residents with death: a qualitative study in Mexico.

BACKGROUND: Physicians play a fundamental role in the care of patients at the end of life that includes knowing how to accompany patients, alleviate their suffering and inform them about their situation. However, in reality, doctors are part of this society that is reticent to face death and lack the proper education to manage it in their clinical practice. The objective of this study was to explore the residents' concepts of death and related aspects, their reactions and actions in situations pertaining to death in their practice, and their perceptions about existing and necessary training conditions. METHODS: A qualitative approach was used to examine these points in depth based on interviews conducted with seven oncology residents. RESULTS: Participants do not have a clear concept of death and, although it is seen as a common phenomenon, they consider it an enemy to beat. The situations to which respondents react more frequently with frustration and sadness after the death of patients were when they felt emotionally involved, if they identify with the patient, in cases of pediatric patients and with patients who refuse treatment. To deal with death, participants raise barriers and attempt to become insensitive. Although residents in this study recognize the importance of training to learn how to better deal with death, it seems they are not fully invested in reaching more of it. CONCLUSIONS: Participants face death in a daily basis without the necessary training, which appears to impact them more than they are willing to accept. They do not achieve their goals managing situations regarding death as well as they assume they do. Despite recognizing the need of more training and support for better coping with death, they prefer to continue to learn from their experience. TRIAL REGISTRATION: Not applicable.

Author Correction: Authentication and characterisation of a new oesophageal adenocarcinoma cell line: MFD-1.

A correction has been published and is appended to both the HTML and PDF versions of this paper. The error has not been fixed in the paper.

Automated Fluorescence Lifetime Imaging High-Content Analysis of Förster Resonance Energy Transfer between Endogenously Labeled Kinetochore Proteins in Live Budding Yeast Cells.

We describe an open-source automated multiwell plate fluorescence lifetime imaging (FLIM) methodology to read out Förster resonance energy transfer (FRET) between fluorescent proteins (FPs) labeling endogenous kinetochore proteins (KPs) in live budding yeast cells. The low copy number of many KPs and their small spatial extent present significant challenges for the quantification of donor fluorescence lifetime in the presence of significant cellular autofluorescence and photobleaching. Automated FLIM data acquisition was controlled by µManager and incorporated wide-field time-gated imaging with optical sectioning to reduce background fluorescence. For data analysis, we used custom MATLAB-based software tools to perform kinetochore foci segmentation and local cellular background subtraction and fitted the fluorescence lifetime data using the open-source FLIMfit software. We validated the methodology using endogenous KPs labeled with mTurquoise2 FP and/or yellow FP and measured the donor fluorescence lifetimes for foci comprising 32 kinetochores with KP copy numbers as low as ~2 per kinetochore under an average labeling efficiency of 50%. We observed changes of median donor lifetime ≥250 ps for KPs known to form dimers. Thus, this FLIM high-content analysis platform enables the screening of relatively low-copy-number endogenous protein-protein interactions at spatially confined macromolecular complexes.

Insuficiencia renal aguda en adultos críticamente enfermos en dos instituciones hospitalarias / Acute kidney failure in critically ill adults from two health care institutions / Insuficiência renal aguda em adultos criticamente doentes em duas instituições hospitalares

Objetivo: Cuantificar la incidencia y los factores de exposición relacionados con el desarrollo de la insuficiencia renal aguda en pacientes hospitalizados en unidades de cuidados intensivos adulto durante tres meses. Materiales y métodos: se realizó un estudio epidemiológico de tipo cuantitativo con dos componentes: descriptivo longitudinal y de cohorte histórica, se emplearon los criterios de AKIN, participaron dos instituciones de salud, una de orden privado y otra de orden público. Resultados: Se incluyeron 186 pacientes, con una edad promedio de 56,2 +/- 20,14 años. Se encontró una incidencia del 21,6 % (IC 95 % 17-30) de insuficiencia renal aguda y una tasa de incidencia de 29,2 por cada 100 pacientes año exposición. En promedio la elevación de creatinina fue 0,47 mg/dL y el gasto urinario de 0,37 cc/kg/h, los días en ocurrir el evento 3,1 (IC 95 % 2,48-3,74). Se encontró relación estadísticamente significativa entre insuficiencia cardíaca aguda 6,84 días (IC 95 % 4,21-9,48) (p=0,026), posoperatorios 9,82 días (IC 95 % 8,42-11,2) (p=0,04) y trauma craneoencefálico 4,5 días (IC 95 % 1,56-7,44) (p=0,043) como causas de ingreso y la aparición de insuficiencia renal aguda Conclusiones: La proporción de incidencia de insuficiencia renal aguda identificada en el presente estudio, es similar a estudios realizados en Colombia, sin embargo, difiere de otros realizados en el exterior. La sepsis fue el diagnóstico con mayor frecuencia entre los pacientes con insuficiencia renal aguda, seguido de la insuficiencia cardíaca aguda. Se encontró significancia estadística en el desarrollo de la insuficiencia renal aguda y la administración de nitroglicerina.

Objective: To quantify the incidence and factors of exposure related to the development of acute kidney failure in hospitalized patients in the adult intensive care unit during three months. Materials and methods: An epidemiological study of quantitative type with two components was performed: descriptive longitudinal study and a retrospective cohort study, AKIN criteria were used, two health care institutions (one private and one public) participated. Results: 186 patients were included with an average age of 56.2 +/- 20,14 years. An incidence of 21.6% was found (IC 95 % 17-30) of acute kidney failure and a rate of incidence of 29.2 for every 100 patients / year of exposure. On average the creatinine elevation was of 0.47 mg/dL and the urine output was of 0.37 cc/kg/h, days of event occurrence 3.1 (IC 95 % 2.48-3.74). A significant statistical relationship was found between acute heart failure 6.84 days (IC 95% 4.21-9.48) (p=0.026), post-operatives 9.82 days (IC 95 % 8.42-11.2) (p=0.04) and traumatic brain injury 4.5 days (IC 95 % 1.56-7.44) (p=0.043), as causes of admission and appearance of acute kidney failure. Conclusions: The incidence proportion of acute kidney failure identified in the present study, is similar to other studies performed in Colombia, however, it differs from studies performed in other countries. Sepsis was the most frequent diagnosis among patients with acute kidney failure, followed by acute heart failure. Statistical significance was found in the development of acute kidney failure and the intake of nitroglycerin.

Objetivo: Quantificar a incidência e os fatores de exposição relacionados com o desenvolvimento da Insuficiência Renal Aguda (IRA) em pacientes adultos hospitalizados em unidades de terapia intensiva durante três meses. Materiais e métodos: realizou-se um estudo epidemiológico de tipo quantitativo com dois componentes: descritivo longitudinal e de coorte histórica, empregaram-se os critérios de AKIN (Acute Kidney Injury Network), participaram duas instituições de saúde, uma de ordem privado e outra de ordem pública. Resultados: Incluíram-se 186 pacientes, com uma idade média de 56,2 ± 20,14 anos. Encontrou-se uma incidência do 21,6 % (IC 95 % 17-30) de insuficiência renal aguda e uma taxa de incidência de 29,2 por cada 100 pacientes ano exposição. Em média a elevação de creatinina foi de 0,47 mg/dL e o gasto urinário de 0,37 cc/kg/h, os dias em ocorrer o evento 3,1 (IC 95 % 2,48-3,74). Encontrou-se relação estatisticamente significativa entre insuficiência cardíaca aguda (ICA) 6,84 dias (IC 95 % 4,21-9,48) (p=0,026), pós-operatórios 9,82 dias (IC 95 % 8,42-11,2) (p=0,04) e traumatismo cranioencefálico (TCE) 4,5 dias (IC 95 % 1,56-7,44) (p=0,043) como causas de ingresso e a aparição de insuficiência renal aguda Conclusões: A proporção de incidência de insuficiência renal aguda identificada no presente estudo, é similar a estudos realizados na Colômbia, no entanto, difere de outros realizados no exterior. A sepse foi o diagnóstico com maior frequência entre os pacientes com insuficiência renal aguda, seguido da insuficiência cardíaca aguda. Obteve-se significância estadística no desenvolvimento da insuficiência renal aguda e a administração de nitroglicerina.

Conocimientos actitudes y prácticas sobre hipertensión arterial en usuarios que asisten a Unidad Comunitaria de Salud Familiar Milagro de La Paz, San Miguel, en periodo de Febrero a Septiembre 2019 / Knowledge, attitudes and practices on arterial hypertension in users who attend the Community Family Health Unit Milagro de La Paz, San Miguel, from February to September 2019

Propósito: Los datos obtenidos de este estudio podrían ser considerados como referentes por el coordinador de la UCSF para elaborar estrategias en educación y comunicación a fin de fortalecer los conocimientos de los usuarios de la Unidad Milagro de la Paz. Materiales y métodos: De tipo descriptivo, de corte transversal en la población adscrita se eligieron 210 usuarios y usuarias que asistieron a la UCSF. Resultados: EL 71% de los entrevistados poseen cierto grado de habilidades cognoscitivas acerca de los valores clínicos establecidos para el diagnóstico de hipertensión arterial, un grupo significativo, 48 % no ven el consumo regulado de sal como importante, por lo que omite las medidas preventivas de consumo de sal siendo un factor de riesgo de nivel alto para la aparición de complicaciones relacionadas con la hipertensión arterial, en relación a las actitudes el 60% de la población confían más en remedios caseros lo que conocemos como el uso de etno-practica para tratar la hipertensión arterial. Conclusiones: en cuanto a los aspectos sociodemográficos el 64% tienen la edad de 40, 45 y 44 años, 69% pertenecer al área urbana, 53% pertenecen al sexo femenino, la ocupación de los entrevistados es empleo informal con un 86%, el nivel académico cursado de escolaridad corresponde en un 96% a la educación media o inferior a esta, el 72% tienen como estado civil casado o unión libre, además el 80 % reconocen que la hipertensión arterial no presenta sintomatología alguna, el 89% de los usuarios entrevistados están conscientes de la necesidad de realizar actividad física e incluir vegetales verdes y frutas en la dieta de una persona que tenga diagnóstico de hipertensión arterial y consideran el consumo de alcohol y tabaco como un factor de riesgo en una persona que padece de esta enfermedad, en lo que respecta a la auto medicación el 42% de la población estudiada consideran en base a sus criterios que la auto medicación es recomendable en una persona que presenta la enfermedad de hipertensión arterial. Recomendaciones: la creación de una estrategia nacional para la reducción del consumo de sal en la dieta de los salvadoreños y en poblaciones de riesgo, así como Alentar a la industria alimentaria a reformular y elaborar los productos alimenticios con menos sal y facilitar la ejecución de campañas educativas en la región de salud dirigidas a concientizar sobre la reducción del consumo de sal grupos de riesgo en las comunidades

Propofol-fentanil en bolo frente a ketofol en infusión continua para sedoanalgesia en colonoscopia electiva / Propofol-fentanyl bolus versus ketofol continuous infusion for sedation-analgesia in elective colonoscopy

Introducción: La colonoscopia se practica con frecuencia y la sedación consciente es útil para realizarla. Objetivos: Comparar propofol-fentanil en bolo con ketofol en infusión continua para colonoscopia. Método: Se realizó un estudio cuasiexperimental en 150 pacientes divididos en dos grupos. En el grupo propofol-fentanil se realizó inducción con fentanil 1,5-3 µg/kg más propofol 0,5-1,5 mg/kg y mantenimiento con bolos de propofol 0,4-0,5 mg/kg. En el grupo Ketofol se empleó una solución que se obtuvo al asociar 50 mL de propofol (1 por ciento) y 0,5 mL de ketamina (5 por ciento); dosis de carga de 1,1 mg/kg y mantenimiento con infusión continua manual. Se estudiaron variables hemodinámicas y respiratorias, nivel de sedación, satisfacción del paciente y del colonoscopista, tiempo de recuperación y eventos adversos. Resultados: La presión arterial media y la SpO2 mostraron diferencias entre los grupos y en los diferentes momentos, con cifras más bajas en el grupo propofol-fentanil. La frecuencia cardiaca no varió entre los grupos. La satisfacción de pacientes y los técnicos en endoscopias fue alta en ambas estrategias. Los pacientes del grupo propofol-fentanil tuvieron tiempo de recuperación superior (27 min). Menos de la mitad de los pacientes presentaron eventos adversos. El dolor, la insatisfacción y la depresión respiratoria fueron los más frecuentes. Conclusiones: Ketofol resultó superior a la asociación propofol-fentanil con mejor estabilidad hemodinámica y respiratoria, niveles de sedación más estables, satisfacción de pacientes y gastroenterólogos, tiempos de recuperación más breves, eventos adversos escasos y leves(AU)

Introduction: Colonoscopy is performed frequently, for which conscious sedation is useful. Objectives: To compare propofol-fentanyl bolus with ketofol continuous infusion for colonoscopy. Methods: A quasi-experimental study was performed in 150 patients divided into two groups. In the propofol-fentanyl group, induction was performed with fentanyl at doses 1.5-3 µg/kg plus propofol at doses 0.5-1.5 mg/kg and maintenance with propofol boluses at doses 0.4-0.5 mg/kg. In the ketofol group, a solution was used as obtained by associating 50 mL of propofol (1 percent) and 0.5 mL of ketamine (5 percent); loading dose of 1.1 mg/kg and maintenance with manual continuous infusion. Hemodynamic and respiratory variables were studied, together with sedation level, patient and colonoscopy technician satisfaction, recovery time and adverse events. Results: Mean arterial pressure and SpO2 showed differences between groups and at different times, with lower figures in the propofol-fentanyl group. The heart rate did not vary between the groups. Patients and endoscopy technician satisfaction was high in both strategies. Patients in the propofol-fentanyl group had longer recovery time (27 min.). Less than half of the patients presented adverse events. Pain, dissatisfaction and respiratory depression were the most frequent. Conclusions: Ketofol was higher to the propofol-fentanyl association with better hemodynamic and respiratory stability, more stable sedation levels, patient and gastroenterologist satisfaction, shorter recovery times, limited and mild adverse events(AU)

Variables perioperatorias que influyen en la morbimortalidad de pacientes operados de fractura de cadera / Perioperative variables that influence the morbidity and mortality of hip fracture operated patients

Introducción: la fractura de cadera es causa común de hospitalización, ocupa un lugar cimero en la morbilidad y mortalidad por enfermedad ortopédica. Objetivo: identificar las variables perioperatorias que influyen en la morbimortalidad de los pacientes que se operan de fractura de cadera en el Hospital Militar Central Dr. Carlos J. Finlay. Métodos: se realizó un estudio analítico, retrospectivo en 135 pacientes intervenidos quirúrgicamente entre enero y diciembre de 2014. Se dividieron en dos grupos para el análisis estadístico, fallecidos y vivos. Las variables estudiadas fueron: causa de muerte, tasas de mortalidad posoperatoria, factores clínicos y quirúrgicos pronósticos de muerte y principales complicaciones. Resultados: la tasa de mortalidad a los 30 días de operados fue 2,2 por ciento y al año 17,8 por ciento. Las principales causas de muerte fueron el infarto agudo de miocardio (45,8 por ciento) y el trombo embolismo pulmonar (16,7 por ciento). La probabilidad de morir los pacientes con cardiopatía isquémica o estado físico ASA 4 (American Society of Anesthesiologists) fue ocho veces superior, cinco veces más si presentaron anemia, cuatro veces mayor si recibieron anestesia general, transfusión de glóbulos intraoperatoria o alguna complicación postoperatoria, tres veces mayor en aquellos pacientes ASA 3 y pérdida sanguínea mayor de 500 mL, y se incrementa si la estadía supera los siete días. Las complicaciones más frecuentes fueron la anemia (33,3 por ciento) y la hipotensión arterial (16,7 por ciento). Conclusiones: se identificaron como factores pronósticos de muerte: el antecedente de cardiopatía isquémica, anemia preoperatoria, clasificación elevada del estado físico, uso de anestesia general, pérdidas sanguíneas mayores de 500 mL, uso de trasfusiones de glóbulos, estadía mayor de siete días y la aparición de complicaciones postoperatorias(AU)

Introduction: Hip fracture is a common cause of hospitalization, occupies a leading place in morbidity and mortality due to orthopedic disease. Objective: To identify the perioperative variables that influence the morbidity and mortality of the patients who undergo hip fracture surgery at the Central Military Hospital Dr. Carlos J. Finlay. Methods: a retrospective, analytical study was conducted in 135 patients surgically intervened between January and December 2014. They were divided into two groups for statistical analysis, deceased and alive. The variables studied were: cause of death, postoperative mortality rates, clinical and surgical prognostic factors of death and main complications. Results: The mortality rate at 30 days after surgery was 2.2 percent and 17.8 percent a year later. The main causes of death were acute myocardial infarction (45.8 percent) and pulmonary thrombus embolism (16.7 percent). The probability of dying due to ischemic heart disease or physical state ASA 4 was eight times higher, five times more if they had anemia, four times higher if they received general anesthesia, intraoperative blood transfusion or postoperative complication, three times higher in those patients ASA 3 and blood loss greater than 500 mL, and it increases if the hospitalization exceeds seven days. The most frequent complications were anemia (33.3 percent) and hypotension (16.7 percent). Conclusions: A history of ischemic heart disease, preoperative anemia, high physical status classification, use of general anesthesia, blood loss greater than 500 mL, use of blood transfusions, stay of more than seven days and appearance of postoperative complications(AU)

Case Report: Intestinal Obstruction as a Late Presentation of Perforation of the Transverse Colon Following Blunt Abdominal Trauma.

Colonic perforation associated with blunt abdominal trauma is rare. Even more so is the formation of an inflammatory adhesion preventing leakage into the peritoneum. We present a case of the above in which the patient presented 1 month later with intestinal obstruction which required surgical intervention. A 38-year-old male, victim of a road traffic accident (RTA), presented with multiple fractures in his extremities which had to be operated on and was later discharged without complications. He was readmitted 1 month following the trauma with intestinal obstruction. During the operation, a stenosing colonic adhesion due to bowel perforation following blunt abdominal trauma was discovered. Resection of the transverse colon and a termino-terminal colo-colonic anastomosis was performed.

Trimetroprim-sulfametoxazol: Un caso de Necrólisis Epidérmica Tóxica / Trimethoprim-sulfamethoxazole: A Case of Toxic Epidermal Necrolysis

Necrólisis Epidérmica Tóxica (NET) es una rara pero grave emergencia caracterizada por difusa exfoliación de la piel y las membranas mucosas debido a pérdida de la epidermis, mediada por respuesta inmune que puede llevar a sepsis y fallo ventilatorio. El Trimetropin-Sulfametoxazol es un antibiótico ampliamente utilizado que es causa de dicha entidad. El diagnóstico prematuro y el tratamiento agresivo es esencial para la reducción de los elevados niveles de morbilidad y mortalidad asociadas con esta enfermedad. Presentamos un caso que fue precipitado debido al uso de Trimetropin-Sulfametoxazol en un hombre de 22 años de edad...(AU)

Toxic Epidermal Necrolysis (TEN) is a rare but serious emergency characterized by diffuse exfoliation of the skin and mucous membranes due to loss of the epidermis, mediated by immune response that can lead to sepsis and ventilatory failure. Trimetropin-Sulfamethoxazole is a widely used antibiotic that causes this entity. Premature diagnosis and aggressive treatment is essential for reducing the high levels of morbidity and mortality associated with this disease. We present a case that was precipitated due to the use of Trimetropin-Sulfamethoxazole in a man of 22 years of age ... (AU)