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Una panorámica ambiental del Gran Caribe, tema pocas veces explorado por las ciencias de la región, una revisión histórica de las relaciones entre sociedad y naturaleza en el Caribe colombiano, y un caso subregional de relaciones entre la sociedad y la naturaleza y de adaptación de la comunidad ribereña del río Magdalena, representado en la figura del Hombre Caimán, son los temas que el profesor Germán Márquez aborda en este volumen. Tres artículos fueron preparados a petición del Museo del Caribe, proyecto bandera de la Corporación Parque Cultural del Caribe, y sirvieron de base para la construcción del guión museológico de la exposición inaugural del nuevo ente cultural. Hoy se entregan al público lector de la región Caribe colombiana y a su comunidad académica, en un esfuerzo conjunto entre el Instituto de Estudios Caribeños de la Universidad Nacional de Colombia y el Parque Cultural del Caribe. Son tres las escalas que se trabajan en estos textos. En “Una perspectiva ecológica y ambiental del Gran Caribe”, la mirada es macroregional; en “Ecosistemas y sociedad en el Caribe colombiano” y en “Notas para una historia ambiental del Caribe colombiano” se privilegia una mirada sobre los ecosistemas de la región y las realidades sociales y económicas que en ellos se presentan, incluida una perspectiva histórica; y en “El hábitat del Hombre Caimán: ecología y cultura en las planicies inundables del Caribe colombiano”, se obtiene una visión directa de las formas que puede llegar a adquirir la relación de los seres humanos con su entorno inmediato. Estamos seguros de que este material será una referencia obligada en el campo de los estudios ambientales del Gran Caribe y el Caribe colombiano, y esperamos contribuir con él a la divulgación del conocimiento y a su apropiación por parte de la sociedad civil regional. A través del conjunto de ensayos que conforman este libro se obtiene un punto de vista muy original y documentado, macroregional y localizado al mismo tiempo, sobre esa interrelación profunda que moldea las realidades ambientales del Caribe. En el escenario de una naturaleza pródiga cuyos ciclos naturales generan unas condiciones de abundancia biológica realmente extraordinarias, el autor describe la triste paradoja de escasez y devastación que ocasionan el desconocimiento, la voracidad y la inequidad social. Este libro, desde su rigurosa perspectiva científica y su acendrado humanismo, ofrece claves y visiones para restituir y armonizar los intercambios entre el medio ambiente y la gente del Caribe en Colombia. Estamos seguros de que este material será una referencia obligada en el campo de los estudios ambientales del Gran Caribe y del Caribe colombiano y esperamos contribuir con el a la divulgación del conocimiento y a su apropiación por parte de la sociedad civil regional.

The effect of the environment on the vital cycle of amphibians has been shown in diverse studies, indicating that diet and temperature affect the duration of the larval period, and the size of the newly metamorphosed. We analyzed the effect of temperature and quality of diet on the duration of the larval period and size reached by larvae up until metamorphosis in the species Pleurodema thaul. We used an experimental design with two temperatures (15 ºC and 25 ºC) and two types of diet, one rich in proteins (RP) and one low in proteins (LP). We evaluated body size (cm) and body mass (g), and staged the larval development according to Gosner (1960). Our results indicate that temperature is crucial for the larval development, affecting its duration, whereas diet has a secondary effect on size and mass of larvae, always depending on the temperature of development.

Diabetes mellitus occurs in nearly 10% of patients with acromegaly and is secondary to insulin resistance caused by high levels of growth hormone. Diabetes ketoacidosis has been described as a rare complication of acromegaly, resulting from a relative insulin deficiency caused by growth hormone excess. We described the case of a 38 year-old man who presented to the emergency room with a 6-week history of polydipsia, polyuria, polyphagia and weight loss. He also had nausea, vomiting and abdominal pain from two days before admission. His plasma glucose level was 880 mg/dl, plasma osmolarity 368 mOsm/l, arterial pH 7.06 and serum bicarbonate 8.6 mEq/l. At the clinical examination, he had features of acromegaly. Magnetic resonance imaging showed a pituitary macro adenoma and growth hormone dosages were abnormally high. After tumor removal, plasma glucose levels became normal. This case shows the rare association between diabetic ketoacidosis and acromegaly. Surgery, in this case, was the definite modality of treatment.

Objective: To determine whether localization and size are related to the presence of high-grade dysplasia of colon adenomas in patients of a Peruvian hospital., Materials and Methods: This is a descriptive transversal study. We checked colonoscopyreports of 2014-2015 years of Hospital Daniel Alcides Carrion, we included the polyps found in patients older than 18 years old, and excluded reports from patients with colorectal cancer, an antecedent of oncological surgery, inflammatory bowel disease and polyposis (6 or more). We used data based on localization (proximal and distal colon, based on the splenic angle), size (less than 10 mm and 10 mm or more), shape (pediculate and sessile) and grade of dysplasia (low and high-grade). We calculated the strength of association by OR, and we determined whether there was association by Chi-square test with a significance value less than 0.05., Results: We reviewed a total of 1710 of colonoscopy reports, 378 patients had polyps, so the adenoma detection rate was 22.1%. There were 458 polyps, from which 254 were adenomas. From these adenomas, we found an association between distal colon localization and high-grade dysplasia (OR 2.68 IC 1.12-6.42, p < 0.05); likewise, there was an association between the size of the adenomas and high-grade dysplasia (OR 7.75 IC 3.05-19.69, p<0.05). We did not find any association between the shape and grade of dysplasia., Conclusion: This study concludes that there is an association between the size of 10 mm or more and localization in the distal colon with high-grade dysplasia of adenomas.

We prospectively studied 60 consecutive patients in order to evaluate the prevalence of vitamin D deficiency. All of them were inpatients, and were evaluated from October 2013 through May 2014. Levels of 25 OH vitamin D were classified as sufficient (> 30 ng/ml), mild to moderate deficiency (15 to 30 ng/ml) and severe deficiency (< 15 ng/ml). The mean age was 72.1 ± 19.5 years; 43 were females and 17 males. Five percent of the patients had normal values of vitamin D, 31.6% had mild to moderate deficit and 63.3% had severe deficit of the vitamin. Severe deficit was associated with hypoalbuminemia, compared with mild to moderate deficit and with sufficient values (2.98 g/dl vs. 3.52 g/dl and vs. 4.39 g/dl, respectively, p: 0.012) and low levels of serum calcium (8.35 mg/dl vs. 8.61 mg/dl and 9.8 mg/dl, respectively, p: 0.003). Although there was a trend of low vitamin D levels with increasing age, female sex, immobilization, higher levels of glucose and glycated haemoglobin, more duration of hospitalization, we didn't find any statistically significance difference between groups. Vitamin D deficiency is common in hospitalized patients. It correlates with low levels of serum albumin and calcium. Improving diagnosis and recognition of this condition may enable us to improve the management of this deficit.

Achromobacter xylosoxidans is a rare cause of bacteremia, and little information on treatment is available. The majority of patients who have developed Achromobacter bacteremia have presented predisposing causes to the infection. A case of community-acquired pneumonia and bacteremia due to A. xylosoxidans in a previously healthy patient is reported. Achromobacter is usually resistant to ampicillin, cephalosporins (1st, 2nd, and 3rd generation), aminoglycosides, and fluoroquinolones. Piperacillin, piperacillin-tazobactam, and trimethoprim-sulfamethoxazole inhibit most isolates.

Unlabelled: Despite worldwide recommendations, the screening for colorectal cancer (CRC) is not routinely performed in our country. Consequently, we conducted a pilot study to evaluate an immunological fecal occult blood test (FOBT)., Methods: We studied 332 average-risk patients (age over 50 years, asymptomatic, with no personal or family history of CRC) who consulted primary care-generalists from Buenos Aires. They were randomly assigned to screening with one (group I) or three (group II) samples of FOBT (OC-Hemodia). Colonoscopy and/or barium enema and upper gastrointestinal endoscopy were indicated to patients with one or more positive samples., Results: 141 of 162 patients in group I (87.0%) and 142 of 170 patients in group II (83.5%) returned samples (NS). Three of 162 patients were tested positive in group I (1.8%) and 15 of 170 in group II (8.8%) (P = 0.005), with a global positivity of 5.4%. The colon was examined in 14 patients (77.8%) and 4 did not attend after repeated calls. Colonic study showed: CRC 1, adenomatous polyps 3, adenomatous polyps and hemorrhoids 1, diverticula 5, hemorrhoids 1, normal 2, intolerance 1. Upper endoscopy was performed in 9 patients: erosive gastritis 4, duodenal ulcer 1, normal 4. Both studies were normal in only 1 patient., Conclusions: 1) Immunological FOBT had a good compliance and an adequate positivity rate to be used in the screening for CRC. 2) Despite the use of an immunological test three samples are required to improve results. 3) Upper and lower gastrointestinal lesions, including CRC and polyps, were detected in almost all patients who were examined. 4) Our data justify the use of FOBT in wider population studies to assess its efficacy in the prevention of CRC.

Trichobezoars are rare medical entities that must be considered in the differential diagnosis of patients with abdominal mass. We describe a case of an unsuspected intestinal trichobezoar in a nine years old girl. The patient presented an acute lower abdominal pain. We found an echogenic abdominal mass in the pelvic sonography. A double contrast barium enema was scheduled and a rapid relief of symptoms during the preparation of it was accomplished with the expulsion of a mass of hair.

We report a case of an esophagic squamous papilloma (SP) in a 90 year old patient. This pathology is benign and its diagnosis is generally a finding during an upper digestive endoscopy. Only 150 cases have been reported in the world's medical literature. Treatment consists in an endoscopic resection with diathermic snare or a conservative approach with periodical endoscopic control and observation depending of the type of patient.

A direct 2 stage enzymatic test and the direct anti gamma globulin test were used to predict hemolytic disease of the newborn. Maternal allo-antibodies were determined in cord blood of all newborns from April to June 1988. 0.25% bromelase was used for the 2 Stage Enzymatic Test and a polyspecific anti-gammaglobulin serum was used for the Anti Gamma Globulin Test. Of 618 newborns 97 had parental ABO heterospecificity. Maternal allo-antibodies were present in 20 cases (3.2%). 20 of 86 fullterm newborns developed jaundice presumably due to ABO incompatibility. Blood exchange was required in 6, while phototherapy was sufficient in the rest. The 2 Stage Enzymatic Test was positive in 20 of these cases and the Anti Gamma Globulin Test was positive in 10. Thus, these tests may be used to predict hemolytic disease of the newborn due to ABO incompatibility.

Desmoid tumors are rare, less than 0.1% of all tumors (6.2%). The word desmoid has been recognized since 1838, and applied to non-encapsulated tumors, of connective origin and locally infiltrative. Generally, their course is painless and the recurrence rate is high if resection has not been complete. Most of these tumors can be found in different anatomic areas, most commonly the anterior abdominal wall although other sites, intra- or extra-abdominal, have been reported. We describe the case of a 50 year old female patient, with abdominal pain caused by an intraabdominal desmoid tumor.

A 46-year-old woman presented with abdominal pain, nausea vomiting and abdominal distention. Small bowel x-rays and CT scan of the abdomen revealed small bowel obstruction due to malignant melanoma. The diagnosis of cutaneous melanoma was performed 8 years prior to admission on one lesion in the back. Patient received surgical treatment. Completed resection of an involved jejunal [correction of ileal] segment was performed. Three tumor masses were found at laparotomy. Metastasis from malignant melanoma at the gastrointestinal tract occurs frequently though rarely are these intestinal lesions symptomatic. The efficacy of surgical treatment for symptomatic metastatic melanoma is justified to relief symptoms and prolonged survival.