Atención médica de body packers en un territorio colombiano / Medical care for body packers in a Colombian territory

Introducción. El número de capturas a los body packers, que son aquellas personas que ingieren paquetes con estupefacientes para tráfico ilegal, ha aumentado paulatinamente. El objetivo de este estudio fue presentar los casos de body packers atendidos en dos instituciones de salud de Florencia, un territorio al sur de Colombia, entre 2003 y 2017. Métodos. Este es un estudio retrospectivo descriptivo. Se hizo un análisis univariado en RStudio y Microsoft Excel® de variables sociodemográficas y clínicas. Se emplearon medidas de tendencia central y dispersión para las variables continuas, frecuencias y proporciones para las variables categóricas. Resultados. Se incluyeron 72 pacientes. La mayoría de los casos fueron reportados entre 2007 y 2012 (77,5 %). La relación entre hombres y mujeres fue de 4,9:1. La edad media fue de 29,1 años. El principal motivo de admisión fue para chequeo médico tras captura por parte de los organismos de seguridad nacional (76,4 %). En 9 de cada 10 admitidos se realizaron estudios de imagen (94,4 %); la principal ayuda diagnóstica fue la radiografía de abdomen simple (84,7 %), con una sensibilidad del 91,6 %. Se realizó manejo expectante en tres de cada cuatro pacientes (74,6 %). El 6,9 % presentaron complicaciones, con una mortalidad (1,4 %). Conclusiones. La radiografía de abdomen simple es una ayuda diagnóstica adecuada para el tamizaje de los body packers. El manejo conservador es aceptable, teniendo en cuenta el porcentaje bajo de complicaciones.

Introduction. The number of arrests of body packers, who are those people who ingest packages with narcotics for illegal trafficking, has gradually increased. The objective of this study was to present the cases of body packers treated in two health institutions in Florencia, a territory in southern Colombia, between 2003 and 2017. Methods. This is a descriptive retrospective study. A univariate analysis was performed in RStudio and Microsoft Excel® of sociodemographic and clinical variables. Measures of central tendency and dispersion were used for continuous variables, frequencies and proportions for categorical variables. Results. 72 patients were included. Most cases were reported between 2007 and 2012 (77.5%). The ratio between men and women was 4.9:1. The mean age was 29.1 years. The main reason for admission was for medical check-up after capture by national security agencies (76.4%). In nine out of ten admitted patients, imaging studies were performed (94.4%); the main diagnostic imaging was simple abdominal X-ray (84.7%), with a sensitivity of 91.6%. Expectant management was performed in three out of four patients (74.6%). 6.9% presented complications, with one mortality (1.4%). Conclusions. Simple abdominal x-ray is an adequate diagnostic tool for screening body packers. Conservative management is acceptable, taking into account the low percentage of complications.

Biocomposite Macrospheres Based on Strontium-Bioactive Glass for Application as Bone Fillers.

Traditional bioactive glass powders are typically composed of irregular particles that can be packed into dense configurations presenting low interconnectivity, which can limit bone ingrowth. The use of novel biocomposite sphere formulations comprising bioactive factors as bone fillers are most advantageous, as it simultaneously allows for packing the particles in a 3-dimensional manner to achieve an adequate interconnected porosity, enhanced biological performance, and ultimately a superior new bone formation. In this work, we develop and characterize novel biocomposite macrospheres of Sr-bioactive glass using sodium alginate, polylactic acid (PLA), and chitosan (CH) as encapsulating materials for finding applications as bone fillers. The biocomposite macrospheres that were obtained using PLA have a larger size distribution and higher porosity and an interconnectivity of 99.7%. Loose apatite particles were observed on the surface of macrospheres prepared with alginate and CH by means of soaking into a simulated body fluid (SBF) for 7 days. A dense apatite layer was formed on the biocomposite macrospheres' surface produced with PLA, which served to protect PLA from degradation. In vitro investigations demonstrated that biocomposite macrospheres had minimal cytotoxic effects on a human osteosarcoma cell line (SaOS-2 cells). However, the accelerated degradation of PLA due to the degradation of bioactive glass may account for the observed decrease in SaOS-2 cells viability. Among the biocomposite macrospheres, those composed of PLA exhibited the most promising characteristics for their potential use as fillers in bone tissue repair applications.

The characterization of RNA-binding proteins and RNA metabolism-related proteins in fungal extracellular vesicles.

RNA-binding proteins (RBPs) are essential for regulating RNA metabolism, stability, and translation within cells. Recent studies have shown that RBPs are not restricted to intracellular functions and can be found in extracellular vesicles (EVs) in different mammalian cells. EVs released by fungi contain a variety of proteins involved in RNA metabolism. These include RNA helicases, which play essential roles in RNA synthesis, folding, and degradation. Aminoacyl-tRNA synthetases, responsible for acetylating tRNA molecules, are also enriched in EVs, suggesting a possible link between these enzymes and tRNA fragments detected in EVs. Proteins with canonical RNA-binding domains interact with proteins and RNA, such as the RNA Recognition Motif (RRM), Zinc finger, and hnRNP K-homology (KH) domains. Polyadenylate-binding protein (PABP) plays a critical role in the regulation of gene expression by binding the poly(A) tail of messenger RNA (mRNA) and facilitating its translation, stability, and localization, making it a key factor in post-transcriptional control of gene expression. The presence of proteins related to the RNA life cycle in EVs from different fungal species suggests a conserved mechanism of EV cargo packing. Various models have been proposed for selecting RNA molecules for release into EVs. Still, the actual loading processes are unknown, and further molecular characterization of these proteins may provide insight into the mechanism of RNA sorting into EVs. This work reviews the current knowledge of RBPs and proteins related to RNA metabolism in EVs derived from distinct fungi species, and presents an analysis of proteomic datasets through GO term and orthology analysis, Our investigation identified orthologous proteins in fungal EVs on different fungal species.

Síndrome pilórico en un body packer / Pyloric syndrome in a body packer

Introducción. El embalaje y transporte de estupefacientes dentro del organismo, o body packing, es una práctica frecuente en Centroamérica y el Caribe. Además del riesgo de muerte por la exposición a las sustancias tóxicas, existe el riesgo de complicaciones mecánicas con indicación de manejo quirúrgico. El Hospital de Engativá, por su cercanía al aeropuerto de Bogotá, D.C., Colombia, es el centro de referencia para el tratamiento de estos pacientes. Caso clínico. Un hombre de 65 años traído al hospital por un episodio emético con expulsión de cuatro cápsulas para el transporte de estupefacientes. Al examen físico se encontraron masas palpables en el hemiabdomen superior, sin abdomen agudo. La tomografía de abdomen informó un síndrome pilórico secundario a retención gástrica de cuerpos extraños. Fue llevado a laparotomía y gastrotomía logrando la extracción de 97 objetos cilíndricos de látex que contenían sustancias ilícitas. Discusión. En los body packer asintomáticos, la administración de soluciones laxantes es una estrategia terapéutica segura. Los casos reportados de obstrucción gastrointestinal son infrecuentes y se relacionan con la ingesta de un gran número de cápsulas, por lo que es necesario el tratamiento quirúrgico. Conclusión. El síndrome pilórico es una presentación infrecuente en un body packer. Se debe tener un alto índice de sospecha para garantizar un manejo oportuno

Introduction. Packaging and transportation of narcotic drugs inside a human body, or body packing, is a frequent practice in Central America and the Caribbean. In addition to the risk of death due to exposure to toxic substances, there is a risk of mechanical complications with an indication for surgical management. The Engativá Hospital, due to its proximity to the airport in Bogotá, D.C., Colombia, is the reference center for the treatment of these patients. Clinical case. A 65-year-old man brought to the hospital for an emetic episode with expulsion of four narcotic transport capsules. Physical examination revealed palpable masses in the upper abdomen, without an acute abdomen. Abdominal tomography revealed pyloric syndrome secondary to gastric retention of foreign bodies. He was taken to laparotomy and gastrotomy, achieving the extraction of 97 cylindrical latex objects that contained illicit substances. Discussion. In asymptomatic body packers, the administration of laxative solutions is a safe therapeutic strategy. Reported cases of gastrointestinal obstruction are infrequent and are related to the ingestion of a large number of capsules, for which surgical treatment is necessary. Conclusion. Pyloric syndrome is an uncommon presentation in body packers. A high index of suspicion is required to ensure timely management

Description and evaluation of cocaine body-packers management in French Guiana (2016-2019).

INTRODUCTION: French Guiana is a hub for drugs trafficking between South America and Europe. In Corpore transport, or Body-packing, is one of the options favored. In 2018, 577 people were arrested for smuggling cocaine from French Guiana to mainland France. The objective of this study was to update the epidemiological data and to evaluate the overall management of body-packers. METHODS: A monocentric retrospective and observational study included patients admitted to the emergency department of the Cayenne General Hospital from January 1st, 2016 to December 31st, 2019 after ingestion of cocaine pellets. RESULTS: During the period, 668 people were referred to Cayenne hospital's emergency department by for suspected body-packing. Two hundred nineteen were excluded due to the absence of cocaine pellets in the initial X-ray or because they were carrying cannabis pellets. The mean age was 25.2 years with a sex ratio of 2.21 males per female. Among them, 13.7% of cases were complicated without endangering the vital prognosis. The mean number of pellets was similar between the population with and without complications (respectively 54.1 [50.9-57.4] and 57.8 [48.9-66.6], p = 0.22). The presence of cocaine in the urine was not significantly associated with the risk of complications (OR = 0.5, [95%CI = 0.1-1.8], p = 0.23). Compared to the CT-scanner which has the highest diagnostic accuracy (Se 100%, Sp 94%), the sensitivity of the Abdominal X-ray was 44%. CONCLUSION: This study showed that complications were rare, most of which were digestive stagnation requiring endoscopy. Given the low rate of complications and their low severity the average duration of hospitalization was relatively short. The type 3, micro-industrial quality packaging, almost exclusively used in body-packing in French Guiana, seems to be the main factor in this reduction of complications. This observation suggests possible adaptations of the current protocol for body-packers monitoring.

Physical load and heart rate behavior in workers in the slaughterhouse and meat packing industries / Carga física e comportamento da frequência cardíaca em trabalhadores de frigorífico

Abstract High physical overload during the workday and some conditions present in the workplace can generate several losses in the worker's health. The use of tools capable of identifying physical load (PL), such as heart rate (HR) analysis, is essential. The aim of the study was to evaluate the physical load and heart rate behavior of workers in the slaughterhouse. The cardiovascular load reached by two individuals was 12% and 24%. In relation to the PL rating, they fit as moderately heavy to heavy work. The HR, was higher at the end of the work when compared to the beginning. Furthermore, it was pointed out that the temperature, noise, and body mass index were above normality values. The physical workload was classified as moderately heavy to heavy. The limit HR was reached in some moments of the work by one of the workers and two of them reached higher HR values at the end of the work.

Resumo A elevada sobrecarga física durante a jornada de trabalho e algumas condições presentes no ambiente de trabalho podem gerar diversos prejuízos na saúde do trabalhador. A utilização de ferramentas capazes de identificar a carga física (CF), como a análise da frequência cardíaca (FC), é fundamental. O objetivo do estudo foi avaliar o comportamento da carga física e da frequência cardíaca dos trabalhadores de frigorífico. A carga cardiovascular alcançada por dois indivíduos foi de 12% e 24%. Em relação à classificação da CF, enquadram-se como trabalhos moderadamente pesados ​​a pesados. A FC, foi maior no final do trabalho quando comparado ao início. Além disso, apontou-se que a temperatura, o ruído e o índice de massa corporal estavam acima dos valores da normalidade. A CF de trabalho foi classificada como moderadamente pesada a pesada. A FC limite foi atingida em alguns momentos do trabalho por um dos trabalhadores e dois deles atingiram valores maiores de FC ao final do trabalho.

Clinical, Diagnostic, and Treatment Features of Body Packing in Brazil: Drugs, Cell Phones, and Beyond.

INTRODUCTION: Body packing consists of the concealment of substances (drugs and non-narcotics) or products inside the human body with the purpose of smuggling and may represent an emergency due to the fatal risk of narcotic toxicity, intestinal obstruction, and visceral perforation. However, non-narcotic body packing, especially in developing countries, is under-evaluated. Thus, the objective of this study was to evaluate cases of body packers in Brazil as regards narcotic and non-narcotic contents. METHODS: This retrospective study analyzes the medical records of body packers admitted from January 2015 to December 2019 at one of the main tertiary hospitals in central Brazil. RESULTS: Ten cases of body packing were observed. We found that five patients carried drugs, while seven carried non-narcotic substances such as cell phones and accessories. All the patients were male, prisoners, and young adults. In six patients, there was gastrointestinal obstruction, and in three, there was acute narcotic intoxication. Abdominal radiography diagnosed eight of the cases. In nine of the cases, emergency laparotomy was required, but all patients successfully recovered. CONCLUSION: There was a higher prevalence of body packing of non-narcotic content; however, diagnostic and surgical approaches were similar to those of narcotic content. Clinicians must be aware of both non-narcotic and narcotic body packing.

Body Packer y Body Stuffer: Serie de Casos. Revisión / Body Packer y Body Stuffer: serie de casos. Revision

"Body packing", "Body pushing" y "Body stuffing" son distintas formas de transportar sustancias ilegales dentro del cuerpo humano. Frente al ingreso en la unidad de emergencias de un "Body Packer", conocido como "tragador de paquetes" con fines de contrabando o un "Body Stuffer" llamados "tragadores rápidos", quienes ingieren en forma compulsiva paquetes manufacturados para la venta de sustancias ante la posibilidad de ser sorprendidos por agentes de la ley; se plantean una serie de desafíos en cuanto al tratamiento que al día de hoy permanecen en debate. Generalmente se prefiere mantener una conducta conservadora facilitando la expulsión de los paquetes. En aquellos casos en los que los pacientes presenten paquetes atascados o rotos o no mejoren con el tratamiento conservador, se recomienda el tratamiento quirúrgico.El presente trabajo tiene por objetivo reportar una serie de casos internados por ingesta de paquetes potencialmente peligrosos que se sometieron a una evacuación farmacológica y/o quirúrgica en 8 pacientes y una revisión bibliográfica sobre el tema.

"Body packing", "Body pushing", and "Body stuffing" are different ways to use the interior of the human body to transport illegal substances. In the face of a "Body Packer" or a "Body Stuffer" known as "fast swallowers", which are those cases in which they compulsively swallow manufactured packages for the sale of substances before the possibility of being surprised by law enforcement officers, a series of challenges present themselves regarding the treatment, which is currently up for debate. Generally, a conservative conduct is preferred, facilitating the expulsion of the packages. In those cases, in which patients have stuck or broken packages or do not improve with conservative treatment, surgical treatment is recommended.The present paper aims to report a series of cases in which the patients were admitted due to an intake of potentially dangerous packages and put through a pharmacological evacuation and/or surgical evacuation of 8 patients, and a bibliographical revision on the subject.

Epidemiology and medical management of body-packers in French Guiana between 2010 and 2015.

Background: French Guiana is used as a drug trafficking pipeline of cocaine to Europe. The number of arrests for transporting cocaine in corpore has increased exponentially in recent years. Since 2010, Cayenne Hospital's emergency care unit has applied a medical management protocol system for body-packers. Our objective was to describe the epidemiology of body-packers and to evaluate medical management. Method: A retrospective descriptive study was performed among patients hospitalized in Cayenne Hospital for transporting cocaine in corpore between January 2010 and November 2015. In addition, a qualitative study including interviews of body-packers imprisoned in Rémire-Montjoly prison was conducted in April 2016. Result: A total of 282 patients were included in the study. The median age was 24 years and the sex ratio M/W was to 4/1. Among them, 3.5% showed signs of severity (9 with pre-existing condition and 1 with severe form). No surgery or deaths were reported. Ten endoscopies were performed because of the delay in evacuation without complications. Approximately 28% of patients had urinary screening, of which 60.7% were positive. The median length of stay was 1.8 days. Prolonged length of stay was significantly associated with the presence of gastrointestinal symptoms, hypoglycemia, or having swallowed a minimum of 10 pellets. Conclusion: This study led to a change in the management of body-packers in the hospital setting in Guiana. A computed tomography scan at discharge became more prevalent. Endoscopy has emerged as an effective and safe alternative to surgery. Despite the increase in the number of patients treated, it should be noted that there were few complications and no deaths in our cohort.

Periodontitis in sheep in Pernambuco, Northeastern Brazil / Periodontite em ovinos em Pernambuco, Nordeste do Brasil

Cases of periodontitis in sheep from the Agreste and Zona da Mata regions of Pernambuco, Northeastern Brazil, are described. Information on breed, age and sex of affected animals as well as clinical and pathological aspects of the disease were obtained during farm visits. Fifteen animals from a total of 450 Santa Inês sheep, aged between three and twelve years, showed low body condition score, dull coat, and difficulty in feeding followed by pain on palpation of the mandibular region. Physical examination of the oral cavity of affected animals and post mortem findings of slaughtered individuals revealed varying degrees of periodontitis, wear, fracture, mobility, and loss of teeth associated with gingival retraction, presence of biofilm and food packing between incisors, premolars and molars teeth. Increased mandibular volume was observed in eight animals and, in two of them, an abscess fistula, exclusively in mandibular teeth. The occurrence of periodontitis in sheep had not been recorded until now in Northeastern Brazil and, thus, this is the first description of cases in the region.

Descrevem-se casos de periodontite em ovinos provenientes das regiões do Agreste e Zona da Mata de Pernambuco, Nordeste do Brasil. Informações sobre raça, idade e sexo dos animais afetados bem como os aspectos clínicos e patológicos dos surtos foram obtidos a partir de visitas às propriedades e são reportados. 15 animais de um total de 450 ovinos da raça Santa Inês, com idade entre três a doze anos de idade manifestaram baixa condição corporal, pelagem sem brilho e dificuldade de alimentar-se, acompanhado de dor à palpação na região mandibular. O exame físico da cavidade oral dos animais afetados e os achados post mortem de indivíduos abatidos revelaram graus variados de periodontite, desgaste, fratura, mobilidade e perda dentária, associados a retração gengival, presença de biofilme e compactação de resíduos alimentares entre os dentes incisivos, pré-molares e molares. Em oito animais havia aumento de volume mandibular e em dois deles observaram-se abscessos fistulados que ocorreram exclusivamente nos dentes mandibulares. A ocorrência de periodontite em ovinos não têm sido registrada no Nordeste do Brasil, sendo estes os primeiros casos descritos na região.

Triglyceride Lenses at the Air-Water Interface as a Model System for Studying the Initial Stage in the Biogenesis of Lipid Droplets.

Lipid droplets (LD) are intracellular structures consisting of an apolar lipid core, composed mainly of triglycerides (TG) and steryl esters, coated by a lipid-protein mixed monolayer. The mechanisms underlying LD biogenesis at the endoplasmic reticulum membrane are a matter of many current investigations. Although models explaining the budding-off of protuberances of phase-segregated TG inside bilayers have been proposed recently, the assumption of such initial blisters needs further empirical support. Here, we study mixtures of egg phosphatidylcholine (EPC) and TG at the air-water interface in order to describe some physical properties and topographic stability of TG bulk structures in contact with interfaces. Brewster angle microscopy images revealed the appearance of microscopic collapsed structures (CS) with highly reproducible lateral size (∼1 µm lateral radius) not varying with lateral packing changes and being highly stable at surface pressures (π) beyond collapse. By surface spectral fluorescence microscopy, we were able to characterize the solvatochromism of Nile Red both in monolayers and inside CS. This allowed to conclude that CS corresponded to a phase of liquid TG and to characterize them as lenses forming a three-phase (oil-water-air) system. Thereby, the thicknesses of the lenses could be determined, observing that they were dramatically flattened when EPC was present (6-12 nm compared to 30-50 nm for lenses on EPC/TG and TG films, respectively). Considering the shape of lenses, the interfacial tensions, and the Neumann's triangle, this experimental approach allows one to estimate the oil-water interfacial tension acting at each individual microscopic lens and at varying compression states of the surrounding monolayer. Thus, lenses formed on air-water Langmuir films can serve to assess variables of relevance to the initial step of LD biogenesis, such as the degree of dispersion of excluded-TG phase and shape, spatial distribution, and oil-water interfacial tension of lenses.

Body packing: tráfico de drogas y cirugía. Reporte de un caso / Body packing: drug traffic and surgery. Case report

Resumen Objetivo: Exponer el caso de un paciente con intoxicación aguda por cocaína en contexto de un body packing syndrome, considerando sus aspectos médico-quirúrgicos y legales. Materiales y Método: Se obtuvo la ficha clínica, con resguardo de anonimato, de un paciente que acude al servicio de urgencia (SU) y que es intervenido y evolucionando posteriormente en el Hospital el Pino de San Bernardo, Chile. Resultados: Paciente fue sometido a una gastrotomía, una enterotomía y una colotomía después de haber sido estabilizado por paro cardiorrespiratorio presentado en SU. Es trasladado a unidad de cuidados intensivos (UCI) donde evoluciona desfavorablemente. Discusión: El body packing syndrome es una entidad clínica infrecuente que, en la minoría de los casos, puede presentar complicaciones severas que requieren de un tratamiento médico-quirúrgico inmediato. Conclusión: Considerando que tanto el consumo como el tráfico de drogas se mantienen como un importante problema de salud pública y que sus consecuencias pueden ser devastadoras, es importante tener conocimiento sobre el tema.

Aim: To present the case of a patient with acute cocaine intoxication in the context of body packing syndrome, taking into consideration its medical-surgical and legal aspects. Materials and Method: A clinical record with anonymity protection was obtained, from a patient who was admitted to the emergency room and who was subsequently operated on and managed at Hospital El Pino in San Bernardo, Chile. Results: Patient underwent a gastrotomy, an enterotomy and a colotomy after being stabilized from a cardiorespiratory arrest in the emergency room. He was transferred to the Intensive Care Unit (ICU) where he evolved unfavorably. Discussion: Body packing is an infrequent clinical entity that, in a few cases, may develop severe complications that require immediate medical-surgical treatment, in addition to notification to authorities. Conclusion: Considering that both drug use and traffick remain as an important public health concern and that as its consequences may be devastating, it is important to have a knowledge on the subject.

Core-softened water-alcohol mixtures: the solute-size effects.

Water is the most anomalous material on Earth, with a long list of thermodynamic, dynamic and structural behaviors that deviate from what is expected. Recent studies have indicated that these anomalies may be related to a competition between two liquids, which means that water has a potential liquid-liquid phase transition (LLPT) that ends at a liquid-liquid critical point (LLCP). In a recent study [J. Mol. Liq., 2020, 320, 114420], using molecular dynamics simulations and a core-softened potential approach, we have shown that adding a simple solute such as methanol can "kill" the density-anomalous behavior as the LLCP is suppressed by spontaneous crystallization in a hexagonal close packing (HCP) crystal near the LLPT. Now, we extend this work to realize how longer-chain alcohols will affect the complex behavior of water-alcohol mixtures in the supercooled regime. Besides core-softened (CS) methanol, ethanol and 1-propanol were added to a system of identical particles that interact through the continuous shouldered well (CSW) potential. We observed that the density anomaly gradually decreases its extension in phase diagrams until it disappears with the growth of the non-polar chain and the alcohol concentration, different from the liquid-liquid phase transition (and the LLCP), which remained present in all analyzed mixtures, according to Nature, 2001, 409, 692. For our model, the longer non-polar chains and higher concentrations gradually impact the competition between the scales in the CS potential, leading to a gradual disappearing of the anomalies until the TMD total disappearance is observed when the first coordination shell structure is also affected: short-range ordering is favored, leading to less competition between short- and long-range ordering and, consequently, to the extinction of anomalies. Also, the non-polar chain size and concentration have an effect on the solid phases, favoring the hexagonal close packed (HCP) solid and the amorphous solid phase over the body-centered cubic (BCC) crystal. These findings help to elucidate the behavior of water solutions in the supercooled regime and indicate that the LLCP can be observed in systems without density-anomalous behavior.

Damage control surgery in lung trauma.

Damage control techniques applied to the management of thoracic injuries have evolved over the last 15 years. Despite the limited number of publications, information is sufficient to scatter some fears and establish management principles. The severity of the anatomical injury justifies the procedure of damage control in only few selected cases. In most cases, the magnitude of the physiological derangement and the presence of other sources of bleeding within the thoracic cavity or in other body compartments constitutes the indication for the abbreviated procedure. The classification of lung injuries as peripheral, transfixing, and central or multiple, provides a guideline for the transient bleeding control and for the definitive management of the injury: pneumorraphy, wedge resection, tractotomy or anatomical resection, respectively. Identification of specific patterns such as the need for resuscitative thoracotomy, or aortic occlusion, the existence of massive hemothorax, a central lung injury, a tracheobronchial injury, a major vascular injury, multiple bleeding sites as well as the recognition of hypothermia, acidosis or coagulopathy, constitute the indication for a damage control thoracotomy. In these cases, the surgeon executes an abbreviated procedure with packing of the bleeding surfaces, primary management with packing of some selected peripheral or transfixing lung injuries, and the postponement of lung resection, clamping of the pulmonary hilum in the most selective way possible. The abbreviation of the thoracotomy closure is achieved by suturing the skin over the wound packed, or by installing a vacuum system. The management of the patient in the intensive care unit will allow identification of those who require urgent reintervention and the correction of the physiological derangement in the remaining patients for their scheduled reintervention and definitive management.

Las técnicas de control de daños aplicadas al manejo de lesiones torácicas han evolucionado en los últimos 15 años. A pesar de que el número de publicaciones es limitado, la información es suficiente para desvirtuar algunos temores y establecer los principios de manejo. La severidad del compromiso anatómico justifica el procedimiento de control de daños solamente en algunos casos. En la mayoría, la magnitud del deterioro fisiológico y la presencia de otras fuentes de sangrado dentro del tórax o en otros compartimientos corporales constituyen la indicación del procedimiento abreviado. La clasificación de la lesión pulmonar como periférica, transfixiante y central o múltiple, proporciona una pauta para el control transitorio del sangrado y para el manejo definitivo de la lesión: neumorrafía, resección en cuña, tractotomía o resecciones anatómicas, respectivamente. La identificación de ciertos patrones como la necesidad de toracotomía de reanimación o de oclusión aórtica, la existencia de un hemotórax masivo, de una lesión pulmonar central, una lesión traqueobronquial o una lesión vascular mayor, así como el reconocimiento de hipotermia, acidosis o coagulopatía, constituyen la indicación de una toracotomía de control de daños. En estos casos, el cirujano concluye de manera abreviada los procedimientos con empaquetamiento de las superficies sangrantes, el manejo primario con empaquetamiento de algunas lesiones pulmonares periféricas o transfixiante seleccionadas y el aplazamiento de la resección pulmonar, pinzando el hilio de la manera más selectiva posible. La abreviación del cierre de la toracotomía se logra con la sutura de la piel sobre el empaquetamiento de la herida, o mediante la instalación de un sistema de presión negativa. El manejo del paciente en cuidados intensivos permitirá identificar aquellos que requieren reintervención urgente y corregir la alteración fisiológica de los restantes para su reoperación programada y manejo definitivo.

Damage control surgery in lung trauma / Cirugía de control de daños del trauma pulmonar

Abstract Damage control techniques applied to the management of thoracic injuries have evolved over the last 15 years. Despite the limited number of publications, information is sufficient to scatter some fears and establish management principles. The severity of the anatomical injury justifies the procedure of damage control in only few selected cases. In most cases, the magnitude of the physiological derangement and the presence of other sources of bleeding within the thoracic cavity or in other body compartments constitutes the indication for the abbreviated procedure. The classification of lung injuries as peripheral, transfixing, and central or multiple, provides a guideline for the transient bleeding control and for the definitive management of the injury: pneumorraphy, wedge resection, tractotomy or anatomical resection, respectively. Identification of specific patterns such as the need for resuscitative thoracotomy, or aortic occlusion, the existence of massive hemothorax, a central lung injury, a tracheobronchial injury, a major vascular injury, multiple bleeding sites as well as the recognition of hypothermia, acidosis or coagulopathy, constitute the indication for a damage control thoracotomy. In these cases, the surgeon executes an abbreviated procedure with packing of the bleeding surfaces, primary management with packing of some selected peripheral or transfixing lung injuries, and the postponement of lung resection, clamping of the pulmonary hilum in the most selective way possible. The abbreviation of the thoracotomy closure is achieved by suturing the skin over the wound packed, or by installing a vacuum system. The management of the patient in the intensive care unit will allow identification of those who require urgent reintervention and the correction of the physiological derangement in the remaining patients for their scheduled reintervention and definitive management.

Resumen Las técnicas de control de daños aplicadas al manejo de lesiones torácicas han evolucionado en los últimos 15 años. A pesar de que el número de publicaciones es limitado, la información es suficiente para desvirtuar algunos temores y establecer los principios de manejo. La severidad del compromiso anatómico justifica el procedimiento de control de daños solamente en algunos casos. En la mayoría, la magnitud del deterioro fisiológico y la presencia de otras fuentes de sangrado dentro del tórax o en otros compartimientos corporales constituyen la indicación del procedimiento abreviado. La clasificación de la lesión pulmonar como periférica, transfixiante y central o múltiple, proporciona una pauta para el control transitorio del sangrado y para el manejo definitivo de la lesión: neumorrafía, resección en cuña, tractotomía o resecciones anatómicas, respectivamente. La identificación de ciertos patrones como la necesidad de toracotomía de reanimación o de oclusión aórtica, la existencia de un hemotórax masivo, de una lesión pulmonar central, una lesión traqueobronquial o una lesión vascular mayor, así como el reconocimiento de hipotermia, acidosis o coagulopatía, constituyen la indicación de una toracotomía de control de daños. En estos casos, el cirujano concluye de manera abreviada los procedimientos con empaquetamiento de las superficies sangrantes, el manejo primario con empaquetamiento de algunas lesiones pulmonares periféricas o transfixiante seleccionadas y el aplazamiento de la resección pulmonar, pinzando el hilio de la manera más selectiva posible. La abreviación del cierre de la toracotomía se logra con la sutura de la piel sobre el empaquetamiento de la herida, o mediante la instalación de un sistema de presión negativa. El manejo del paciente en cuidados intensivos permitirá identificar aquellos que requieren reintervención urgente y corregir la alteración fisiológica de los restantes para su reoperación programada y manejo definitivo.

Comparison of working equid welfare across three regions of Mexico.

BACKGROUND: Factors affecting working equid welfare are wide-ranging and reflect cultural, economic and climatic conditions, the type of work equids are used for, and individual differences in the practices of their handlers. In Mexico working equids are widely used for facilitating agricultural activities, however, welfare issues are common. OBJECTIVES: To assess working equids across three communities in Mexico, identify predominant welfare problems and document how these problems vary across locations, associated working roles and species type. STUDY DESIGN: Cross-sectional survey. METHODS: The study combined the administration of a wide-ranging questionnaire to equid handlers/owners and a welfare assessment of their animal. 120 equid owners were asked about their equid management practices, the working conditions and health status of their animal. The welfare of their equids (56 donkeys, 7 mules, 57 horses) was assessed by evaluating body condition, signs of illness or injury and behavioural indicators. RESULTS: Welfare varied by species, working role, sex and location. The poorest welfare was seen in one of the two arid regions (the third location having a tropical climate). Donkeys had poorer welfare than horses, and equids used for packing had poorer welfare than those used for riding and agroforestry. Overall poor body condition and wounds were the most common problems seen. MAIN LIMITATIONS: Work type, species type and location strongly co-varied, thus the impact of each factor could not be assessed in isolation. The sample size was relatively small. CONCLUSIONS: Results showed significant regional variations in welfare, suggesting that environmental and/or cultural variations are producing a major effect on welfare.

Evaluación de carga física en los procesos de empacado de fruta en empresas de la provincia de río negro en la patagonia, argentina

Introducción. Este estudio observacional de corte transversal describió el análisis realizado con una población de ocho operarios, para valorar la exposición a carga física de los trabajadores de la actividad de empaque de fruta en la provincia de Río Negro, Argentina. Métodos. El análisis que se efectuó con los métodos manuales RULA y Check List OCRA, favoreció la evaluación de la exposición a factores de riesgo que pueden ocasionar trastornos en miembros superiores. Resultados. La carga física en las actividades de selección y empaque de fruta alcanzan niveles críticos en movimientos y esfuerzos, están relacionados con más de 15 enfermedades de acuerdo con la OIT y la legislación argentina. Para disminuir el nivel de riesgo, se recomendaron tiempos de descanso, rotación de personal, apoyos corporales adecuados, entre otros. Conclusión. Se recomienda evaluar el proceso de manera sistémica para proponer una intervención integral que mejore el bienestar de los operarios.

Introduction. This cross-sectional observational study described the analysis carried out with a population of eight operators to assess the exposure of fruit packing workers to a physical load in the Rio Negro province, Argentina. Materials and methods. The analysis carried out with the RULA and OCRA Checklist manual methods favored assessing exposure to risk factors that can cause upper limb disorders. Results. According to the ILO and Argentine legislation, the physical load in the fruit selection and packing activities reaches critical levels in movements and efforts; they are related to more than 15 diseases. Breaks, staff rotation, adequate body support, among others, are recommended to reduce the level of risk. Conclusion. It is advisable to assess the process systemically to propose a comprehensive intervention that improves the operators' well-being.

Dilemas na implementação da Convenção-Quadro para o Controle do Tabaco da Organização Mundial da Saúde / Dilemas en la implementación del Convenio Marco para el Control del Tabaco de la Organización Mundial de la Salud / Dilemmas in the implementation of the World Health Organization Framework Convention on Tobacco Control

O artigo analisa alguns dilemas relacionados à implementação da Convenção-Quadro para o Controle do Tabaco, destacando as dificuldades dos Estados participantes para adotar políticas públicas, com custo-benefício comprovado, que visam à redução da oferta e demanda do tabaco. Especificamente, o artigo examina a recomendação para a adoção de políticas de padronização das embalagens de cigarro, presente nas diretrizes para a implementação dos Artigos 11 e 13 da Convenção. Por meio da análise de casos, identificamos fatores políticos e jurídicos que dificultam a implementação da Convenção, incluindo a inibição regulatória produzida pela abertura de litígios por parte da indústria do tabaco, que utiliza-se das cláusulas de arbitragem investidor-Estado existentes em acordos bilaterais de investimentos. Conclui-se que, apesar dos custos impostos aos Estados e dos atrasos na adoção dessas políticas, no médio ou longo prazo, as decisões proferidas pelos tribunais arbitrais e pelo Órgão de Solução de Controvérsias da Organização Mundial do Comércio podem consolidar o entendimento acerca da legalidade e efetividade de políticas que adotam o referido modelo.

El artículo analiza algunos dilemas relacionados con la implementación del Convenio Marco para el Control del Tabaco, destacando las dificultades de los Estados participantes para adoptar políticas públicas, con coste-beneficio comprobado, que tienen como objetivo la reducción de la oferta y demanda del tabaco. Específicamente, el artículo examina la recomendación para la adopción de políticas de estandarización de los paquetes de cigarrillos, presente en las directrices para la implementación de los Artículos 11 y 13 del Convenio. Mediante el análisis de casos, identificamos factores políticos y jurídicos que dificultan la implementación del Convenio, incluyendo la inhibición regulatoria, producida por la apertura de litigios por parte de la industria del tabaco, que recurre a cláusulas de arbitraje inversor-Estado, existentes en acuerdos bilaterales de inversión. Se concluye que, a pesar de los costes impuestos a los Estados, y de los atrasos en la adopción de esas políticas, en el medio o largo plazo, las decisiones proferidas por los tribunales arbitrales y por el Órgano de Solución de Diferencias de la Organización Mundial del Comercio pueden consolidar el entendimiento acerca de la legalidad y efectividad de políticas que adoptan el referido modelo.

The article analyzes some dilemmas related to the implementation of the Framework Convention on Tobacco Control, underscoring the States parties' difficulties in adopting public policies with proven cost-benefit and aimed at reducing tobacco's supply and demand. Specifically, the article examines the recommendation to adopt policies for plain cigarette packaging, as provided in the guidelines for implementation of the Convention's Articles 11 and 13. Based on case analysis, we identified political and legal factors that hinder the Convention's implementation, including the regulatory chill produced by legal claims filed by the tobacco industry, which uses investor-State arbitration clauses from bilateral investment agreements. The article concludes that despite the costs imposed on States and the delays in the adoption of such policies, in the medium and long term the rulings handed down by the arbitration courts and the World Trade Organization's Dispute Settlement Body can consolidate the understanding of the legality and effectiveness of policies that adopt the model.

Evaluación de carga física en los procesos de empacado de fruta en empresas de la Provincia de Rio Negro en la Patagonia Argentina / Evaluation of physical load in fruit packing processes in companies of the Province of Rio Negro in Patagonia, Argentina / Avaliação da carga física nos processos de embalagem de frutas em empresas da Província de Rio Negro, na Patagônia Argentina

Introducción. Este estudio observacional de corte transversal, describió el análisis realizado con una población de 8 operarios, para valorar la exposición a carga física de los trabajadores de la actividad de empaque de fruta en la provincia de en Rio Negro­Argentina. Métodos. El análisis que se efectúo con los métodos manuales RULA y Check List OCRA, favoreció la evaluación de la exposición a factores de riesgo que pueden ocasionar trastornos en miembros superiores. Resultados. La carga física en las actividades de selección y empaque de fruta alcanzan niveles críticos en movimientos y esfuerzos, están relacionados con más de 15 enfermedades de acuerdo con la OIT y legislación argentina. Para disminuir el nivel de riesgo se recomendaron tiempos de descanso, rotación de personal, apoyos corporales adecuados entre otros. Conclusión. Se recomienda evaluar el proceso de manera sistémica, para proponer una intervención integral que mejore el bienestar de los operarios

Introduction. This cross-sectional observational study described the analysis carried out with a population of 8 workers, to assess the exposure to physical load of workers in the fruit packing activity in the province of Rio Negro-Argentina. Methods. The analysis carried out with the manual methods RULA and Check List OCRA, favored the evaluation of the exposure to risk factors that can cause upper limb disorders. Results. The physical load in fruit sorting and packing activities reaches critical levels in movements and efforts, which are related to more than 15 diseases according to ILO and Argentinean legislation. In order to reduce the level of risk, rest times, personnel rotation, adequate body support, among others, were recommended. Conclusion. It is recommended to evaluate the process in a systemic way, in order to propose an integral intervention to improve the well-being of the workers.

Introdução. Este estudo observacional transversal descreveu a análise realizada com uma população de 8 trabalhadores, para avaliar a exposição à carga física de trabalhadores na atividade de embalagem de frutas na província de Rio Negro-Argentina. Métodos. A análise realizada com os métodos manuais RULA e Check List OCRA, favoreceu a avaliação da exposição a fatores de risco que podem causar distúrbios nos membros superiores. Resultados. A carga física nas atividades de seleção e embalagem de frutas atinge níveis críticos em movimentos e esforços, que estão relacionados a mais de 15 doenças segundo a OIT e a legislação argentina. Para reduzir o nível de risco, foram recomendados tempos de descanso, rotação de pessoal, apoio corporal adequado, entre outros. Conclusões. Recomenda-se avaliar o processo de forma sistémica, a fim de propor uma intervenção integral para melhorar o bem-estar dos trabalhadores.