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Hexane is the most widely solvent used in the lipids extraction process, as the case of the sugarcane wax. However, the use of this solvent is highly harmful to the environment and to human health. Limonene is a monoterpene found in the citrus peel, with great potential for use as a green solvent. In this study, the partial and total substitution of hexane by limonene was performed in the process of the sugarcane peel wax extraction to evaluate the effect of this substitution on the physicochemical characteristics of the wax. The extracted samples were compared with a commercial wax sample (carnauba) using the Thermogravimetric Analysis (TGA), Differential Scanning Calorimetry (DSC) and Infrared by Fourier Transform (FTIR) analyses. Through this study, we can conclude that the waxes obtained from the use of the hexane and limonene mixture solvents presented similar physicochemical characteristics to those found in commercial waxes. Thus, the total and/or partial substitution of the hexane by solvents less harmful to health and the environment, such as limonene, can be an alternative in the wax extraction process. Hexane is the most widely solvent used in the lipids extraction process, as the case of the sugarcane wax. However, the use of this solvent is highly harmful to the environment and to human health. Limonene is a monoterpene found in the citrus peel, with great potential for use as a green solvent. In this study, the partial and total substitution of hexane by limonene was performed in the process of the sugarcane peel wax extraction to evaluate the effect of this substitution on the physicochemical characteristics of the wax. The extracted samples were compared with a commercial wax sample (carnauba) using the Thermogravimetric Analysis (TGA), Differential Scanning Calorimetry (DSC) and Infrared by Fourier Transform (FTIR) analyses. Through this study, we can conclude that the waxes obtained from the use of the hexane and limonene mixture solvents presented similar physicochemical characteristics to those found in commercial waxes. Thus, the total and/or partial substitution of the hexane by solvents less harmful to health and the environment, such as limonene, can be an alternative in the wax extraction process.

Coronavirus disease (COVID-19) serology testing evaluates the prevalence of COVID-19 cases.A seroepidemiological survey of COVID-19 among healthcare workers was performed (June 2020 to November 2020) in Ribeirão Preto, São Paulo, Brazil. Overall, 10,172 and 2,129 workers participated in the first and second phases, respectively.First phase: 12.7% tested positive for COVID-19 (73.5% females and 35.2% aged 30-39 years), and 29.6% were nursing technicians. Second phase: 12.1% tested positive for COVID-19 (65.5% females and 33.3% aged 40-49 years), and 24.8% were nursing assistants.In 2020, healthcare workers in Ribeirão Preto had COVID-19 in a similar way.

Background: It has been suggested that patients with a Body Mass Index (BMI) of > 60 kg/m2 should be offered expedited Bariatric Surgery (BS) during the Coronavirus Disease-2019 (COVID-19) pandemic. The main objective of this study was to assess the safety of this approach. Methods: We conducted a global study of patients who underwent BS between 1/05/2020 and 31/10/2020. Patients were divided into three groups according to their preoperative BMI - Group I (BMI60 kg/m2). The effect of preoperative BMI on 30-day morbidity and mortality, procedure choice, COVID-19 specific safety protocols, and comorbidities was assessed. Results: This study included 7084 patients (5197;73.4 % females). The mean preoperative weight and BMI were 119.49 ± 24.4 Kgs and 43.03 ± 6.9 Kg/m2, respectively. Group I included 6024 (85 %) patients, whereas Groups II and III included 905 (13 %) and 155 (2 %) patients, respectively. The 30-day mortality rate was higher in Group III (p = 0.001). The complication rate and COVID-19 infection were not different. Comorbidities were significantly more likely in Group III (p = 70 kg/m2 had a 30-day mortality of 7.7 % (2/26). None of these patients underwent a Roux-en-Y Gastric Bypass. Conclusion: The 30-day mortality rate was significantly higher in patients with BMI > 60 kg/m2. There was, however, no significant difference in complications rates in different BMI groups, probably due to differences in procedure selection.

Background Age ≥ 65 years is regarded as a relative contraindication for bariatric surgery. Advanced age is also a recognised risk factor for adverse outcomes with Coronavirus Disease-2019 (COVID-19) which continues to wreak havoc on global populations. This study aimed to assess the safety of bariatric surgery (BS) in this particular age group during the COVID-19 pandemic in comparison with the younger cohort. Methods We conducted a prospective international study of patients who underwent BS between 1/05/2020 and 31/10/2020. Patients were divided into two groups — patients ≥ 65-years-old (Group I) and patients < 65-years-old (Group II). The two groups were compared for 30-day morbidity and mortality. Results There were 149 patients in Group 1 and 6923 patients in Group II. The mean age, preoperative weight, and BMI were 67.6 ± 2.5 years, 119.5 ± 24.5 kg, and 43 ± 7 in Group I and 39.8 ± 11.3 years, 117.7±20.4 kg, and 43.7 ± 7 in Group II, respectively. Approximately, 95% of patients in Group 1 had at least one co-morbidity compared to 68% of patients in Group 2 (p = < 0.001). The 30-day morbidity was significantly higher in Group I (11.4%) compared to Group II (6.6%) (p = 0.022). However, the 30-day mortality and COVID-19 infection rates were not significantly different between the two groups. Conclusions Bariatric surgery during the COVID-19 pandemic is associated with a higher complication rate in those ≥ 65 years of age compared to those < 65 years old. However, the mortality and postoperative COVID-19 infection rates are not significantly different between the two groups. Graphical abstract

Brazil has experienced some of the highest numbers of COVID-19 cases and deaths globally and from May 2021 made Latin America a pandemic epicenter. Although SARS-CoV-2 established sustained transmission in Brazil early in the pandemic, important gaps remain in our understanding of virus transmission dynamics at the national scale. Here, we describe the genomic epidemiology of SARS-CoV-2 using near-full genomes sampled from 27 Brazilian states and a bordering country - Paraguay. We show that the early stage of the pandemic in Brazil was characterised by the co-circulation of multiple viral lineages, linked to multiple importations predominantly from Europe, and subsequently characterized by large local transmission clusters. As the epidemic progressed under an absence of effective restriction measures, there was a local emergence and onward international spread of Variants of Concern (VOC) and Variants Under Monitoring (VUM), including Gamma (P.1) and Zeta (P.2). In addition, we provide a preliminary genomic overview of the epidemic in Paraguay, showing evidence of importation from Brazil. These data reinforce the usefulness and need for the implementation of widespread genomic surveillance in South America as a toolkit for pandemic monitoring that provides a means to follow the real-time spread of emerging SARS-CoV-2 variants with possible implications for public health and immunization strategies.

Background Vancomycin is a prevalent cause of the severe hypersensitivity syndrome drug reaction with eosinophilia and systemic symptoms (DRESS), which leads to significant morbidity and mortality and commonly occurs in the setting of combination antibiotic therapy, affecting future treatment choices. Variations in HLA class I in particular have been associated with serious T cell–mediated adverse drug reactions, which has led to preventive screening strategies for some drugs. Objective We sought to determine whether variation in the HLA region is associated with vancomycin-induced DRESS. Methods Probable vancomycin-induced DRESS cases were matched 1:2 with tolerant control subjects based on sex, race, and age by using BioVU, Vanderbilt's deidentified electronic health record database. Associations between DRESS and carriage of HLA class I and II alleles were assessed by means of conditional logistic regression. An extended sample set from BioVU was used to conduct a time-to-event analysis of those exposed to vancomycin with and without the identified HLA risk allele. Results Twenty-three subjects met the inclusion criteria for vancomycin-associated DRESS. Nineteen (82.6%) of 23 cases carried HLA-A*32:01 compared with 0 (0%) of 46 of the matched vancomycin-tolerant control subjects (P = 1 × 10−8) and 6.3% of the BioVU population (n = 54,249, P = 2 × 10−16). Time-to-event analysis of DRESS development during vancomycin treatment among the HLA-A*32:01–positive group indicated that 19.2% had DRESS and did so within 4 weeks. Conclusions HLA-A*32:01 is strongly associated with vancomycin-induced DRESS in a population of predominantly European ancestry. HLA-A*32:01 testing could improve antibiotic safety, help implicate vancomycin as the causal drug, and preserve future treatment options with coadministered antibiotics.

This paper explores the presence of Spanish form of address vos in the university Spanish classroom discourse from the perspective of Language Management Theory. Under this model, language ...

La viscosidad es una propiedad clave en múltiples actividades de la ingeniería de procesos que van desde el diseño y la selección de equipos hasta su uso como índice de calidad. En este artículo se muestran diversas curvas de flujo y el procedimiento del tratamiento de datos para calcular la viscosidad de materiales líquidos de comportamiento no newtoniano, así como la curva de ajuste a modelos empíricos. Se presentan datos de alimentos fluidos, materiales de composición y estructura compleja, obtenidos en el laboratorio, los cuales se analizan de acuerdo con la respuesta que tienen al aplicar un esfuerzo de cizalla o una velocidad de cizalla. En cada caso se indica el instrumento, tipo de dispositivo, las condiciones de ensayo utilizadas y la forma de obtener los parámetros reológicos que definen la curva de flujo, así como la viscosidad correspondiente, incluyendo el significado de los parámetros de ajuste. Los ejemplos mostrados en este artículo sirven de base a cualquier usuario que desee reproducir o interpretar los datos obtenidos en un reómetro usando geometrías convencionales.

The basement of the Central Andes located in central-western Argentina (31º20′S - 69º22′W) is composed by the Cuyania and Chilenia terranes which were amalgamated to Gondwana in the Early-Mid Paleozoic. Between the Precordillera (Cuyania) and Frontal Cordillera (Chilenia) there are exposures of marine metasedimentary rocks associated with mafic rocks with an E-MORB chemical signature that represent the remnants of an extensional basin developed between both terranes. The stratigraphic features and the distribution of the Early-Mid Paleozoic units along the Western Precordillera were constrained by remote sensing techniques. This allowed us to identify two stages in the evolution of the sedimentary in-fill of the marine basin: an initial stage (Mid-Late Ordovician) marked by widespread extensional tectonics and a finning-upwards sequence interbedded with volcanic-plutonic mafic rocks; and a Late Ordovician?-Devonian where the sedimentation was characterized by the development of coarsening-upwards sequences with low participation of mafic rocks. Flattened parallel folds associated with pre-Andean thrusts have locally a top-to-the SW vergence. These pre-Andean (Late Devonian) structures are the relics of the Chanic orogen whose double vergence is the result of the control exerted by previous structures related to the ordovician rifting. This is constrained by the residual and regional magnetic anomalies which reflect an important correlation between deep and surface structures. We propose the inception of a subduction zone with an eastward polarity on the proto-Pacific margin of Gondwana as the responsible for the compressive geotectonic framework that led to the closure of the Western Precordillera basin during the Late Devonian and the development of the Chanic thick-skinned-dominated orogen. Fil: Ariza, Juan Pablo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - San Juan; Argentina. Universidad Nacional de San Juan. Facultad de Ciencias Exactas, Físicas y Naturales. Instituto Geofísico Sismológico Volponi; Argentina Fil: Boedo, Florencia Lucila. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Estudios Andinos "Don Pablo Groeber". Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Estudios Andinos "Don Pablo Groeber"; Argentina Fil: Sanchez, Marcos Ariel. Universidad Nacional de San Juan. Facultad de Ciencias Exactas, Físicas y Naturales. Instituto Geofísico Sismológico Volponi; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - San Juan; Argentina Fil: Christiansen, Rodolfo Omar. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - San Juan; Argentina. Universidad Nacional de San Juan. Facultad de Ciencias Exactas, Físicas y Naturales. Instituto Geofísico Sismológico Volponi; Argentina Fil: Perez Lujan, Sofia Beatriz. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - San Juan. Centro de Investigaciones de la Geosfera y Biosfera. Universidad Nacional de San Juan. Facultad de Ciencias Exactas Físicas y Naturales. Centro de Investigaciones de la Geosfera y Biosfera; Argentina Fil: Vujovich, Graciela Irene. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Estudios Andinos "Don Pablo Groeber". Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Estudios Andinos "Don Pablo Groeber"; Argentina Fil: Martínez, Myriam Patricia. Universidad Nacional de San Juan. Facultad de Ciencias Exactas, Físicas y Naturales. Instituto Geofísico Sismológico Volponi; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - San Juan; Argentina

In this research, emphasis is placed on the information and diagnostic phase of the physical environment for land-use planning (LUP). Our work is mainly focused on a land-planning case study of a tectonic depression, the Tulum Valley, which extends into the Pampean flat-slab segment. We propose the use of tectonic structures to define Environment Units (EUs) as necessary boundaries for the LUP. For this purpose, we have studied tectonic structures using geophysical methods and, subsequently, subjected multiple dimensions of the physical environment in the territory to an exhaustive analysis. Moreover, we have examined the influence of structural geology on water, soils, processes, materials and forms in the landscape. The study revealed the close and significant relationship between the different elements of the physical environment observable on the surface (shape, distribution, appearance, degree of development) and the tectonic structures, which supported the use of this criterion to define EUs. In order to test it, we applied the same methodology in another area of South America, the city of Bucaramanga, where it was possible to define EUs based on tectonics and to also establish comparisons. The methodology proposed for the diagnostic phase based mainly on the tectonic factor represents a challenge as regards its application in other active tectonic zones. Some limitations could arise such as fragmented environmental information from different institutions or the small to non-existent number of tectonic studies available. As a strong point, we find that the method allows achieving a comprehensive study of the environmental setting and thus to propose activities and land uses in each EU according to the real reception capacity of the land. This exhaustive analysis of the physical environment will also help decision-makers to understand and manage the socio-natural risks of the territory where communities develop.

Background Enoxaparin is the recommended agent for deep vein thrombosis (DVT) chemoprophylaxis in trauma patients. Current literature suggests weight-based dosing is superior to standard dosing for adequate chemoprophylaxis. Literature regarding the use of weight-based enoxaparin in the setting of traumatic brain injury (TBI) however is limited. Methods A retrospective analysis of adult trauma patients admitted between January 1, 2018 to February 28, 2019 was performed. Sixty-six patients with TBI receiving weight-based enoxaparin met inclusion criteria. Incidence of intracranial hemorrhage (ICH) expansion was the primary endpoint. Newly diagnosed venous thromboembolism (VTE) and death were secondary endpoints. Results Two patients, out of sixty-six, had progression of their TBI requiring surgical intervention. Newly diagnosed VTE occurred in one patient. No deaths were due to ICH expansion or VTE. Conclusions Use of weight-based enoxaparin dosing in the setting of TBI shows promise without an increased incidence of ICH expansion when compared to other studies. Level of Evidence and Study Type: Level IV, Therapeutic.

Acid-base disorders are common in medical practice, especially in patients with circulatory shock. These disorders can range from a simple acidosis or alkalosis to a complex mixed disorder that can lead to death. In general, these changes are manifestations or complications of pre-existing pathologies, such as central nervous system (CNS) impairment, pulmonary failure, endotoxic shock, cardiac arrest, chronic renal failure, adrenal hyperactivity, diabetes mellitus, liver problems, sepsis, or even medical maneuvers such as cardiopulmonary bypass and mechanical ventilation. In situations of acidosis or alkalosis, changes in cell permeability and cellular enzymatic function are noted, which can lead to the dysfunction of several organs and systems. These systemic changes promoted by pH variations are quite diverse: increased pulmonary vascular resistance; reduction of systemic vascular resistance; alteration of the electrical activity of the myocardium and the central nervous system; changes in myocardial contractility; and modification of the response to specific chemical agents, endogenous, and exogenous, such as hormones and vasoactive drugs.

Although methylene blue (MB) has been used for more than 20 years in the treatment of vasoplegic syndrome (VS), few quality clinical studies can allow the procedure to become a protocol. The pathophysiology of vasoplegia after cardiopulmonary bypass is multifactorial, with no final consensus on its real mechanism. For didactic purposes, emphasis will be given to three aspects, which are the most mentioned in clinical and laboratory studies on the subject: (a) the systemic inflammatory reaction; (b) the effects of protamine; and (c) a new mechanism recently related to the impairment of vasopressin receptors. There is strong evidence that MB, a guanylate cyclase inhibitor, is an excellent therapeutic option for the treatment of VS in cardiac surgery. Our clinical and laboratory experience, accumulated over a period of 20 years, established some classic concepts about the use of MB in this condition.

Nitric oxide (NO) is a central mediator of many physiological and pathophysiological events. After a thermal injury, an increase in NO was observed in the plasma and urinary levels, but the real importance of this fact is unknown. The guanylate cyclase inhibition by methylene blue (MB) has been proven, in basic and clinical studies, as an adjuvant treatment option in cases of catecholamine-resistant vasoplegia. Its use is safe, generally lifesaving, and the pharmacological inhibition of NO interferes not only in the reversal of vasoplegia but also in vascular permeability, often caused by the systemic inflammatory response associated with burns. Increasing experimental and clinical studies suggest MB as a viable, safe, and useful coadjuvant therapeutic tool for fluid resuscitation.

The idea that inhaled nitric oxide (NO) could cause selective pulmonary vasodilation motivated studies in animals where several mechanisms produced pulmonary hypertension. These studies demonstrated that concentrations of 5–80 ppm produced rapid and reversible pulmonary vasodilation, without systemic effects or adverse reactions. In the lung, as in any other part of the body, the NO formed from L-arginine in a reaction catalyzed by nitric oxide synthase (NOS) induces vasodilation through a guanosine 3′5′-cyclic monophosphate (cGMP)-dependent pathway. Since NO exists as a gas, it can be administered by inhalation to the alveoli and blood vessels close to these alveoli. As it undergoes rapid inactivation by hemoglobin, inhaled NO can perform selective pulmonary vasodilation when there is pulmonary vasoconstriction, without causing systemic vasodilation.

Since the mid-1970s of the last century, the presence of H1 and H2 receptors in the pulmonary and systemic circulation has been described, illustrating the importance of histamine in anaphylactic shock (ASh) mediation, since when released and transported by the bloodstream, it can produce an effect on the entire cardiovascular system, in addition to other tissues where histaminergic receptors can also be found. One of the hypotheses that could explain the important vasodilatory effect of histamine in ASh is that histamine binds to H1 receptors in the vascular endothelium, activating the nitric oxide (NO) production, one of the relaxing factors derived from the endothelium, which diffuses to vascular smooth muscle and activates the guanosine 3′5′-cyclic monophosphate (cGMP) production, resulting in vasodilation. Histamine can also bind to H2 receptors present in vascular smooth muscle, activating the adenosine 3′5′-cyclic monophosphate (cAMP) production pathway that also results in vasodilation. Thus, the vasodilation resulting from the activation of the cGMP and cAMP pathways synergistically contribute to the development and maintenance of the characteristic ASh hypotension. Therefore, treatment of Ash with MB is an option as rescue therapy.

Infectious endocarditis is a life-threatening condition that occasionally requires emergency valve replacement. Patients with an ongoing systemic inflammatory response because of infective endocarditis (IE) and those who need cardiopulmonary bypass (CPB) for emergency valve replacement may demonstrate resistant hypotension related to vasoplegia. It presents a spectrum of clinical presentation and is associated with a systemic inflammatory response and the release of endothelial nitric oxide (NO). Hemodynamically it is characterized by arterial vasodilation, high cardiac output despite myocardial depression, and decreased sensitivity of the heart and peripheral vessels to sympathomimetic agents. These observations led us to propose a protocol with the use of MB in cases of emergency surgery in patients with vasoplegic syndrome: (1) 3 mg.Kg−1 bolus infusion right after anesthetic induction (perhaps even earlier); (2) infusion of 1 mg.Kg−1 (intravenous (IV) or in the oxygenator) if blood pressure maintenance is not possible due to high perfusion flow and high doses of norepinephrine, and (3) repeat the infusion in bolus (or continuous if the patient is stable) after CPB discontinuity.

Since the 1990s, nitric oxide (NO) has been associated with vasoplegia of septic shock resistant to high doses of catecholamines. After exposure to bacterial endotoxin or specific cytokines, the inducible nitric oxide synthase (iNOS) expression occurs in a wide variety of tissues. This enzyme produces large NO amounts over long periods, closely related to the pathophysiological changes in sepsis. NO synthesis inhibitors can reverse hypotension caused by endotoxin and cytokine, and these agents could, in theory, constitute a modern therapeutic approach to severe septic shock. Preliminary studies in humans suggest that NOS inhibition improves blood pressure and stabilizes hemodynamics, but mortality rates remain undetermined. It can be said that the use of synthesis inhibitors was associated with increased mortality compared to the control group in humans, causing multicenter studies to be interrupted. The participation of the overproduction of NO by the iNOS expression is evident, leading to a vasoplegia state that is irresponsible to high doses of catecholamines. Since guanylate cyclase is the endothelium-dependent relaxation enzyme, MB is a potent inhibitor of this enzyme and an essential option for the vasoplegia in sepsis treatment.

Before presenting the circulatory shock as a vasoplegic endothelium dysfunction, the classical conceptual and practical approach is, at least, a good editorial choice. The focus of the present abstract begins with the best definition of circulatory shock. Perhaps the best approach to defining the cardiocirculatory shock is that of Robert Hardaway, who begins his discussion by stating, “What shock is not”: (1) low blood pressure; (2) acidosis; (3) low cardiac output; (4) adrenal gland failure, and (5) hypovolemia. This approach is interesting because it demonstrates the entire evolution of the circulatory shock concept as the pathophysiological concepts have changed. So, in search of a universal definition, it was concluded that the best definition of the shock state would be “inadequate capillary perfusion” or, simply, “bad tissue perfusion.” Shock treatment should be aggressive and started early. The fundamental therapy objective is to treat the cause, correct the hemodynamic change, and, at the same time, neutralize abnormalities resulting from poor tissue perfusion. Based on these concepts, the pivotal role of vascular endothelium is made clear.

Soluble guanylate cyclase (sGC) is the primary enzyme responsible for catalyzing the conversion of guanosine-5′ triphosphate (GTP) to guanosine 3′5′-cyclic monophosphate (cGMP), and it has been described for nearly 40 years after its identification in mammalian cells. Nitric oxide (NO) was described in the late 1970s as responsible for its activation and, therefore, for the formation of cGMP. Ten years later, when the endothelium-derived relaxing factor (EDRF) was discovered and identified as NO, mammalian cells were shown capable of synthesizing this inorganic compound, identifying it then as an endogenous sGC activator. The result was the characterization of the NO-sGC-cGMP transduction system. The stimulation of sGC by NO causes relaxation, increasing the cGMP production and activating cGMP-dependent protein kinase (PKG).

This chapter was based on the association of the concepts since they are always present when discussing vasoplegic endothelial dysfunction or vasoplegic syndrome. The pathophysiological link is the situation that involves distributive circulatory shock, a hyperdynamic state with low systemic vascular resistance, and arterial hypotension resistant to the effect of vasopressor amines. Many factors associated with the cardiocirculatory shock (surgical trauma, ischemia-reperfusion of organs, changes in body temperature, and release of endotoxins) have been well documented as inducing a complex inflammatory response (SIRS). This inflammatory cascade can contribute to the development of postoperative complications, including, but not limited to, respiratory failure, renal dysfunction, hemorrhagic disorders, neurological dysfunction, and changes in cardiac and liver function, vasoplegic endothelial dysfunction, and, ultimately, multiple organ failure.

Shock treatment in neonatal patients remains a challenge, with difficulties ranging from diagnosis to drug use. The drugs currently available for the treatment of shock are overly aggressive, and patients in shock have worse results showing a higher incidence of serious sequelae, for example, intraventricular cerebral hemorrhage. The main cause of distributive shock in children, especially neonatal patients, is septic shock. Mortality in sepsis is still high worldwide, and neonates and children with distributive shock are especially susceptible to the undesirable side effects of high-dose catecholamine infusions. However, they can significantly benefit from methylene blue (MB) infusion before catecholamine infusions. Unfortunately, there is a widely publicized concept that MB cannot be used in children and neonates because it causes pulmonary hypertension. There is evidence that MB can be a useful medication in neonatal and pediatric hemodynamic management, as it has the potential to minimize the use of traditional vasoactive amines, known to cause a deleterious effect in these patients. Therefore, MB, little studied in pediatrics, can prove to be a beneficial medicine in pediatrics and further studies should be performed.

After the onset of cardiac arrest, global ischemia activates the glia and the complement system with the release of cytokines by neurons. The pro-inflammatory cascade is initiated by the expression of adhesion molecules, polymorphonuclear leukocyte chemotaxis, and the reactive oxygen species production. As a result, there is an increase in vascular permeability, blood clotting activation, platelet activation, and vasoconstrictors release, contributing to the regional flow reduction. Cerebral edema increased blood-brain barrier (BBB) permeability and neurological damage are seen early in ischemia-induced by cardiac arrest. The positive nitric oxide synthase (NOS) regulation is associated with an increase in nitric oxide (NO) production that induces the BBB breakdown. It has been suggested that pretreatment with pharmacological agents can reduce excess NO or oxidative stress, decreasing the interruption of BBB permeability caused by ischemia/reperfusion injury. Methylene blue (MB), a nontoxic dye and scavenger cleaner, recently proved to be a potential aid in the resuscitation of cardiac arrest, attenuating oxidative, inflammatory, myocardial, and neurological lesions.

Cardiogenic shock was classically considered as a left ventricle mechanical failure until the beginning of the century (2000–2003). By this time systemic inflammatory response (SIRS), complement activation, inflammatory cytokines release, inducible nitric oxide synthase (iNOS) expression, and vasodilation would not solely have a crucial position in the shock genesis but also on its evolution. Nowadays, cardiogenic shock, a devastating final result of acute myocardial infarction, is related to extraordinarily excessive mortality. Treatment techniques ought to center attention on rapid reperfusion and hemodynamic support. New pathophysiological interpretations and treatments based totally on vasoplegia triggered through increased iNOS expression have been suggested. The unfavorable evidence for the iNOS inhibition in human cardiogenic shock led to an exceptional suggestion, based on smooth muscle relaxation by guanosine 3′5′-cyclic monophosphate (cGMP), without interfering with NO synthesis and without producing tissue necrosis, associated with the use of NOS inhibitors. Thus, MB for all that has been written in this book could be a therapeutic option, not yet tested, for vasoplegia related to cardiogenic shock.

The endothelium of arteries and veins has long been studied by doctors and researchers who deal with cardiovascular diseases. However, a global view of endothelial function was not possible until the past two decades that witnessed the discovery of prostacyclin production, the subsequent discovery of endothelium-derived nitric oxide (NO), and other vasoactive factors. There are three known endothelium-dependent vasodilation mechanisms: (1) dependent on the cGMP system (NO – nitric oxide); (2) dependent on the adenosine 3′5′-cyclic monophosphate (cAMP) system (PGI2 – prostacyclin); and (3) hyperpolarization (EDHF – hyperpolarizing factor of the endothelium still unknown or nonexistent). These mechanisms are synergistic with each other, with NO being the most important factor, because in addition to being an endogenous vasodilator, it is also an antiplatelet factor. These basic concepts are fundamental to understand the vasoplegic endothelium dysfunction.

Prehospital hypotensive resuscitation with volume resuscitation with reagents that inhibit the free oxygen radical formation, such as MB, can improve resuscitation and survival to treat hypovolemic states. Also, a study in dogs was conducted to assess prehospital resuscitation after refractory hemorrhagic shock with a combination of MB and lactated Ringer’s limited volume solution. Since the early 1990s, studies have investigated nitric oxide (NO) and the induction of calcium-independent nitric oxide synthase (NOS) in the development of vascular hyporeactivity to norepinephrine (NE) and vascular decompensation associated with hemorrhagic shock in experimental animals. Vascular decompensation after prolonged periods of hemorrhagic shock was characterized by an inability of humans and animals to maintain blood pressure, despite blood reinfusion. This progressive decline in blood pressure is mediated by the advanced NO formation by iNOS because it was prevented by L-NMMA or by dexamethasone.

Día a día los ciudadanos encaran la necesidad de tramitar documentos de diverso tipo para acreditar su identidad, conducir un automóvil o certificar una condición determinada; deben pagar los recibos de servicios públicos o asegurar la inscripción de una firma, un sello o un número en un papel que, de no encontrarse “en regla”, puede obstaculizar su salida del país, el acceso a algún beneficio o servicio o la compra de un inmueble. Pero, ¿qué tanto saben del funcionario que se encuentra detrás de la ventanilla? ¿cuál es el verdadero rostro de ese empleado, muchas veces oculto detrás de pilas de documentos o del cristal de una ventana? ¿qué estudió? ¿dónde trabajó antes? ¿cuál es su situación contractual? ¿cómo fue su proceso de reclutamiento? ¿hasta cuándo estará vinculado a su empleo actual? ¿qué hace en su jornada laboral? ¿qué piensa de su trabajo y de los usuarios de los servicios que tiene a su cargo? o ¿cómo su manera de pensar influye en las labores que desarrolla? A la luz del estudio de caso de dos entidades municipales adscritas a la Alcaldía de Santiago de Cali, el libro busca contribuir a la comprensión del funcionamiento del estado colombiano a partir de una aproximación etnográfica a las burocracias de rango intermedio que, con las operaciones, procedimientos y rutinas que despliegan en el ejercicio de su trabajo, pero también mediante los valores, principios y creencias que ponen en juego, materializan la presencia del estado en la vida diaria de la gente. Para ello, nos apoyamos en la noción de intimidad burocrática, que posee dos acepciones diferentes, pero compatibles entre sí. Por un lado, basándonos en la idea de “intimidad cultural” de Herzfeld, hacemos referencia a aquellos rumores, comentarios y creencias que se ponen en circulación dentro de un grupo y que son considerados por sus miembros como una fuente de vergüenza externa o como parte de lo íntimo pero que paradójicamente, les proporciona la seguridad de compartir una sociabilidad común y de poseer un recurso simbólico de autoprotección. Esto último se manifestaría en forma de imitación, ironía, rechazo o burla. Y, por otro, la noción de intimidad burocrática también nos recuerda el carácter intimidatorio y de inhibición que tanto los empleados públicos como el resto de la ciudadanía suelen asignar a todo lo que representa lo estatal.