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El propósito de este artículo es, por un lado, reflexionar y problematizar la noción de derechos humanos en América Latina. Por otro lado, describir y analizar los instrumentos y mecanismos de protección internacionales e interamericanos de los derechos humanos que promueven herramientas para su respeto y garantías para todas las personas. Por último, se procura analizar el caso Lhaka Honhat, teniendo en cuenta los marcos institucionales que el Sistema Interamericano de Protección de los Derechos Humanos emplea ante la alegada violación del derecho a la propiedad en perjuicio de las comunidades indígenas de la localidad de Rivadavia, Provincia de Salta, Argentina. El interés de abordar estos objetivos retoma la idea de pensar la protección de los derechos humanos como respuestas normativas a problemáticas y necesidades que acontecen en la sociedad. De tal modo, se recurre a herramientas teóricas para discutir las concepciones que giran en torno a cómo se entienden los derechos humanos en la actualidad, y de qué manera ciertos instrumentos, mecanismos y sistemas a nivel internacional e interamericano promueven su protección respecto a los pueblos indígenas. En consecuencia, se asume que los derechos humanos componen un campo de luchas sociales, históricas y culturales por la dignidad, entendiéndolos como el acceso igualitario a bienes necesarios para la vida, cuyos resultados deben garantizarse por normas jurídicas, políticas y económicas.

Tramas de desigualdades: mulheres rurais no ensino superior universitário, Salta Argentina Este artigo apresenta a análise das várias posições sociais ocupadas por mulheres jovens que se deslocam de seu lugar de origem no contexto rural (San Carlos, Salta, Argentina) para a capital da província para estudar na Universidade Nacional de Salta (UNSa). Levamos em conta que esse grupo de mulheres jovens passa por diferentes experiências na instituição universitária, nas quais são questionadas a partir de suas condições sociais, etárias, rurais e de gênero. Tais experiências compõem um campo de múltiplos significados em que se misturam a diversidade cultural, o esforço pela formação acadêmica, bem como as relações históricas de desigualdade. Palavras-chave: desigualdades, mulheres rurais, ensino superior, deslocamento, experiências. Tramas de las desigualdades: mujeres rurales en la educación superior universitaria, Salta Argentina RESUMEN. Este artículo presenta el análisis de las diversas posiciones sociales que ocupan mujeres jóvenes que se desplazan de su lugar de origen en el contexto rural (San Carlos, Salta, Argentina) hacia la capital de la provincia para realizar estudios en la Universidad Nacional de Salta (UNSa). Tomamos en cuenta que este grupo de mujeres jóvenes transitan por diferentes experiencias en la institución universitaria, en las cuales son interpeladas a partir de su condición social, etaria, rural y de género. Tales experiencias conforman un campo de múltiples sentidos en los que se entremezclan la diversidad cultural, el esfuerzo por lograr un título académico, como así también históricas relaciones de desigualdad. Palabras claves: desigualdades, mujeres rurales, educación superior, desplazamiento, experiencias. Plots of inequalities: rural women in university higher education, Salta Argentina ABSTRACT. This article presents the analysis of the various social positions occupied by young women who move from their place of origin in the rural context (San Carlos, Salta, Argentina) to the capital of the province to study at the National University of Salta (UNSa). We take into account that this group of young women goes through different experiences in the university institution, in which they are questioned based on their social, age, rural and gender conditions. Such experiences make up a field of multiple meanings in which cultural diversity, the effort to achieve an academic degree, as well as historical relations of inequality intermingle. Keywords: inequalities, rural women, higher education, displacement, experiences. Tramas de desigualdades: mulheres rurais no ensino superior universitário, Salta Argentina Este artigo apresenta a análise das várias posições sociais ocupadas por mulheres jovens que se deslocam de seu lugar de origem no contexto rural (San Carlos, Salta, Argentina) para a capital da província para estudar na Universidade Nacional de Salta (UNSa). Levamos em conta que esse grupo de mulheres jovens passa por diferentes experiências na instituição universitária, nas quais são questionadas a partir de suas condições sociais, etárias, rurais e de gênero. Tais experiências compõem um campo de múltiplos significados em que se misturam a diversidade cultural, o esforço pela formação acadêmica, bem como as relações históricas de desigualdade. Palavras-chave: desigualdades, mulheres rurais, ensino superior, deslocamento, experiências. Tramas de las desigualdades: mujeres rurales en la educación superior universitaria, Salta Argentina RESUMEN. Este artículo presenta el análisis de las diversas posiciones sociales que ocupan mujeres jóvenes que se desplazan de su lugar de origen en el contexto rural (San Carlos, Salta, Argentina) hacia la capital de la provincia para realizar estudios en la Universidad Nacional de Salta (UNSa). Tomamos en cuenta que este grupo de mujeres jóvenes transitan por diferentes experiencias en la institución universitaria, en las cuales son interpeladas a partir de su condición social, etaria, rural y de género. Tales experiencias conforman un campo de múltiples sentidos en los que se entremezclan la diversidad cultural, el esfuerzo por lograr un título académico, como así también históricas relaciones de desigualdad. Palabras claves: desigualdades, mujeres rurales, educación superior, desplazamiento, experiencias. Plots of inequalities: rural women in university higher education, Salta Argentina ABSTRACT. This article presents the analysis of the various social positions occupied by young women who move from their place of origin in the rural context (San Carlos, Salta, Argentina) to the capital of the province to study at the National University of Salta (UNSa). We take into account that this group of young women goes through different experiences in the university institution, in which they are questioned based on their social, age, rural and gender conditions. Such experiences make up a field of multiple meanings in which cultural diversity, the effort to achieve an academic degree, as well as historical relations of inequality intermingle. Keywords: inequalities, rural women, higher education, displacement, experiences. Tramas de desigualdades: mulheres rurais no ensino superior universitário, Salta Argentina Este artigo apresenta a análise das várias posições sociais ocupadas por mulheres jovens que se deslocam de seu lugar de origem no contexto rural (San Carlos, Salta, Argentina) para a capital da província para estudar na Universidade Nacional de Salta (UNSa). Levamos em conta que esse grupo de mulheres jovens passa por diferentes experiências na instituição universitária, nas quais são questionadas a partir de suas condições sociais, etárias, rurais e de gênero. Tais experiências compõem um campo de múltiplos significados em que se misturam a diversidade cultural, o esforço pela formação acadêmica, bem como as relações históricas de desigualdade. Palavras-chave: desigualdades, mulheres rurais, ensino superior, deslocamento, experiências. Tramas de las desigualdades: mujeres rurales en la educación superior universitaria, Salta Argentina RESUMEN. Este artículo presenta el análisis de las diversas posiciones sociales que ocupan mujeres jóvenes que se desplazan de su lugar de origen en el contexto rural (San Carlos, Salta, Argentina) hacia la capital de la provincia para realizar estudios en la Universidad Nacional de Salta (UNSa). Tomamos en cuenta que este grupo de mujeres jóvenes transitan por diferentes experiencias en la institución universitaria, en las cuales son interpeladas a partir de su condición social, etaria, rural y de género. Tales experiencias conforman un campo de múltiples sentidos en los que se entremezclan la diversidad cultural, el esfuerzo por lograr un título académico, como así también históricas relaciones de desigualdad. Palabras claves: desigualdades, mujeres rurales, educación superior, desplazamiento, experiencias. Plots of inequalities: rural women in university higher education, Salta Argentina ABSTRACT. This article presents the analysis of the various social positions occupied by young women who move from their place of origin in the rural context (San Carlos, Salta, Argentina) to the capital of the province to study at the National University of Salta (UNSa). We take into account that this group of young women goes through different experiences in the university institution, in which they are questioned based on their social, age, rural and gender conditions. Such experiences make up a field of multiple meanings in which cultural diversity, the effort to achieve an academic degree, as well as historical relations of inequality intermingle. Keywords: inequalities, rural women, higher education, displacement, experiences. Tramas de desigualdades: mulheres rurais no ensino superior universitário, Salta Argentina Este artigo apresenta a análise das várias posições sociais ocupadas por mulheres jovens que se deslocam de seu lugar de origem no contexto rural (San Carlos, Salta, Argentina) para a capital da província para estudar na Universidade Nacional de Salta (UNSa). Levamos em conta que esse grupo de mulheres jovens passa por diferentes experiências na instituição universitária, nas quais são questionadas a partir de suas condições sociais, etárias, rurais e de gênero. Tais experiências compõem um campo de múltiplos significados em que se misturam a diversidade cultural, o esforço pela formação acadêmica, bem como as relações históricas de desigualdade. Palavras-chave: desigualdades, mulheres rurais, ensino superior, deslocamento, experiências. Tramas de las desigualdades: mujeres rurales en la educación superior universitaria, Salta Argentina RESUMEN. Este artículo presenta el análisis de las diversas posiciones sociales que ocupan mujeres jóvenes que se desplazan de su lugar de origen en el contexto rural (San Carlos, Salta, Argentina) hacia la capital de la provincia para realizar estudios en la Universidad Nacional de Salta (UNSa). Tomamos en cuenta que este grupo de mujeres jóvenes transitan por diferentes experiencias en la institución universitaria, en las cuales son interpeladas a partir de su condición social, etaria, rural y de género. Tales experiencias conforman un campo de múltiples sentidos en los que se entremezclan la diversidad cultural, el esfuerzo por lograr un título académico, como así también históricas relaciones de desigualdad. Palabras claves: desigualdades, mujeres rurales, educación superior, desplazamiento, experiencias. Plots of inequalities: rural women in university higher education, Salta Argentina ABSTRACT. This article presents the analysis of the various social positions occupied by young women who move from their place of origin in the rural context (San Carlos, Salta, Argentina) to the capital of the province to study at the National University of Salta (UNSa). We take into account that this group of young women goes through different experiences in the university institution, in which they are questioned based on their social, age, rural and gender conditions. Such experiences make up a field of multiple meanings in which cultural diversity, the effort to achieve an academic degree, as well as historical relations of inequality intermingle. Keywords: inequalities, rural women, higher education, displacement, experiences. Tramas de desigualdades: mulheres rurais no ensino superior universitário, Salta Argentina Este artigo apresenta a análise das várias posições sociais ocupadas por mulheres jovens que se deslocam de seu lugar de origem no contexto rural (San Carlos, Salta, Argentina) para a capital da província para estudar na Universidade Nacional de Salta (UNSa). Levamos em conta que esse grupo de mulheres jovens passa por diferentes experiências na instituição universitária, nas quais são questionadas a partir de suas condições sociais, etárias, rurais e de gênero. Tais experiências compõem um campo de múltiplos significados em que se misturam a diversidade cultural, o esforço pela formação acadêmica, bem como as relações históricas de desigualdade. Palavras-chave: desigualdades, mulheres rurais, ensino superior, deslocamento, experiências. Tramas de las desigualdades: mujeres rurales en la educación superior universitaria, Salta Argentina RESUMEN. Este artículo presenta el análisis de las diversas posiciones sociales que ocupan mujeres jóvenes que se desplazan de su lugar de origen en el contexto rural (San Carlos, Salta, Argentina) hacia la capital de la provincia para realizar estudios en la Universidad Nacional de Salta (UNSa). Tomamos en cuenta que este grupo de mujeres jóvenes transitan por diferentes experiencias en la institución universitaria, en las cuales son interpeladas a partir de su condición social, etaria, rural y de género. Tales experiencias conforman un campo de múltiples sentidos en los que se entremezclan la diversidad cultural, el esfuerzo por lograr un título académico, como así también históricas relaciones de desigualdad. Palabras claves: desigualdades, mujeres rurales, educación superior, desplazamiento, experiencias. Plots of inequalities: rural women in university higher education, Salta Argentina ABSTRACT. This article presents the analysis of the various social positions occupied by young women who move from their place of origin in the rural context (San Carlos, Salta, Argentina) to the capital of the province to study at the National University of Salta (UNSa). We take into account that this group of young women goes through different experiences in the university institution, in which they are questioned based on their social, age, rural and gender conditions. Such experiences make up a field of multiple meanings in which cultural diversity, the effort to achieve an academic degree, as well as historical relations of inequality intermingle. Keywords: inequalities, rural women, higher education, displacement, experiences.

The purpose of this article is, on the one hand, to reflect and problematize the notion of human rights in Latin America. On the other hand, to describe and analyze the instruments and mechanisms of international and inter-American protection of human rights that promote tools for their respect and guarantees for all people. Finally, an attempt is made to analyze the Lhaka Honhat case, taking into account the institutional frameworks that the Inter-American System for the Protection of Human Rights employs in the face of the alleged violation of the right to property to the detriment of the indigenous communities of the town of Rivadavia, Province of Salta, Argentina. The interest in addressing these objectives takes up the idea of ​​thinking about the protection of human rights as normative responses to problems and needs that occur in society. In this way, theoretical tools are used to discuss the conceptions that revolve around how human rights are currently understood and, in what way, certain instruments, mechanisms and systems at the international and inter-American levels promote their protection regarding indigenous peoples. Consequently, it is assumed that human rights make up a field of social, historical and cultural struggles for dignity, understanding them as equal access to goods necessary for life, the results of which must be guaranteed through legal, political and economic norms. El propósito de este artículo es, por un lado, reflexionar y problematizar la noción de derechos humanos en América Latina. Por otro lado, describir y analizar los instrumentos y mecanismos de protección internacionales e interamericanos de los derechos humanos que promueven herramientas para su respeto y garantías para todas las personas. Por último, se procura analizar el caso Lhaka Honhat, teniendo en cuenta los marcos institucionales que el Sistema Interamericano de Protección de los Derechos Humanos emplea ante la alegada violación del derecho a la propiedad en perjuicio de las comunidades indígenas de la localidad de Rivadavia, Provincia de Salta, Argentina. El interés de abordar estos objetivos retoma la idea de pensar la protección de los derechos humanos como respuestas normativas a problemáticas y necesidades que acontecen en la sociedad. De tal modo, se recurre a herramientas teóricas para discutir las concepciones que giran en torno a cómo se entienden los derechos humanos en la actualidad, y de qué manera ciertos instrumentos, mecanismos y sistemas a nivel internacional e interamericano promueven su protección respecto a los pueblos indígenas. En consecuencia, se asume que los derechos humanos componen un campo de luchas sociales, históricas y culturales por la dignidad, entendiéndolos como el acceso igualitario a bienes necesarios para la vida, cuyos resultados deben garantizarse por normas jurídicas, políticas y económicas. O objetivo deste artigo é refletir e problematizar a noção de direitos humanos na América Latina e, por outro lado, descrever e analisar os instrumentos e mecanismos de proteção internacional e interamericana dos direitos humanos que promovem ferramentas para seu respeito e garantias para todas as pessoas. Finalmente, procura analisar o caso "Lhaka Honat", levando em conta os marcos institucionais que o Sistema Interamericano de Proteção dos Direitos Humanos emprega diante da suposta violação do direito de propriedade em detrimento das comunidades indígenas da cidade de Rivadavia, Província de Salta, Argentina. O interesse em abordar estes objetivos se baseia na idéia de pensar na proteção dos direitos humanos como respostas normativas aos problemas e necessidades que ocorrem na sociedade. Desta forma, ferramentas teóricas são utilizadas para discutir as concepções que giram em torno de como os direitos humanos são compreendidos atualmente e como certos instrumentos, mecanismos e sistemas em nível internacional e interamericano promovem sua proteção com respeito aos povos indígenas. Consequentemente, assume-se que os direitos humanos constituem um campo de lutas sociais, históricas e culturais pela dignidade, entendida como igualdade de acesso aos bens necessários à vida, cujos resultados devem ser garantidos por normas legais, políticas e econômicas.

En los últimos 15 años se han descrito 3 casos de Colitis Ulcerosa concurrente con Neurofibromatosis Tipo 1 (NF1) en adultos y adolescentes, pero no en niños; y aunque puede ser un hallazgo casual, se postula una vía patogénica común entre ambas enfermedades, basada en la desregulación de los mastocitos en el tracto digestivo. Objetivo: Reportar el caso clínico de una preescolar que debuta con Colitis Ulcerosa concomitante con infección por CMV, con antecedente de NF1, y discutir el origen común entre ambas enfermedades. Caso Clínico: Preescolar de 2 años y medio con historia previa de NF1 que se presenta con diarrea sanguinolenta. Al examen endoscópico la mucosa desde el margen anal hasta el ciego se observó eritematosa, con pérdida de la transparencia vascular. Las biopsias de mucosa colónica mostraron signos de inflamación crónica, concordantes con el diagnóstico de Colitis Ulcerosa, e infección por CMV diagnosticada por PCR.Conclusión: En estudios previos se ha sugerido que los mastocitos podrían tener un rol patogénico en el desarrollo de la CU, sin embargo, no se conoce el significado clínico de los hallazgos descritos. Se necesitan futuras investigaciones para profundizar en el rol de los mastocitos en el desarrollo de CU y confirmar una asociación genética entre ambas enfermedades.

Introducción: El trasplante hepático (TH), es una terapia establecida en el tratamiento de diversas enfermedades del hígado agudas y crónicas terminales y del carcinoma hepatocelular (CHC). Las principales indicaciones en nuestro medio son la cirrosis de diferentes etiologías, el CHC, la atresia de vías biliares en niños y la falla hepática fulminante (FHF). Menos del 10% corresponden a indicaciones inhabituales, que incluyen pacientes con una miscelánea de enfermedades entre las cuales están la enfermedad poliquística hepática (EPH), enfermedades metabólicas (Niemann – Pick, otras), el síndrome hepato/portopulmonar, metástasis de diferentes tumores, etc.Objetivo: Describir y evaluar los resultados obtenidos con el trasplante hepático en estas indicaciones.Material y Método: Estudio de cohorte no concurrente que incluyó los TH por indicaciones inhabituales realizados entre marzo de 1997 y diciembre de 2016. De 295 TH realizados, 34 (11,5%) fueron por estas indicaciones.Resultados: Las causas más frecuentes fueron el síndrome porto/hepatopulmonar en 11 (40,7%) pacientes y la EPH en 9 (26,5%). Las enfermedades metabólicas representaron la tercera indicación, con 5 (14,7%) casos. 7 (20,6%) pacientes eran menores de 18 años. Las complicaciones más frecuentes fueron biliares y la trombosis de arteria hepática en 6 (17,6%) y 4 (11,8%) casos respectivamente; estos últimos eran portadores de una EPH masiva. 4 (12,5%) pacientes requirieron retrasplante. La mortalidad a 90 días fue de 2 (5,9%) enfermos. Conclusión: El TH es una opción factible en este grupo de pacientes con resultados similares a los obtenidos en las indicaciones clásicas.

El brote del virus SARS-CoV-2 que comenzó a fines del año 2019 en China, se ha expandido a Chile y al mundo rápidamente. Hasta la fecha, en Chile, ha afectado a 18.435 personas con una letalidad en adultos de 1,4%. Los pacientes pediátricos con enfermedades hepáticas crónicas son también susceptibles a COVID-19 y podrían tener una peor evolución. El objetivo es entregar recomendaciones sobre el tratamiento médico de pacientes pediátricos con daño hepático crónico (DHC), hepatitis autoinmune (HAI), Enfermedad de hígado graso no alcohólico (EHGNA) y trasplantados hepáticos (TH) en relación a COVID-19. Lo primordial es evitar el contagio y para esto, lo más importante es el lavado de manos, uso de mascarilla en espacios públicos y cerrados, como el distanciamiento social y evitar contacto con personas sintomáticas. Los pacientes con DHC, HAI, EHGNA y TH deben evitar los controles presenciales y favorecer la telemedicina. No existe evidencia que recomiende la modificación del tratamiento basal en estos casos. En pacientes COVID-19 (+) se recomienda medidas de aislamiento, preferir uso de paracetamol como antipirético y analgésico y en el manejo de la inmunosupresión, debe considerarse cada caso de forma individual, según gravedad y con evaluación del especialista. Además, se revisan las actuales terapias específicas para COVID-19 y sus precauciones en pacientes con hepatopatías. Las medidas de prevención del contagio, aislamiento social y diagnóstico precoz son fundamentales en pacientes con enfermedad hepática y el riesgo de infección por SARSCoV-2.

In this paper we examine the well-posedness and ill-posedeness of the Cauchy problems associated with a family of equations of ZK-KP-type \begin{document}$ \begin{cases} u_{t} = u_{xxx}-\mathscr{H}D_{x}^{\alpha}u_{yy}+uu_{x}, \cr u(0) = \psi \in Z \end{cases} $\end{document} in anisotropic Sobolev spaces, where \begin{document}$ 1\le \alpha \le 1 $\end{document}, \begin{document}$ \mathscr{H} $\end{document} is the Hilbert transform and \begin{document}$ D_{x}^{\alpha} $\end{document} is the fractional derivative, both with respect to \begin{document}$ x $\end{document}.

Resumen La infección de transmisión sexual por Chlamydia trachomatis, tiene una alta prevalencia en Chile y otras latitudes, y se asocia a graves riesgos para la salud reproductiva de quienes se infectan. El cribado con autotoma de la muestra y detección mediante amplificación de ácidos nucleicos es la forma más eficaz de control sanitario. Hasta ahora, en Chile, el diagnóstico y manejo epidemiológico de C. trachomatis no se realiza en la salud pública. El Ministerio de Salud de Chile está haciendo importantes avances para iniciar esta implementación. La Sociedades Médicas se comprometen a participar en este proceso para lograr el eficaz control de esta infección en nuestra población.

The sexually transmitted infection caused by Chlamydia trachomatis has a high prevalence in Chile and other latitudes and is associated with serious risks to the reproductive health of those who become infected. Screening with self- collected samples and detection by amplification of nucleic acids is the most effective form of sanitary control. Until now, in Chile, the diagnosis and epidemiological management of C. trachomatis is not carried out in public health. The Ministry of Health of Chile is making important progress to start this implementation. The Medical Societies are committed to participate in this process to achieve effective control of this infection in our population.

Late graft loss (LGL) and late mortality (LM) following liver transplantation (LT) in children were analyzed from the studies of pediatric liver transplantation (SPLIT) database. Univariate and multivariate associations between pre- and postoperative factors and LGL and LM in 872 patients alive with their primary allografts 1 year after LT were reviewed. Thirty-four patients subsequently died (LM) and 35 patients underwent re-LT (LGL). Patients who survive the first posttransplant year had 5-year patient and graft survival rates of 94.2% and 89.2%, respectively. Graft loss after the first year was caused by rejection in 49% of the cases with sequelae of technical complications accounting for an additional 20% of LGL. LT for tumor, steroid resistant rejection, reoperation in the first 30 days and >5 admissions during the first posttransplant year were independently associated with LGL in multivariate analysis. Malignancy, infection, multiple system organ failure and posttransplant lymphoproliferative disease accounted for 61.8% of all late deaths after LT. LT performed for FHF and tumor were associated with LM. Patients who are at or below the mean for weight at the time of transplant were also at an increased risk of dying. Frequent readmission was also found to be associated with LM.

To examine the outcome of technical variant liver transplant techniques relative to whole organ liver transplantation in pediatric liver transplant recipients.Technical variant liver transplant techniques comprising split, reduced, and live-donor liver transplantation evolved to address the need for timely and size appropriate grafts for pediatric recipients.Analysis of data from the Studies of Pediatric Liver Transplantation (SPLIT) registry, a multicenter database of 44 North American pediatric liver transplant programs. The outcome (morbidity and mortality) of each of the technical variants were compared with that of whole organ recipients.Data were available on 2192 transplant recipients (1183 whole, 261 split, 388 reduced, and 360 live donor). Recipients of all technical variant graft type were significantly younger than whole organ recipients, but on average spent 2.3 months less on the waiting list. Thirty-day post-transplant morbidity was increased for each type of technical variant relative to whole organ (45.1% whole, 66.7% split, 65.5% reduced, 51.9% live-donor). Biliary complications (30 day: 7.5% whole, 18.8% split, 16% reduced, 17.5% live-donor) and portal vein thrombosis (30 day: 3.6% whole, 8% split, 8% reduced, 7.5% live-donor) were more common in all technical variant types. Graft type was an independent predictor of graft loss (death or retransplantation) in a multivariate analysis. Split and reduced (relative risk = 1.74 and 1.77, respectively) grafts had a worse outcome when compared with whole organ recipients.Technical variant techniques expand the pediatric donor pool and reduce time from listing to transplant, but they are associated with increased morbidity and mortality.

Background In living donor liver transplantation (LDLTx) organ procurement is usually well controlled, and allows to assess liver preservation and graft function under standardized conditions. Because publications on histidine-tryptophan-ketoglutarate (HTK) solution are limited, we prospectively studied its safety and efficacy in a consecutive series of LDLTx. Methods Twenty-four patients received 22 right, 1 left, and 1 left lateral lobe graft. Liver preservation was done by gravity perfusion with HTK through portal vein, and hepatic artery, and flushing of bile ducts. Total ischemia time was 191 ± 68 minutes. Results There was no primary nonfunction, and all partial liver grafts showed good recovery: peak aspartate aminotransferase 577 U/L, total bilirubin 15.15 mg/dL, and partial thromboplastin time 49.37 seconds. One graft was lost from parenchymal fracture secondary to portal hyperperfusion after 6 days, and the patient was salvaged with retransplantation. Thirty-day mortality, including sudden cardiac death, pancreatitis, and hepatic artery rupture, was not related to graft dysfunction. Eight of 24 recipients developed early biliary leakage. There was no late ischemic type biliary lesion. Conclusion These results confirm that HTK solution is safe and effective when used in LDLTx. Potential advantages of HTK in comparison to other preservation solutions are low potassium concentration, low viscosity, no particles, in situ perfusion, no need to flush before reperfusion, improved biliary protection, better recovery of microcirculatory changes, ready to use, and lower costs. Because the risk–benefit ratio is of particular importance in LDLTx the use of HTK solution should be encouraged.

Introduction As we have learned, there are no golden rules of immunosuppression in solid organ transplantation, and every transplant program is using its own regimen to prevent or treat rejection. We have retrospectively analyzed the incidence and severity of acute rejection in a consecutive series of living donor liver transplants. The major objective during the whole study period was to ultimately avoid any steroids from the beginning. Methods Twenty one adult patients and five children received 23 right, one left, and two left lateral lobe grafts from genetically or emotionally related living donors, including four ABO-incompatible pairs. The majority of patients had triple initial immunosuppression, based on tacrolimus, mycophenolate mofetil or sirolimus, and basiliximab or daclizumab. Except methylprednisolone administered before reperfusion in 13 patients, only seven had prednisolone after transplantation, and 12/26 had a completely steroid-free regimen. Results The overall incidence of biopsy-proven acute rejection was 4/21 in adults (19%) and 4/5 in children (80%). Rejections were mild in five and moderate in three cases, respectively, and easily reversed with steroids in all patients. Different combinations of immunosuppressive drugs or ABO incompatibility did not seem to have an influence on the risk of rejection. Conclusion Despite the small number of patients in this series, completely steroid-free triple-drug immunosuppression with tacrolimus, mycophenolate mofetil, and basiliximab is safe and efficient to prevent acute rejection in adult recipients of living donor liver transplants. At least short-term administration of prednisolone should be considered in pediatric patients.

La elección de los distintos métodos anticonceptivos debe basarse en dos pilares fundamentales: la evidencia científica disponible y la adecuación al contexto de la paciente o la pareja. La Organización Mundial de la Salud (OMS) viene realizando el esfuerzo desde hace más de quince años de actualizar los criterios de elegibilidad de los métodos anticonceptivos tras la revisión de la evidencia disponible, y presentar estos resultados para facilitar al personal sanitario y a los organismos oficiales el consejo anticonceptivo más adecuado en cada situación. El médico de familia juega un papel determinante en aproximar estos criterios a la realidad de cada una de sus pacientes, de manera que se consiga indicar el mejor método disponible en cada caso, siempre aportando la información adecuada y respetando las opiniones y deseos de cada mujer o pareja. En el artículo analizamos cuál debe ser este proceso, cuáles son los aspectos importantes a recoger en la anamnesis, qué exploraciones son necesarias, y cuáles son las indicaciones y contraindicaciones de cada método anticonceptivo. Tomamos como eje conductor la última revisión que la OMS ha realizado al respecto, publicada el invierno pasado, y desde ahí analizamos las distintas posibilidades clínicas a las que nos podemos enfrentar. Para una buena praxis en este terreno, deberemos seguir estas evidencias y mantener siempre una actitud de respeto a la capacidad de decisión de la paciente o la pareja. El objetivo último de esta revisión es ayudar al clínico en la práctica clínica diaria a escoger en cada caso la mejor opción.

Cholestasis is defined as a disorder affecting the production of bile resulting in the retention of its components in the liver and blood. In children, this disorder is almost always due to genetic alterations. Functionally, cholestasis may be the result of hepatic failure to secrete bile due to decrease in transport, synthesis or biliary obstruction. Extrahepatic cholestasis may be caused by biliary atresia and other obstructions of the bile ducts. Intrahepatic cholestasis may be the result of several disorders including progressive familial intrahepatic cholestasis (PFIC) types 1, 2 and 3, an autosomal recessive disease due to mutations in the genes ATP8B1, ABCBll and ABCB4 respectively. Pathophysiology and clinical presentation of this disease are now well understood. Clinically, these patients may present with jaundice, itching, anorexia, and generally unwell. Laboratory tests may disclose conjugated bilirubin over lmg/dl or larger than 20% of total bilirubin. Ursodeoxycholic acid, cholestiramine and biliary diversion may help in some of these conditions. Ongoing research into the mechanisms of genetic cholestasis could be key to therapy.

Objetivo. Identificar factores asociados al consumo de tabaco en escolares de 1º de ESO. Diseño. Estudio analítico de casos y controles apareados por sexo (razón 1:3). Emplazamiento. Centros escolares pertenecientes a 16 zonas básicas de salud de Albacete y Ciudad Real. Participantes. Escolares de 1º de ESO seleccionados mediante cuestionario autocumplimentado. En la muestra participaron 146 escolares fumadores (casos) y 438 no fumadores (controles). Mediciones principales. Variables sobre consumo de tabaco en el entorno sociofamiliar, rendimiento escolar, consumo de alcohol, práctica deportiva y otras relacionadas con estilos de vida. Resultados. En los adolescentes fumadores fue significativamente superior (p < 0,001) la proporción de padres fumadores y con menor nivel de estudios, así como la de hermanos, amigos o profesores fumadores. El consumo de alcohol, la ausencia de práctica deportiva, mayor edad, mayor disponibilidad de dinero o menor número de asignaturas aprobadas fueron otros factores asociados (p < 0,01). Mediante regresión logística, las variables asociadas independientemente fueron: amigos fumadores (OR:11,3; IC95%:4,2-30,9), consumo de alcohol (OR:6,9; IC95%:3,1-15,1), ausencia de práctica deportiva (OR:3,3; IC95%:1,4-7,6), mayor edad (14-15 años) (OR:2,3; IC95%:1,2-4,6) y menor nivel de estudios del padre (OR:2,0; IC95%:1,1-3,9). Conclusiones. En el consumo de tabaco en adolescentes se identifican factores de exposición relacionados con el estilo de vida, tanto personal como de padres o amigos, entre ellos la presencia de fumadores en el entorno sociofamiliar o la menor dedicación a prácticas deportivas. Por otra parte, pueden ser también factores de riesgo algunas variables sociodemográficas como el menor nivel de estudios de los padres o la mayor edad del joven.

Bismuth subsalicylate (BSS) and placebo were evaluated in a double-blind, placebo-controlled study as adjunct to rehydration therapy in 123 children, aged 4 to 28 months, hospitalized with acute diarrhea. The dosing regimen was 20 mg/kg five times daily for 5 days. Significant benefits were noted in the BSS group compared with placebo as manifested by decreases in stool frequency and stool weights and an improvement in stool consistency, significant improvement in clinical well-being, and shortening of the disease duration. Patients treated with BSS had a significant reduction in duration of hospital stay (6.9 days) compared with placebo-treated patients (8.5 days). Also, intravenous fluid requirements decreased significantly more rapidly and to a greater degree in the BSS-treated group. Bismuth subsalicylate was associated with clearance of pathogenic Escherichia coli from the stools in 100% of cases but was not different from placebo in rotavirus elimination. Bismuth subsalicylate was well tolerated with no reported adverse effects. Blood bismuth and serum salicylate levels were well below levels considered toxic. In this study, BSS provided effective adjunctive therapy for acute diarrhea, allowing children to get well sooner with less demand on the nursing and hospital staff.

In children with acute hepatic failure, it has been suggested to offer living donor transplantation to all parents when a deceased donor organ can not be provided. Ethically, living related donation is coercive by its very nature, especially in emergencies. We report a 36-year-old woman who died from a drug overdose 57 days after living donor liver resection. The recipient was her 3-year-old son, who experienced acute hepatic failure as a result of acetaminophen intoxication. A deceased donor organ had not become available within 2 days after listing. Was the death of this living donor preventable or unpreventable? Certainly if the mother had decided not to take drugs, she would not have died from an overdose. One could argue that this was her personal choice, and beyond our influence. On the other hand, if we had not performed the surgery, the recipient might have died without receiving a liver transplant in time.

OBJECTIVE. Acetaminophen cysteine protein adducts are a widely recognized correlate of acetaminophen-mediated hepatic injury in laboratory animals. The objective of this study was to use a new assay for the detection of acetaminophen cysteine protein adducts in children with acute liver failure to determine the role of acetaminophen toxicity in acute liver failure of unknown cause. METHODS. Serum samples from children with acute liver failure were measured for acetaminophen cysteine protein adducts using high-performance liquid chromatography with electrochemical detection. For comparison, samples from children with well-characterized acetaminophen toxicity and children with known other causes of acute liver failure also were measured for acetaminophen cysteine protein adducts. The analytical laboratory was blinded to patient diagnoses. RESULTS. Acetaminophen cysteine protein adduct was detected in 90% of samples from children with acute liver failure that was attributed to acetaminophen toxicity, 12.5% of samples from children with acute liver failure of indeterminate cause, and 9.6% of samples from children with acute liver failure that was attributed to other causes. Adduct-positive patients from the indeterminate cause subgroup had higher levels of serum aspartate aminotransferase and alanine aminotransferase and lower levels of bilirubin. Adduct-positive patients also had lower rates of transplantation and higher rates of spontaneous remission. CONCLUSIONS. A small but significant percentage of children with acute liver failure of indeterminate cause tested positive for acetaminophen cysteine protein adducts, strongly suggesting acetaminophen toxicity as the cause of acute liver failure. An assay for the detection of acetaminophen cysteine protein adducts can aid the diagnosis of acetaminophen-related liver injury in children.

In order to evaluate the perception of mothers on the care given to their hospitalized children, a survey was specially designed and carried out with 100 mothers on the day of their child's discharge. Hospital care was rated excellent or good by a 96%, regular or bad by 4% of surveyed mothers. Most (74%) mothers saw at least one member of the caring team acting affectionately with their children; only 2% complained that her child was reprimanded or punished. Lack of equipment or human resources and comfort facilities were frequently perceived by mothers but quality of care was generally considered to be satisfactory. This kind of studies is probably useful to improve community's health services.

Results of a pilot study suggest that bismuth subsalicylate (BSS) favorable altered the course of rotavirus-associated diarrhea in children. This was more evident in those who also had a bacterial pathogen. Subsequently 123 infants and children with acute diarrhea were admitted to a randomized parallel double-blind placebo- controlled clinical trial. Patients received either BSS at a dosage of 100 mg/(kg x d) for 5 days or a placebo. Patients in the 2 groups were comparable with respect to age sex weight height and baseline disease parameters. Compared with subjects treated with placebo those who received BSS had significantly lower stool weight sooner improved stool consistency sooner shorter hospital stay fewer number of stools decreased need for intravenous fluids and better evolution of clinical condition. The maximum mean serum level of salicylate occurred on day 3 and the mean blood level of bismuth on the last day of dosing (day 5) was 5.8 ppb. (authors)

Objectives To determine short-term outcome for children with acute liver failure (ALF) as it relates to cause, clinical status, and patient demographics and to determine prognostic factors. Study design A prospective, multicenter case study collecting demographic, clinical, laboratory, and short-term outcome data on children from birth to 18 years with ALF. Patients without encephalopathy were included if the prothrombin time and international normalized ratio remained ≥20 seconds and/or >2, respectively, despite vitamin K. Primary outcome measures 3 weeks after study entry were death, death after transplantation, alive with native liver, and alive with transplanted organ. Results The cause of ALF in 348 children included acute acetaminophen toxicity (14%), metabolic disease (10%), autoimmune liver disease (6%), non-acetaminophen drug-related hepatotoxicity (5%), infections (6%), other diagnosed conditions (10%); 49% were indeterminate. Outcome varied between patient sub-groups; 20% with non-acetaminophen ALF died or underwent liver transplantation and never had clinical encephalopathy. Conclusions Causes of ALF in children differ from in adults. Clinical encephalopathy may not be present in children. The high percentage of indeterminate cases provides an opportunity for investigation.

Limy bile syndrome (LBS) is a rare condition in which a radiopaque gallbladder and/or bile ducts are noted on plain roentgenograms. LBS is caused by calcium carbonate precipitation in the bile and is usually associated with distal biliary tract obstruction. The etiology of limy bile syndrome is unclear; however, it may be a long-term complication of total parenteral nutrition.

Along a one year period 112 infants admitted with non enterocolic acute diarrhea were studied for isolation of potentially ethiologic agents, namely enteropathogenic bacteria (Salmonella, Shigella, Campylobacter, classic enteropathogenic, enteroinvasive and enterotoxigenic Escherichia coli), Rotavirus (viral RNA electrophoresis) and enteroparasites (Telemann and PAFS). The most frequently identified pathogen was rotavirus (57.8%), followed by thermo labile toxin producing Escherichia coli (19.7%). The frequency of classic enteropathogenic Escherichia coli was 13.9%, that of thermo stable toxin producing Escherichia coli 5.7%, Shigella 4.1%, Campylobacter 3.3% and Salmonella 1.6%. Bacteriae were isolated from 40.2%, of patients, predominantly in summer. Enteroparasites were detected in 13.1% of the cases, Entamoeba histolytica being the most frequent. In 32.8% of the cases more than one pathogen was isolated.

INTRODUCCION El agua constituye entre el 60 y el 90% del peso de la mayoria de los tejidos y su importancia en los sistemas vivos es indis-cutible. El agua ha sido siempre sujeto de preocupacion y curiosidad por parte de los biologos aunque aun se dispone de muy po-co conocimiento basico sobre las caracteris­ticas del agua celular. De aqui que sea ne-cesario todavia, aceptar como validas algu-nas suposiciones fundamentales sobre el es-tado fisico del agua celular, para aceptar cualquier modelo sobre la celula viva que describa la distribution desigual de iones entre el interior y el exterior, los aspectos dinamicos del movimiento de agua y iones hacia y desde la celula y los fen6menos bio-electricos celulares. El esclarecimiento ulti­mo de estas caracteristicas de la celula viva, requerira un conocimiento mas concreto so­bre el estado fisico del agua. En los ultimos dos siglos, han emergido dos escuelas de pensamiento diferente con respecto al estado fisico del agua celular. Una de ellas es la teoria clasica mas amplia-mente aceptada, que supone convencional-mente que la celula es equivalente a una solucion acuosa diluida, rodeada de una membrana semipermeable, que sigue las le-yes osmoticas y electricas propias de las so-luciones diluidas (1-8). La otra es la teoria "holistica", mantenida persistentemente por un grupo menos numeroso de investigado-res que sostiene que el agua citoplasmatica