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Background and aimsDespite enteral nutrition (EN) is the preferred route of nutrition in patients with critical illness, EN is not always able to provide optimal nutrient provision and parenteral nutrition (PN) is needed. This is strongly associated with gastrointestinal (GI) complications, a feature of gastrointestinal dysfunction and disease severity. The aim of the present study was to investigate factors associated with the need of PN after start of EN, together with the use and complications associated with EN.MethodsAdult patients admitted to 38 Spanish intensive care units (ICUs) between April and July 2018, who needed EN therapy were included in a prospective observational study. The characteristics of EN-treated patients and those who required PN after start EN were analyzed (i.e., clinical, laboratory and scores).ResultsOf a total of 443 patients, 43 (9.7%) received PN. One-third (29.3%) of patients presented GI complications, which were more frequent among those needing PN (26% vs. 60%, p = 0.001). No differences regarding mean energy and protein delivery were found between patients treated only with EN (n = 400) and those needing supplementary or total PN (n = 43). Abnormalities in lipid profile, blood proteins, and inflammatory markers, such as C-Reactive Protein, were shown in those patients needing PN. Sequential Organ Failure Assessment (SOFA) on ICU admission (Hazard ratio [HR]:1.161, 95% confidence interval [CI]:1.053–1.281, p = 0.003) and modified Nutrition Risk in Critically Ill (mNUTRIC) score (HR:1.311, 95% CI:1.098–1.565, p = 0.003) were higher among those who needed PN. In the multivariate analysis, higher SOFA score (HR:1.221, 95% CI:1.057–1.410, p = 0.007) and higher triglyceride levels on ICU admission (HR:1.004, 95% CI:1.001–1.007, p = 0.003) were associated with an increased risk for the need of PN, whereas higher albumin levels on ICU admission (HR:0.424, 95% CI:0.210–0.687, p = 0.016) was associated with lower need of PN.ConclusionA higher SOFA and nutrition-related laboratory parameters on ICU admission may be associated with the need of PN after starting EN therapy. This may be related with a higher occurrence of GI complications, a feature of GI dysfunction.Clinical trial registrationClinicalTrials.gov: NCT03634943.

We present a new altitudinal record for Salta Toad, Rhinella rumbolli (Carrizo, 1992). This species is recorded in northern Argentina and southern Bolivia from 700 to 1800 m a.s.l. Our new record comes from San Lorencito, Méndez Province, Tarija Department, Bolivia, and extends the altitudinal range by 569 m a.s.l.

Resumen: La presencia de una pieza de metal en el extremo de los catéteres autoposicionantes provoca dudas e incertidumbres a la hora de realizar una resonancia magnética (RM) a pacientes que portan este tipo de catéter.Simulamos un peritoneo con un catéter lastrado para comprobar el comportamiento del catéter durante la realización de una resonancia en equipos 1,5 T y 3 T. Y revisamos los casos en los que se realizaron RM en pacientes con este tipo de catéter.En la simulación, la punta del catéter peritoneal autoposicionante provoca un artefacto de susceptibilidad magnética que dificulta la visión de zonas cercanas, pero se comporta como dispositivo seguro para la RM. Se realizaron 14 RM en pacientes con catéteres autoposicionantes, ninguna en la zona abdominal. No hubo complicaciones en los pacientes ni en la técnica tras la realización de RM. Abstract: The fact that self-locating catheters have a piece of metal at the tip leads to doubt and uncertainty around performing magnetic resonance imaging (MRI) in patients with this type of catheter.We simulated a peritoneum with a weighted catheter to ascertain how the catheter behaved during MRI scans in 1.5 T and 3 T machines. We also reviewed cases in which MRI had been performed in patients with this type of catheter.In the simulation, the tip of the self-locating peritoneal catheter caused a magnetic susceptibility artefact that made it difficult to see nearby areas, but it proved to be a safe device for MRI. 14 MRI scans were performed in patients with self-locating catheters, none in the abdominal area. There were no complications in the patients or the technique after performing MRI.

The fact that self-locating catheters have a piece of metal at the tip leads to doubt and uncertainty around performing magnetic resonance imaging (MRI) in patients with this type of catheter.We simulated a peritoneum with a weighted catheter to ascertain how the catheter behaved during MRI scans in 1.5 T and 3 T machines. We also reviewed cases in which MRI had been performed in patients with this type of catheter.In the simulation, the tip of the self-locating peritoneal catheter caused a magnetic susceptibility artefact that made it difficult to see nearby areas, but it proved to be a safe device for MRI. 14 MRI scans were performed in patients with self-locating catheters, none in the abdominal area. There were no complications in the patients or the technique after performing MRI. Resumen: La presencia de una pieza de metal en el extremo de los catéteres autoposicionantes provoca dudas e incertidumbres a la hora de realizar una resonancia magnética (RM) a pacientes que portan este tipo de catéter.Simulamos un peritoneo con un catéter lastrado para comprobar el comportamiento del catéter durante la realización de una resonancia en equipos 1,5 T y 3 T. Y revisamos los casos en los que se realizaron RM en pacientes con este tipo de catéter.En la simulación, la punta del catéter peritoneal autoposicionante provoca un artefacto de susceptibilidad magnética que dificulta la visión de zonas cercanas, pero se comporta como dispositivo seguro para la RM. Se realizaron 14 RM en pacientes con catéteres autoposicionantes, ninguna en la zona abdominal. No hubo complicaciones en los pacientes ni en la técnica tras la realización de RM.

Las grandes ciudades colombianas enfrentan el comienzo del siglo XXI con una preocupación adicional en sus posibilidades de desarrollo y habitabilidad: la movilidad. Éste término, fácilmente asociado con la manera como vehículos y personas fluyen por las distintas opciones que brindan las infraestructuras de transporte urbano, tiene mucho más trasfondo e involucra el estudio de la forma como nuestras ciudades se han ido materializando en el tiempo. Las universidades de San Buenaventura y de Medellín, en la ciudad de Medellín, Colombia, han coincidido en el abordaje común del problema de la movilidad y su efecto en las formas de ocupación del territorio en esa ciudad mediante una investigación. El presente artículo ofrece los resultados de dicha investigación para lo cual asume una postura conceptual frente al término "movilidad", relaciona la movilidad con la ocupación de Medellín por medio de variables clave y álgebra de mapas y establece como conclusión algunas orientaciones para ser consideradas en la planeación del espacio. Se encuentra que algunos aspectos de la vida de la ciudad, como su densidad, decisiones de compra de vivienda, opciones de transporte y planificación territorial tienen diferentes consecuencias en la movilidad y permiten ofrecer soluciones.As grandes cidades colombianas enfrentam o início do século XXI com uma preocupação adicional nas suas possibilidades de desenvolvimento e habitabilidade: a mobilidade. Este termo, facilmente associado com a maneira como veículos e pessoas fluem pelas diferentes opções que brindam as infraestruturas de transporte urbano, tem muito mais fundo e envolve o estudo da forma como nossas cidades se foram materializando no tempo. As Universidades de San Buenaventura e de Medellín, na cidade de Medellín, na Colômbia, coincidiram na abordagem comum do problema da mobilidade e seu efeito nas formas de ocupação do território nessa cidade mediante uma pesquisa. O presente artigo oferece os resultados de dita pesquisa para o qual assume uma postura conceptual frente ao termo "mobilidade", relaciona a mobilidade com a ocupação de Medellín por meio de variáveis código e álgebra de mapas e estabelece como conclusão algumas orientações para ser consideradas na planificação do espaço. Encontra-se que alguns aspectos da vida da cidade, como sua densidade, decisões de compra de moradia, opções de transporte e planejamento territorial têm diferentes consequências na mobilidade e permitem oferecer soluções.Major Colombian cities face the beginning of the 21st century with an additional concern in their possibilities for development, sustainability, and inhabitability: urban mobility. This term, easily associated with the way vehicles and individuals flow through the different urban transport infrastructure options, has more background and involves the study of how these cities have materialized in time. It implies, therefore, a broader reading that must be established from a different frame of knowledge. Universidad de San Buenaventura and Universidad de Medellín, in the city of Medellín, Colombia, have coincided in studying the mobility problem and their effect on the territorial occupation of that city. The present paper offers the results of the above mentioned research for which assumes a conceptual position about the term "mobility", it relates the mobility to the occupation of Medellin by means of key variables and map algebra and establishes as conclusion some directions to be considered in the planning of the space. We found that several aspects of city life, like occupation density, property purchase decisions, transportation options, and territorial planning have different consequences on mobility and allow offering solutions.

We describe the Genetic Counseling as the translation of the hereditary cancer knowledge to the clinical practice. Genetic counseling is a process for information, which takes place at the Genetic Counseling Units, where individual cancer risk and mutation risk are estimated, genetic tests are performed authorized through the Informed Consent Document, the genetic test?s results are discussed, and screening and risk reducing strategies are recommended. The genetic test is offered when there is a suitable gene for the study, with meaningful results for the diagnosis of the hereditay syndrome and for the medical and surgical management of individuals at risk. It is essential that the genetic test be done within the Genetic Counseling before and after the test.