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Se presenta la metodología utilizada para la determinación de umbrales asociados a avenidas torrenciales en el municipio de Mocoa – Putumayo (Colombia). Estos se proponen en términos de precipitación, cota de nivel del agua (msnm) y caudal; y se obtuvieron con soporte en la modelación basada en la física de un escenario de avenida torrencial y su afectación a viviendas cercanas al cauce. Se determinaron también umbrales lluvia - deslizamiento con base en el análisis probabilístico de curvas reportadas en la literatura y su comparación con dos eventos previos ocurridos en Mocoa. Se evidencia la necesidad de la redundancia en la propuesta de los umbrales dada la alta incertidumbre epistémica y aleatoria incluida en el proceso de modelación física, la complejidad del proceso en la ocurrencia de una avenida torrencial y su posterior impacto sobre la protección de la vida, principal objetivo de la gestión del riesgo de desastres, en caso de que el sistema de alerta temprana no tenga el funcionamiento adecuado. Por primera vez se presenta un procedimiento para la generación de los umbrales para un Sistema de Alerta Temprana de avenidas torrenciales en Colombia proveniente de un análisis físico integrado articulado con análisis probabilistas de la información disponible.

Few sclerophyllous plants from the central coast of Chile have been systematically studied. This work describes the phytochemical composition and antimicrobial properties of Baccharis concava Pers. (sin. B. macraei), a shrub found in the first line and near the Pacific coast. B. concava has been traditionally used by indigenous inhabitants of today’s central Chile for its medicinal properties. Few reports exist regarding the phytochemistry characterization and biological activities of B. concava. A hydroalcoholic extract of B. concava was prepared from leaves and small branches. Qualitative phytochemical characterization indicated the presence of alkaloids, steroids, terpenoids, flavonoids, phenolic, and tannin compounds. The antimicrobial activity of this extract was assessed in a panel of microorganisms including Gram-positive bacteria, Gram-negative bacteria, and pathogenic yeasts. The extract displayed an important antimicrobial effect against Gram-positive bacteria, Candida albicans, and Cryptococcus neoformans but not against Gram-negatives, for which an intact Lipopolysaccharide is apparently the determinant of resistance to B. concava extracts. The hydroalcoholic extract was then fractionated through a Sephadex LH-20/methanol–ethyl acetate column. Afterward, the fractions were pooled according to a similar pattern visualized by TLC/UV analysis. Fractions obtained by this criterion were assessed for their antimicrobial activity against Staphylococcus aureus. The fraction presenting the most antimicrobial activity was HPLC-ESI-MS/MS, obtaining molecules related to caffeoylquinic acid, dicaffeoylquinic acid, and quercetin, among others. In conclusion, the extracts of B. concava showed strong antimicrobial activity, probably due to the presence of metabolites derived from phenolic acids, such as caffeoylquinic acid, and flavonoids, such as quercetin, which in turn could be responsible for helping with wound healing. In addition, the development of antimicrobial therapies based on the molecules found in B. concava could help to combat infection caused by pathogenic yeasts and Gram-positive bacteria, without affecting the Gram-negative microbiota.

In this experience, the design of a methodological proposal for water characterization of tropical shallow tropical wetland complexes is presented. Such methodology consists of nine steps, which are fed using the available secondary information and the primary information obtained from the work field. The final objective of the proposal is to identify the most important physical processes in the studied wetland, as much as the spatial and temporal scales that can capture their essence. The shallow tropical wetland complex of La Rinconada (Magdalena, Colombia) was chosen as a case of study, to validate the methodology, where it was established that the dominant physical processes are connected with the expansion and contraction of the water surface the interaction between the river and the main water body, through a narrow channel that connects the two hydrosystems (river and wetland) and the thermal dynamics within the lentic water body. In the same way, the characteristic scales of the mentioned processes were determined to, finally, present the characterization of the wetland complex.

AIM: To compare under similar conditions intraoperative surgical efficiencies metrics between an active fluidics and a gravity based phacoemulsification systems. METHODS: Adult patients who were diagnosed with a cataract that compromised visual acuity inferior to 20/40 were included in the study. Patients were excluded from the study if they had a history of severe retinal disorders, clinically significant corneal endothelial dystrophy or history of corneal disease. All phacoemulsification surgeries were performed by a single surgeon. Both phacoemulsification systems used the 0.9 mm 45-degree aspiration bypass system Intrepid Balanced tip and the 0.9 mm Intrepid Ultra infusion sleeve. All cataracts were classified using the Lens Opacities Classification System III, cumulative dissipated energy (CDE) and aspiration fluids were measured in each surgery. RESULTS: Totally 2000 eyes were included in the study. Phacoemulsification was performed in 1000 (50%) eyes with an active fluid dynamics system and in 1000 (50%) eyes with a gravity-based fluidic system. Mean CDE until fracture of the lens was 1.1 and 1.9 percent-seconds and total mean CDE used was 5.6 and 7.2 percent-seconds using an active fluidics dynamics system and gravity-based fluidic system, respectively (P

Attention deficit-hyperactivity disorder (ADHD) is a neurodevelopmental disorder with high incidence in children and adolescents characterized by motor hyperactivity, impulsivity, and inattention. Magnetic resonance imaging (MRI) has revealed that neuroanatomical abnormalities such as the volume reduction in the neocortex and hippocampus are shared by several neuropsychiatric diseases such as schizophrenia, autism spectrum disorder and ADHD. Furthermore, the abnormal development and postnatal pruning of dendritic spines of neocortical neurons in schizophrenia, autism spectrum disorder and intellectual disability are well documented. Dendritic spines are dynamic structures exhibiting Hebbian and homeostatic plasticity that triggers intracellular cascades involving glutamate receptors, calcium influx and remodeling of the F-actin network. The long-term potentiation (LTP)-induced insertion of postsynaptic glutamate receptors is associated with the enlargement of spine heads and long-term depression (LTD) with spine shrinkage. Using a murine model of ADHD, a delay in dendritic spines’ maturation in CA1 hippocampal neurons correlated with impaired working memory and hippocampal LTP has recently reported. The aim of this review is to summarize recent evidence that has emerged from studies focused on the neuroanatomical and genetic features found in ADHD patients as well as reports from animal models describing the molecular structure and remodeling of dendritic spines.

Household survey data from 27 sites in 22 countries were collected in 2017–2018 in order to construct and validate a cross-cultural household-level water insecurity scale. The resultant Household Water Insecurity Experiences (HWISE) scale presents a useful tool for monitoring and evaluating water interventions as a complement to traditional metrics used by the development community. It can also help track progress toward achievement of Sustainable Development Goal 6 ‘clean water and sanitation for all’. We present HWISE scale scores from 27 sites as comparative data for future studies using the HWISE scale in low- and middle-income contexts. Site-level mean scores for HWISE-12 (scored 0–36) ranged from 1.64 (SD 4.22) in Pune, India, to 20.90 (7.50) in Cartagena, Colombia, while site-level mean scores for HWISE-4 (scored 0–12) ranged from 0.51 (1.50) in Pune, India, to 8.21 (2.55) in Punjab, Pakistan. Scores tended to be higher in the dry season as expected. Data from this first implementation of the HWISE scale demonstrate the diversity of water insecurity within and across communities and can help to situate findings from future applications of this tool. HIGHLIGHTS We present comparison scores of the Household Water Insecurity Experiences (HWISE) scale, a novel household water insecurity index validated for use in low- and middle-income countries.; These scores can aid interpretation of future implementation of the HWISE scale.; The HWISE scale should still be evaluated in new contexts, such as high-income settings.;

Medicinal plants have been used since prehistoric times and continue to treat several diseases as a fundamental part of the healing process. Inflammation is a condition characterized by redness, pain, and swelling. This process is a hard response by living tissue to any injury. Furthermore, inflammation is produced by various diseases such as rheumatic and immune-mediated conditions, cancer, cardiovascular diseases, obesity, and diabetes. Hence, anti-inflammatory-based treatments could emerge as a novel and exciting approach to treating these diseases. Medicinal plants and their secondary metabolites are known for their anti-inflammatory properties, and this review introduces various native Chilean plants whose anti-inflammatory effects have been evaluated in experimental studies. Fragaria chiloensis, Ugni molinae, Buddleja globosa, Aristotelia chilensis, Berberis microphylla, and Quillaja saponaria are some native species analyzed in this review. Since inflammation treatment is not a one-dimensional solution, this review seeks a multidimensional therapeutic approach to inflammation with plant extracts based on scientific and ancestral knowledge.

Phylloicus bromeliarium (Trichoptera: Calamoceratidae) es registrada por primera vez en Venezuela. Larvas de esta especie fueron recolectadas en brácteas de la fitotelmata Guzmania cylindrica (Bromeliaceae), dentro de un bosque nublado a 2000 m.s.n.m.

Abstract Background There are many high-volume trauma centers in limited resource environments where a thorough clinical examination of patients may contribute to a more economical, accurate, and widely applicable method of determining the proper management of patients with penetrating neck injuries. The purpose of this study was to validate thorough physical examination as a reliable diagnostic tool in these patients. Methods We performed an observational retrospective study of a diagnostic accuracy test where we compared clinical findings (symptoms and soft signs on admission of the patient) with the definitive findings according to the gold standard test for each particular situation (selective studies, clinical observation and surgical exploration). The study was conducted at Hospital Occidente Kennedy (HOK) between August 2009 and June 2010. Results The sample consisted of the clinical records of 207 (n = 207) patients who went to the emergency room for penetrating neck wounds at Hospital Occidente Kennedy (HOK). Of the total sample, 36.2% (n = 75) of patients were considered “asymptomatic” as they didn’t present with any soft signs of injury. Vascular soft signs were present in 57% (n = 118) of the patients, soft signs of the airway and the upper gastrointestinal tract were present in 15.9% (n = 33) and 21.3% (n = 44) of the patients respectively. The sensitivity and negative predictive value (NPV) of any soft sign to determine injuries which require surgical repair was 97.4% [CI] [86.5–99.5%] and 98.7% [CI] [92.8–99.8%] respectively, with a range of confidence [CI] of 95%. Conclusions Our study’s main findings suggest that patients with neck injuries and no vascular, airway, or gastrointestinal soft sign can be safely managed with a conservative approach. It is important to emphasize the value of the clinical examination since there are many contexts in the modern world where a considerable amount of the population is afflicted by neck trauma and treated under conditions where technological resources are limited.

Se analizó una comparación entre la resección anterior y la resección abdominoperineal para el tratamiento de! cáncer del recto, en términos de recurrencia local y sobrevida a 5 años; igualmente se compararon en el grupo de la primera técnica mencionada, los casos de anastomosis manuales y mecánicas.

Characterization of allelic variants is relevant to demonstrate associations among genetic background and susceptibility to develop cardiovascular diseases, which are the main cause of death in Chile. Association of APOB, APOE, and MTHFR polymorphisms with higher lipid levels and the risk of developing hypertension and cardiovascular diseases have been described. Thus, the aim of this study was to assess genotype distribution and relative allelic frequency of ApoB rs693, ApoE rs7412, ApoE rs429358, MTHFR rs1801131, and MTHFR rs1801133 allelic variants and their effects on lipid profile in young healthy men and women from Northern Chile. A group of 193 healthy subjects were enrolled for this study. Genotyping of rs693 (APOB), rs7412 and rs429358 (APOE), and rs1801131 and rs1801133 (MTHFR) polymorphisms were performed by real time PCR. In addition, lipid profiles were determined and associated to genetic data. The genotype distribution was APOB rs693 (CC = 37%, CT = 41%, and TT = 22%), APOE rs7412/rs429358 (E4 = 0.06, E3 = 0.91, and E2 = 0.03), MTHFR rs1801131 (AA = 57%, AC = 30%, and CC = 13%), and MTHFR rs1801133 (CC = 20%, CT = 47%, and TT = 33%). The association of the genetic variants with plasma lipid levels showed that women, but not men, carrying APOB mutated allele (T) and Apo E4 allele presented lower values of total cholesterol when compared with C/C homozygous genotype or E3 allele, respectively (p < 0.05). In addition, a subgroup analysis revealed that ApoB C/C homozygous women exhibited higher values of HDL-C when compared with men carrying identical genotype (p < 0.01). On the other hand, women carrying E4 allele exhibited lower values of triglycerides when compared with male carrying identical genotype (p < 0.05). Finally, women carrying mutate allele (C) for MTHFR rs1801131 showed lower levels of triglycerides when compared with A/A homozygous genotype (p < 0.05) and lower levels of LDL-C for MTHFR rs1801133 in females carrying (T) allele when compared with males carrying identical genotype (p < 0.05). In summary, the present data showed that APOB, APOE, and MTHFR single nucleotide polymorphisms are associated to lipid levels in a gender-dependent manner among healthy subjects from Northern Chile, especially in women.

BackgroundCardiac rehabilitation programs, consisting of exercise training and disease management interventions, reduce morbidity and mortality after acute myocardial infarction. ObjectiveIn this pilot study, we aimed to developed and assess the feasibility of delivering a health watch–informed 12-week cardiac telerehabilitation program to acute myocardial infarction survivors who declined to participate in center-based cardiac rehabilitation. MethodsWe enrolled patients hospitalized after acute myocardial infarction at an academic medical center who were eligible for but declined to participate in center-based cardiac rehabilitation. Each participant underwent a baseline exercise stress test. Participants received a health watch, which monitored heart rate and physical activity, and a tablet computer with an app that displayed progress toward accomplishing weekly walking and exercise goals. Results were transmitted to a cardiac rehabilitation nurse via a secure connection. For 12 weeks, participants exercised at home and also participated in weekly phone counseling sessions with the nurse, who provided personalized cardiac rehabilitation solutions and standard cardiac rehabilitation education. We assessed usability of the system, adherence to weekly exercise and walking goals, counseling session attendance, and disease-specific quality of life. ResultsOf 18 participants (age: mean 59 years, SD 7) who completed the 12-week telerehabilitation program, 6 (33%) were women, and 6 (33%) had ST-elevation myocardial infarction. Participants wore the health watch for a median of 12.7 hours (IQR 11.1, 13.8) per day and completed a median of 86% of exercise goals. Participants, on average, walked 121 minutes per week (SD 175) and spent 189 minutes per week (SD 210) in their target exercise heart rate zone. Overall, participants found the system to be highly usable (System Usability Scale score: median 83, IQR 65, 100). ConclusionsThis pilot study established the feasibility of delivering cardiac telerehabilitation at home to acute myocardial infarction survivors via a health watch–based program and telephone counseling sessions. Usability and adherence to health watch use, exercise recommendations, and counseling sessions were high. Further studies are warranted to compare patient outcomes and health care resource utilization between center-based rehabilitation and telerehabilitation.

Niña de 3 años, con peso de 14 kg y antecedentes de episodios de neumonía adquirida en la comunidad y comunicación interauricular. En la exploración física se encuentra a la auscultación un soplo sistólico de grado II/IV en foco pulmonar y desdoblamiento del segundo ruido cardiaco.

Introduction Water fetching for household needs can cause injury, but documentation of the burden of harm globally has been limited. We described the frequency, characteristics and correlates of water-fetching injuries in 24 sites in 21 low-income and middle-income countries in Asia, Africa and Latin America and the Caribbean.Methods In a survey of 6291 randomly selected households, respondents reported whether and how they had experienced water-fetching injuries. Responses were coded for injury type, mechanism, bodily location and physical context. We then identified correlates of injury using a multilevel, mixed-effects logistic regression model.Results Thirteen per cent of respondents reported at least one water-fetching injury. Of 879 injuries, fractures and dislocations were the most commonly specified type (29.2%), and falls were the most commonly specified mechanism (76.4%). Where specified, 61.1% of injuries occurred to the lower limbs, and dangerous terrain (69.4%) was the most frequently reported context. Significant correlates included being female (aOR=1.50, 95% CI 1.15 to 1.96); rural (aOR=4.80, 95% CI 2.83 to 8.15) or periurban residence (aOR=2.75, 95% CI 1.64 to 4.60); higher household water insecurity scores (aOR=1.09, 95% CI 1.07 to 1.10) and reliance on surface water (aOR=1.97, 95% CI 1.21 to 3.22) or off-premise water sources that required queueing (aOR=1.72, 95% CI 1.19 to 2.49).Conclusion These data suggest that water-fetching injuries are an underappreciated and largely unmeasured public health challenge. We offer guidelines for comprehensive data collection on injuries to better capture the true burden of inadequate water access. Such data can guide the design of interventions to reduce injury risk and promote equitable water access solutions.

En este artículo se indaga por las imágenes de la ciencia en las novelas históricas El nuevo reino (Estupiñan 2008) y La francesa de Santa Bárbara(Peláez 2009), como un acercamiento a la relación entre mujer y ciencia en Santafé de Bogotá en el Virreinato de la Nueva Granada a finales del siglo XVIII y comienzos del siglo XIX. El análisis apela a categorías de la teoría y la crítica literaria, como la propia categoría de novela histórica, pero también a otras provenientes de la historia de la ciencia y los estudios de la divulgación científica. La pregunta, abordada desde la dicotomía entre mujeres de ciencia y mujeres en la ciencia, es si estas novelas funcionan como medios para propagar las narrativas dominantes sobre el lugar de la mujer en la historia de la ciencia neogranadina o como críticos de esas mismas narrativas.

The human Respiratory Syncytial Virus (hRSV) is the leading cause of severe acute lower respiratory tract infections (ALRTIs) in humans at all ages and is the main cause of hospitalization due to pneumonia, asthma, and bronchiolitis in infants. hRSV symptoms mainly develop due to an excessive host immune and inflammatory response in the respiratory tissue. hRSV infection during life is frequent and likely because of non-optimal immunological memory is developed against this virus. Vaccine development against this pathogen has been delayed after the detrimental effects produced in children by vaccination with a formalin-inactivated hRSV preparation (FI-hRSV), which caused enhanced disease upon natural viral infection. Since then, several studies have focused on understanding the mechanisms underlying such disease exacerbation. Along these lines, several studies have suggested that antibodies elicited by immunization with FI-hRSV show low neutralizing capacity and promote the formation of immune complexes containing hRSV (hRSV-ICs), which contribute to hRSV pathogenesis through the engagement of Fc gamma receptors (FcγRs) expressed on the surface of immune cells. Furthermore, a role for FcγRs is supported by studies evaluating the contribution of these molecules to hRSV-induced disease. These studies have shown that FcγRs can modulate viral clearance by the host and the inflammatory response triggered by hRSV infection. In addition, ICs can facilitate viral entry into host cells expressing FcγRs, thus extending hRSV infectivity. In this article, we discuss current knowledge relative to the contribution of hRSV-ICs and FcγRs to the pathogenesis caused by hRSV and their putative role in the exacerbation of the disease caused by this virus after FI-hRSV vaccination. A better understanding FcγRs involvement in the immune response against hRSV will contribute to the development of new prophylactic or therapeutic tools to promote virus clearance with limited inflammatory damage to the airways.

Introduction A wide range of water-related problems contribute to the global burden of disease. Despite the many plausible consequences for health and well-being, there is no validated tool to measure individual- or household-level water insecurity equivalently across varying cultural and ecological settings. Accordingly, we are developing the Household Water Insecurity Experiences (HWISE) Scale to measure household-level water insecurity in multiple contexts.Methods and analysis After domain specification and item development, items were assessed for both content and face validity. Retained items are being asked in surveys in 28 sites globally in which water-related problems have been reported (eg, shortages, excess water and issues with quality), with a target of at least 250 participants from each site. Scale development will draw on analytic methods from both classical test and item response theories and include item reduction and factor structure identification. Scale evaluation will entail assessments of reliability, and predictive, convergent, and discriminant validity, as well as the assessment of differentiation between known groups.Ethics and dissemination Study activities received necessary ethical approvals from institutional review bodies relevant to each site. We anticipate that the final HWISE Scale will be completed by late 2018 and made available through open-access publication. Associated findings will be disseminated to public health professionals, scientists, practitioners and policymakers through peer-reviewed journals, scientific presentations and meetings with various stakeholders. Measures to quantify household food insecurity have transformed policy, research and humanitarian aid efforts globally, and we expect that an analogous measure for household water insecurity will be similarly impactful.

A agricultura de precisão é uma importante ferramenta para maximizar a produção. Nela mapas de produtividade indicam a localização de áreas críticas, ajudando a fazer intervenções localizadas, a fim de aumentar a produtividade e consequentemente a rentabilidade. Objetivou-se avaliar a variabilidade espacial da produtividade, perdas quantitativas na colheita mecanizada e a lucratividade em área de produção de soja. Realizou-se um levantamento de dados georreferenciados em uma área de 20,90 ha. Foram utilizadas técnicas geoestatísticas para a determinação da variabilidade espacial. A dependência espacial foi moderada para todos os parâmetros estudados, observando-se regiões com maior ou menor variabilidade espacial na produtividade, nas perdas quantitativas de grãos e na lucratividade. A produtividade média foi de 3.748,63 kg.ha-1 e 67,65 % da área total apresentou patamares de produtividade de 3.254,05 a 3.609,91 kg.ha-1 e de 3.609,91 a 3.965,91 kg.ha-1. As perdas totais de grãos encontrados por ocasião da colheita foram baixas (49,59 kg.ha-1). A lucratividade média foi 1.252,54 $.ha-1, com duas regiões representativas de lucro de 1.187,20 a 1.354,78 $.ha-1 e de 1.019,62 a 1.187,20 $.ha-1, correspondente a 67,65 % da área total. Pode-se dizer que a semelhança na variabilidade espacial dos mapas de produtividade e lucratividade ocorre por este último ter sido confeccionado a partir de dados de produtividade, o que permitiria ao produtor investigar os motivos das baixas produtividades, sugerindo eventualmente um estudo da fertilidade do solo, no intuito de encontrar e corrigir o problema que levou às baixas produtividades, a fim de melhorar a relação custo/benefício, tendo como resultado um maior lucro.

Introduction. Hepatocellular carcinoma is the most common primary tumor of the liver and is diagnosed in more than a half million people worldwide each year. This study aims to assess factors associated with the recurrence and survival of patients with hepatocellular carcinoma and liver transplantation in a cohort of patients from Medellín, Colombia.Material and methods. This was a descriptive retrospective study of a consecutive series of liver transplant patients from the Pablo Tobon Uribe Hospital of Medellín from January 2004 to May 2013. Demographic, clinical, imaging, and pathology variables were analyzed.Results. Three hundred thirty liver transplants were performed during the study period, 54 cases (16.4%) had one or more hepatocellular carcinomas in the explant, and 79.6% of these patients were men. Cirrhotic patients had different etiologies, but most of them were due to alcohol abuse (22.2%), followed by hepatitis B virus infection (20.4 %), and hepatitis C virus infection (18.5%). In the pathology specimen, 51.9% had only one focus of hepatocellular carcinoma, 22.2% had two foci and 12.9% had three tumors. Recurrence of hepatocellular carcinoma occurred in 7.4% patients with an average time of 81 months. During follow-up, 25.9% of the patients died in an average time of 67.9 months (CI95 59.1-80.1 months).Conclusion. Recurrence and survival of patients with liver transplantation for hepatocellular carcinoma in this study had a similar behavior as that reported in the world literature. The factors associated with these outcomes were vascular invasion, poor tumor differentiation and satellitosis.

The gut and the brain communicate bidirectionally through anatomic and humoral pathways, establishing what is known as the gut–brain axis. Therefore, interventions affecting one system will impact on the other, giving the opportunity to investigate and develop future therapeutic strategies that target both systems. Alterations in the gut–brain axis may arise as a consequence of changes in microbiota composition (dysbiosis), modifications in intestinal barrier function, impairment of enteric nervous system, unbalanced local immune response and exaggerated responses to stress, to mention a few. In this review we analyze and discuss several novel pharmacological targets within the gut–brain axis, with potential applications to improve intestinal and mental health.

Ceratitis capitata es una de las principales plagas de la fruticultura mundial y en Argentina es la Mosca de los Frutos de mayor abundancia y distribución. El desarrollo de una trampa artificial de oviposición, puede ser una herramienta útil de monitoreo para hembras grávidas. El objetivo de este trabajo fue evaluar la capacidad atrayente para la oviposición de C. capitata sobre esferas de agar de color amarillo, rojo, verde, negro y sin color; en condiciones de laboratorio. Se observaron diferencias estadísticamente significativas, siendo las esferas rojas y negras las más atractivas sobre las verdes, amarillas y sin color. En laboratorio, la mayor atracción alcanzada por el rojo y negro sustentaría la hipótesis de que el fuerte contraste respecto al fondo incrementaría la atracción de los colores más oscuros.

A nivel mundial, existe una tendencia orientada a la gerencia de los procesos como metodología apropiada para lograr plenamente la satisfacción del cliente. Todas las teorías y herramientas que apuntan en este sentido, aportan mejoras. Acorde con esta orientación, este artículo se propone explorar algunas teorías o métodos de aplicación dentro del ámbito de la gestión por procesos, propuesta administrativa que tiene entre sus antecedentes, a la teoría de la contingencia, la gestión integral, y la organización horizontal.Estas últimas coinciden en algunos aspectos de la metodología y conducen al concepto de organización por procesos. No se pretende en este texto, establecer prioridades o calificar como mejores a algunas de las metodologías expuestas. Se invita al lector a que identifique qué es lo más práctico en su organización a través de la comparación de las diferentes tendencias.There is a worldwide trend to use process-oriented management as an appropriate methodology to fully satisfy customer’s needs. All theories and tools than focus on this matter, propose even better improvements. Accordingly, the purpose of this article is to explore some theories or methods used into process management area, an administrative proposal who have among its predecessors, contingency theory, the integral management, reaching up to the horizontal organization These proposals coincide in some methodological aspects, and, lead to process organization concept. This text does not pretend to establish some priorities or to assess some methodologies as the better ones. The reader is invited to identify what ideas are more practical to his own organization through comparison of the different trends.

Carrion’s disease (CD), is a human bartonellosis, that is, endemic in the Andes of Peru, Ecuador, and Colombia. Bartonella bacilliformis, a native hemotrophic bacteria, is the causative agent of CD, and the interaction with the host could have produced changes in the gene frequencies of erythrocyte antigens. The goal here is to investigate the relationship between allele frequencies of blood group systems MNS, Diego, and Duffy and the clinical phases of CD, within a genetic context. In this associative and analytical study, 76 individuals from Bagua Grande, the province of Utcubamba, and the department of Amazonas in Peru, were enrolled. Forty of them resided in Tomocho-Collicate-Vista Hermosa area (high prevalence of cases in chronic phase, verrucous, or eruptive phase, without previous acute phase). Thirty-six individuals were from the area of Miraflores (high prevalence of cases in acute phase only) and were evaluated for blood group systems MNS, Diego, and Duffy. This study constitutes one of the first attempts at evaluating the genetic factors and clinical phases of CD. No significant statistical differences (P>0.05) between allele frequencies of blood groups MNS, Diego, and Duffy and the prevalence of chronic and acute phases were detected in the two areas of Amazonas, Peru.

The purinergic P2X7 receptor (P2X7R) plays an important role during the immune response, participating in several events such as cytokine release, apoptosis, and necrosis. The bacterial endotoxin lipopolysaccharide (LPS) is one of the strongest stimuli of the immune response, and it has been shown that P2X7R activation can modulate LPS-induced responses. Moreover, a C-terminal binding site for LPS has been proposed. In order to evaluate if LPS can directly modulate the activity of the P2X7R, we tested several signaling pathways associated with P2X7R activation in HEK293 cells that do not express the TLR-4 receptor. We found that LPS alone was unable to induce any P2X7R-related activity, suggesting that the P2X7R is not directly activated by the endotoxin. On the other hand, preapplication of LPS inhibited ATP-induced currents, intracellular calcium increase, and ethidium bromide uptake and had no effect on ERK activation in HEK293 cells. In splenocytes-derived T-regulatory cells, in which ATP-induced apoptosis is driven by the P2X7R, LPS inhibited ATP-induced apoptosis. Altogether, these results demonstrate that LPS modulates the activity of the P2X7R and suggest that this effect could be of physiological relevance.

Arsenic has been associated with multiple harmful effects at the cellular level. Indirectly these defects could be related to impairment of the integrity of the immune system, in particular in lymphoid population. To characterize the effect of Arsenic on redox status on this population, copper smelter workers and arsenic unexposed donors were recruited for this study. We analyzed urine samples and lymphocyte enriched fractions from donors to determinate arsenic levels and lymphocyte proliferation. Moreover, we studied the presence of oxidative markers MDA, vitamin E and SOD activity in donor plasma. Here we demonstrated that in human beings exposed to high arsenic concentrations, lymphocyte MDA and arsenic urinary levels showed a positive correlation with SOD activity, and a negative correlation with vitamin E serum levels. Strikingly, lymphocytes from the arsenic exposed population respond to a polyclonal stimulator, phytohemaglutinin, with higher rates of thymidine incorporation than lymphocytes of a control population. As well, similar in vitro responses to arsenic were observed using a T cell line. Our results suggest that chronic human exposure to arsenic induces oxidative damage in lymphocytes and could be considered more relevant than evaluation of T cell surveillance.

En el cáncer de la cavidad abdominal, la posibilidad de ofrecer un tratamiento con intención curativa se basa en la adecuada selección de los casos, mediante el establecimiento de la clasificación tumoral prequirúrgica y la determinación de la viabilidad de la resección completa; esta base del enfoque terapéutico debe mantenerse en la introducción de nuevas técnicas. La cirugía mínimamente invasiva, mediante el desarrollo de instrumentos V el mejoramiento de las técnicas quirúrgicas ha ganado terreno en su implementación como opción terapéutica en casos seleccionados de cáncer. Sin embargo, la imposibilidad de contacto directo con los órganos comprometidos constituye una situación en la cual la cirugía video asistida mantiene una distancia con los procedimientos tradicionales. La posibilidad de evaluar más detalladamente el compromiso tumoral, afín de establecer la irresecabilidad de las lesiones sin necesidad de grandes incisiones y disecciones, ofrece una mejoría en el abordaje de estos pacientes al disminuir el número de laparotomías innecesarias que pudieran reducir la ocurrencia de complicaciones postoperatorias. Con la introducción del ultrasonido en los procedimientos de cirugía video asistida, se ha mejorado la objetividad de la evaluación intraoperatoria con menor trauma para el paciente, razón por la cual el ultrasonido laparoscópico ha ganado espacio no sólo como herramienta diagnóstica, sino como método de clasificación de las lesiones tumorales del abdomen, con una alta sensibilidad y especificidad. Sin embargo, una tecnología en desarrollo que requiere experiencia y práctica continua del médico que pretende su implementación.

Se presentan los resultados de un estudio descriptivo retrospectivo con 109 pacientes tratados quirúrgicamente por carcinoma gástrico temprano, en el servicio de Gastroenterología y Endoscopia del Instituto Nacional de Cancerología, en el período comprendido entre enero de 1981 y diciembre de 1995. Durante este lapso el cáncer gástrico presenta un incremento en su incidencia, del 5.1 % en 1981 al 8.4% en 1995. Los 109 pacientes representan el 2,5% de los 4.480 pacientes con Cáncer Gástrico tratados en el lapso anotado. El promedio de seguimiento fue de 5.2 años. Un paciente de los 34 con compromiso exclusivo de la mucosa presentaba metástasis ganglionares (3%) y en 18 de 75 pacientes con compromiso de la submucosa (24%). La variedad histológica más frecuente fue la intestinal, en 53%, difusa en 26%, y mixta en 21%. El diámetro promedio de la lesión fue de 2.4 cm. Se practicaron 94 gastrectomías subtotales y 15 totales; la mortalidad postoperatoria fue del 2.8% y la morbilidad, del 7.3%, ocasionada en 3 pacientes por infecciones de la herida quirúrgica, en otros 2 por infección urinaria, en 1 por neumonía basal, en uno por derrame pleural y en 1 paciente por sangrado perianastomótico. La sobrevida general a 5 años jue del 92%, y en los pacientes con metástasis ganglionares esta sobrevida fue del 68% (p=0.023). Se evaluó el grado de penetración del tumor y la variedad histológica con respecto a la sobrevida, sin encontrarse una diferencia significativa.

Se presenta un grupo de 82 pacientes con neoplasias malignas de la región anal, tratados en el servicio de Gastroenterología del Instituto Nacional de Cancerología (lNC), en el período comprendido entre 1935 y 1981. Se revisa la literatura, haciendo énfasis en la anatomía de la región anal. lo frecuencia de las distintas neoplasias. sintomatología, lesiones precancerosas y diferentes tipos de tratamiento. Los hallazgos fueron 69 casos con carcinoma escamo celular. 6 con carcinomas cloacogénico, 3 adenocarcinomas, 3 melanomas y un Ca basocelular. Se estableció que la sobrevida fue inversamente proporcional al tamaño y compromiso de la circunferencia anal. Se plantea un protocolo de tratamiento con quimioterapia y radioterapia Combinadas para los carcinomas escamo celulares. de acuerdo con el tamaño de la lesión y el compromiso circunferencial anal, reservando la cirugía como procedimiento de rescate.

Ha sido dolorosa nuestra experiencia al ver morir pacientes jóvenes en forma más o menos inesperada, cuando creíamos que los tratamientos que estábamos usando darían buenos resultados. Así en el año de 1955 murió una de nuestras pacientes toxémicas, y a comienzos de 1958 otra murió sin que esperáramos resultados fatales. La autopsia de estas pacientes reveló la presencia de infecciones causadas por Clostridium Welchii.

Ha sido ampliamente reconocida la asociación clínica de la abruptio placentae, con la toxemia del embarazo. Los cambios histológicos que sufren el útero y la placenta en estas afecciones concentran la atención de los investigadores. Se busca la posible relación que exista entre las lesiones en estos órganos y la evolución clínica de este gran accidente del embarazo. Igualmente se investiga la relación existente entre las lesiones macroscópicas de estos órganos y las lesiones microscópicas, en especial los cambios degenerativos de la fibra uterina y de la estructura de la placenta.

Ha sido un gran acierto de la Sociedad Colombiana de Obstetricia y Ginecología escoger la Mortalidad Peri-Natal como tema oficial de este Congreso, ya que el interés sobre el problema lo ha vuelto objeto principal de discusión, no sólo en los medios médicos y biológicos, sino también en los socio-económicos mundiales.

Algunos miembros del personal docente del Departamento de Obstetricia y Ginecología de la Facultad de Medicina de la Universidad del Valle, presentan a esta Convención informes preliminares sobre la manera como se están estudiando los problemas de la toxemia en el hospital docente de la Facultad.

Observaciones bastante frecuentes nos han demostrado la facilidad con que las pacientes toxémicas presentan colapso vasomotor inmediatamente después del parto o en las primeras horas del puerperio. Con más frecuencia lo hemos encontrado después de los partos intervenidos (cesárea, fórceps), asi como en los partos prolongados. Los recientes estudios presentados por H. J. Tatum y J. G. Mulé, de New Orleans, nos han demostrado su etiología, y han despertado nuestro interés por este problema, que aunque no muy frecuente es grave.

La tricomoniasis vaginal es muy frecuente en nuestro medio, ya que muestra una incidencia del 13% en las pacientes examinadas en edad reproductiva en la Consulta Externa de Ginecología del Hospital Universitario del Valle. Otros países indican una incidencia del 20 al 30% entre mujeres adultas.