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Introducción: El síndrome del músculo piramidal constituye el conjunto de signos y síntomas originados por la compresión del nervio ciático en su salida de la pelvis a través del canal situado entre el músculo piramidal y el gémino superior. Se presenta una serie de casos de pacientes oncológicos con este síndrome con el objetivo de describir el resultado terapéutico de la infiltración con esteroides en el músculo piramidal sin hidrodisección perineural del ciático. Métodos: Se realizó un estudio prospectivo de 10 casos, evaluados entre Febrero de 2014 y Mayo del 2015, en el servicio de dolor y cuidados paliativos del Instituto Oncológico Nacional “Dr. Juan Tanca Marengo”-Solca-Guayaquil. Ingresaron al estudio pacientes con cáncer de cualquier etiología y criterios diagnósticos de síndrome piramidal. Los pacientes fueron tratados con infiltraciones de corticoides sin hidrodisección perineural del ciático, dirigidas por ultrasonido del músculo piramidal afecto y terapia física. Resultados: Se incluyen 10 casos de pacientes con síndrome piramidal (9 mujeres). Con rangos de edad que entre 50 y 70 años. El lado afectado con mayor frecuencia fue el derecho en 5 casos. En 8 casos la Resonancia magnética fue normal y en 2 casos se describió hipertrofia muscular. El procedimiento de infiltración se realizó sin complicaciones y los pacientes recibieron adicionalmente fisioterapia. El EVA inicial fue > 6 en 8 pacientes y 2 casos con EVA de 5. Los pacientes tuvieron una limitación funcional de un 10-20 %. El EVA postbloqueo disminuyó hasta 0-1 en todos los casos. Conclusión: En la presente serie de casos el síndrome piramidal fue controlado satisfactoriamente con infiltración de esteroides sin hidrodisección perineural del ciático y terapia física.

El artículo analiza la intervención llevada a cabo en el alcázar del conjunto fortificado de La Guardia, de origen islámico, con sucesivas trasformaciones en época cristiana y en el periodo renacentista, en el que cambia su uso a residencia señorial. Después de un periodo de intervenciones inconexas con criterios dispares, algunas de ellas sin acabar, el castillo se encontraba sin uso y con difícil acceso por sus condiciones de mantenimiento. La intervención se ha basado en la conservación de lo existente, poniendo en valor su compleja estratificación, consecuencia de las diversas mutaciones, añadidos y superposiciones históricas, y a la vez en la adecuación de espacios y recuperación de accesos y recorridos para permitir su uso cultural, compatible con la visita turística.

Objetivo: Describir el uso de la terapia de presión negativa con (TPNi) y sin instilación (TPNs) como tratamiento adyuvante en el manejo de infecciones asociadas a dispositivo ortopédico (IADO). Método: Estudio observacional analítico de expedientes de pacientes con IADO manejados con TPNi y TPNs con solución salina al 0.9%, mayores de 18 años, operados en el periodo 2018-2021. Se evaluaron las características clínicas de infección, el agente infeccioso y las variables sociodemográficas. La TPN se realizó con sistema V.A.C.VERAFLO™. Para los análisis se emplearon las pruebas χ2, Fisher y t de Student. Valor estadísticamente aceptado: p < 0.05. Resultados: La muestra fue de 40 pacientes, el 75% masculinos. Fracturas: 42.5% expuestas y 57.5% cerradas. En el 92.5% se aplicó antibiótico profiláctico (30-120 min). Implantes: 35% placas, 12.5% clavo centromedular, 10% prótesis de rodilla y 12.5% cadera. El 47.5% con sangrado < 500 ml. En el 72.5% un tiempo quirúrgico de 2-4 horas. Tiempo de hospitalización previa: TPNs 3 semanas 55.9% y 4 semanas 26.5%; TPNi 3 semanas 50% y 4 semanas 33.3%. Conservación del implante: 73.5% TPNs y 50% TPNi (p = 0.341). Cierre de herida: 91.2% con TPNs y 100% con TPNi (p = 1.000). Conclusiones: El uso de TPNs y TPNi fue útil como tratamiento adyuvante en IADO, y además permitieron conservar el implante y el cierre de la herida en la mayoría de los pacientes.

Editorial

Introduction: To understand the sick leave situation and the causes and effects of a temporary loss of capacity to work allows for the strengthening of policies and management in the provision of health services. Objective: To analyze sick leave in Colombia in the 2016–2018 period. Materials and methods: A retrospective cross-sectional observational study and the relative risk was calculated. Sick leave reports were provided by the Ministry of Health and Social Protection. 12,410,837 reports from formal workers between the ages of 18–70 years and had at least one temporary disability were processed. Results: The average age of people with sick leave was 37.11 years, 53% corresponding to females. On average, sick leave was 90.6% and 5.6% for dependent and independent workers, respectively. The principal causes of disability were musculoskeletal diseases and were more likely in men and adults according to RR. Men in comparison to females and adults in comparison to youths are less likely to have sick leave due to respiratory disease. Conclusions: In Colombia, females presented more temporary sick leave, even if males had more days of disability, even though the median was three days in both genders. Youth and adults had more sick leave days.

Se analizan los depósitos de tormenta de dos secciones estratigráficas de la Formación Vaca Muerta (Tithoniano-Valanginiano) en el área de Bardas Blancas, sur de la provincia de Mendoza. Estos depósitos incluyen: a) depósitos con estratificación entrecruzada de bajo ángulo; b) depósitos con estratificación entrecruzada hummocky de pequeña y gran escala; y c) depósitos laminados con gradación normal intralámina. Las secuencias completas con HCS están compuestas por tres unidades (Sa, Sb y Sc) asociadas al evento de tormenta y una unidad que incluye depósitos de post-tormenta y de buen tiempo (Sd). La comparación con ejemplos actuales y ejemplos del registro, permite estimar un rango batimétrico de 25 a 50 m para los depósitos con estratificación entrecruzada hummocky. Asimismo se discuten posibles orígenes alternativos relacionados con inestabilidades en la interfase de la picnoclina y los efectos de la compactación sobre la preservación de las texturas y estructuras primarias de los depósitos de la Formación Vaca Muerta.

El objetivo de este trabajo es determinar el impacto en la economía colombiana de la producción de petróleo y carbón durante el periodo 1990-2011 y valorar de qué modo la diferente especialización en su aprovechamiento explica los desniveles del valor agregado bruto por persona ocupada observados entre las distintas regiones colombianas. Los resultados, obtenidos mediante la técnica de datos de panel, ponen de manifiesto que la dotación de petróleo y carbón contribuye positivamente a la producción colombiana y que su distinta especialización entre regiones explica 8.14% y 3.32%, respectivamente, de las diferencias del valor agregado bruto por persona ocupada entre las regiones colombianas.

Con el objetivo de estimar el secuestro de carbono en la biomasa aérea de un sistema agrosilvopastoril (sasp) compuesto por cocotero (Cocos nucifera), Leucaena leucocephala Var. Cunningham sembrada en alta densidad y Pennisetum purpureum Cuba CT-115, se llevó a cabo un estudio en un suelo con textura franco arcillo- arenosa. Se utilizó un diseño en bloques al azar con arreglo en parcelas divididas con cuatro tratamientos 0, 40, 60 y 80 mil árboles de leucaena ha-1 y tres repeticiones; la evaluación duró desde su establecimiento hasta 340 días de edad. Los resultados muestran diferencia estadística (P

El presente trabajo tiene por objetivo proponer aspectos fundamentales para la adopción tecnológica en el sistema bovino de doble propósito. Esta propuesta plantea que el proceso de innovación tecnológica se inicia con la descripción del objetivo de la unidad de producción y su situación actual, con énfasis en el área que se pretenda aplicar. Enseguida, se debe identificar, correctamente, la necesidad que se pretende resolver y la alternativa tecnológica más pertinente. Cualquiera que sea el factor que detone la necesidad de tecnificación, la inversión realizada debe ser rentable. Después, se identifican los aspectos de flexibilidad de la alternativa tecnológica, para descubrir las posibilidades de retirarla y sustituirla por otra; o bien, modificarla según las nuevas necesidades de la unidad de producción. Luego, se debe verificar que el productor tenga interés genuino en adoptar la tecnología y que dispone de los recursos financieros necesarios. En este caso, se advierte que no porque la opción tecnológica haya funcionado bien en otra unidad de producción, también lo hará en ésta y viceversa. Además, se requiere que el productor realice la completa adopción de la alternativa tecnológica, que se capacite el personal que la pondrá en marcha y que se lleven a cabo las adecuaciones pertinentes en todo el sistema de producción. Una vez adoptada la alternativa, se deben evaluar los impactos generados. Se concluye que la innovación corresponde a un proceso de aprendizaje modulado en el tiempo, y que la pertinencia de los recursos tecnológicos debe ser objeto de análisis y actualización continua.

Se analizan los depósitos de tormenta de dos secciones estratigráficas de la Formación Vaca Muerta (Tithoniano-Valanginiano) en el área de Bardas Blancas, sur de la provincia de Mendoza. Estos depósitos incluyen: a) depósitos con estratificación entrecruzada de bajo ángulo; b) depósitos con estratificación entrecruzada hummocky de pequeña y gran escala; y c) depósitos laminados con gradación normal intralámina. Las secuencias completas con HCS están compuestas por tres unidades (Sa, Sb y Sc) asociadas al evento de tormenta y una unidad que incluye depósitos de post-tormenta y de buen tiempo (Sd). La comparación con ejemplos actuales y ejemplos del registro, permite estimar un rango batimétrico de 25 a 50 m para los depósitos con estratificación entrecruzada hummocky. Asimismo se discuten posibles orígenes alternativos relacionados con inestabilidades en la interfase de la picnoclina y los efectos de la compactación sobre la preservación de las texturas y estructuras primarias de los depósitos de la Formación Vaca Muerta.Storm deposits (tempestites) have been extensively studied in the sedimentary record, particularly those deposits with hummocky cross-stratification, knowing their bathymetric ranks, facies models and their hydrodynamic conditions (Harms et al., 1975; Dott y Burgeois, 1982; Dumas y Arnott, 2006). However, detailed studies in carbonate sediments are relatively scarce. Recently, other types of interference generated at the picnocline interface (internal waves) were proposed to interpret similar deposits without being controlled by the position of the of storm-wave level (Pomar et al., 2012). The Tithonian - Valanginian deposits in the southern Mendoza - Neuquén Basin are particularly interesting because of their association with a homoclinal carbonate ramp system. During the Late Jurassic - Early Cretaceous a series of marine sequences were developed throughout the basin that are grouped under the Mendoza Group. In the southern Mendoza area it includes the Vaca Muerta Formation (early Tithonian - early Valanginian), the Chachao Formation (early Valanginian) and the Agrio Formation (early Valanginian - early Barremian) (Figs. 1 and 2). The Vaca Muerta Formation is widely distributed over the entire Neuquén Basin. It consists of dark bituminous shales, marls and limestones deposited in response to a rapid and widespread marine transgression originated from the Pacific Ocean, as consequence of a tectonic phase of compressional relaxation (Legarreta and Uliana, 1991). While initial studies show significant variations in the proportions of different lithologies, sedimentological knowledge is still general, with the exception of contributions from the south of the basin (Spalletti et al., 2000, 2008; Scasso et al., 2002, 2005) and southern Mendoza area (Doyle et al., 2005; Kietzmann et al., 2008, 2011). Storm deposits are well developed in the Vaca Muerta Formation. Based on tempestites characteristics and their associated beds four distinct deposits have been identified in the Bardas Blancas area (Fig. 3): (1) packstones with low-angle cross-stratification, (2) packstones/grainstones with large scale hummocky cross-stratification, (3) rudstones/grainstones with small scale hummocky cross-stratification, and (4) laminated wackestones/ packstones with intralaminar normal gradation (Figs. 5 and 6). Packstones with low-angle cross-stratification can be interpreted as anisotropic hummocks deposits or low relief megaripples generated under combined flows during major storms in the middle ramp. A complete sequence of HCS consists of three divisions (Sa-Sc) associated with the storm event, and an upper unit (Sd) that represents the fair-weather period between major storm events. Unit Sa starts with an erosion base and consists in low angle cross-stratified rudstones/grainstones. Unit Sb The unit begins with a second order surface and is composed by packstones and grainstones with hummocky cross-stratification. Unit Sc is represented by peloidal packstones with ripple marks, and finally the unit Sd consists of laminated wackestones/packstones. Laminated wackestones/packstones with intra-laminar normal gradation consist of bioclastic wackestones/packstones composed of saccocomids remains or a rhythmic alternation of peloidal packstones and sandy layers with current ripple marks, which probably represents the distal expression of the storms. Variations from this sequence allow us to make some comparison with other ancient carbonate storm deposits (Kreisa, 1981; Monaco 1992, Sami y Descorchers, 1992; Molina et al., 1997; Zhou et al., 2011). Although deposits of the Vaca Muerta Formation are compositionally similar to those described by Molina et al. (1997), the ideal sequence is similar to that recognized by Monaco (1992) (Fig. 10). The division proposed by Monaco (1992) seems to be the most accurate, since it is based on the recognition of structures generated under different hydrodynamic conditions rather than genetic interpretations associated with the phases of the storm. Comparing the described storm-influenced deposits with ancient and modern storm deposits examples, a relative water depth of 25 to 50 m is estimated for the formation of the HCS limestone facies. Even assuming its origin from internal waves, the position of the pycnocline in warm seas and small basins would be found within the same depth range (Nordberg et al., 2000), so that the deposits described in this paper may be important in future palaeogeographical studies in the Neuquén Basin.

Una de las debilidades de las cadenas alimentarias en México es su falta de integración adecuada que les permita posicionarse como la primera opción del consumidor final. La producción de carne de bovino no está exenta de este señalamiento, condición que ha motivado el diseño e implementación de diferentes programas oficiales encaminados a la integración de los eslabones primarios, criador y finalizador. Para que estos programas sean sustentables a mediano y largo plazo requieren enfrentar, en forma racional, el reto de incorporar -en su diseño- enfoques e intereses gremiales de índole económicos, que si bien son interdependientes, frecuentemente son, a la vez, dispares tanto entre los eslabones como dentro de ellos mismos. Consecuentemente, el abordaje de estas acciones se beneficiará de disponer de análisis y propuestas desde posiciones imparciales, independientes de los intereses particulares de los participantes incluyendo -entre éstos, además de los eslabones productivos primarios- al mismo poder ejecutivo, cabeza del sector, el cual, por razones de políticas gubernamentales a las que está sujeto, se ve inclinado a dar preferencia a acciones con tintes extra-curriculares. Por lo expuesto anteriormente, el sector académico de las universidades públicas, con base en su compromiso social, se involucra como un ente imparcial en estos procesos de construcción de acuerdos, aportando elementos de análisis y sugerencias para que los esfuerzos de integración sectorial rindan los resultados esperados a mediano y largo plazo, en beneficio de la sociedad. Con este marco referencial en mente se elaboró el presente documento.

El objetivo de este estudio fue identificar las principales especies de árboles y arbustos nativos de interés apícola en el estado de Colima, su distribución ecológica y mes de floración. El trabajo consideró una revisión bibliográfica, recorridos de campo en forma mensual a las diferentes comunidades ecológicas del estado, así como la recuperación del conocimiento tradicional de productores y técnicos de la zona de estudio; asimismo, se realizaron colectas de ejemplares para su identificación taxonómica en el herbario del Instituto de Botánica de la Universidad de Guadalajara (IBUG). Los resultados mostraron el potencial apícola de la flora nativa del estado, con 140 especies en total; de los cuales, 120 fueron árboles y 20 arbustos, representados por 45 familias; predominaron las especies de la familia Fabaceae (Leguminosae) con un 21.43%. Por su utilidad apícola, las de mayor número correspondió a las nectaríferas (58%), seguidas de las nectarífera- poliníferas (33%) y poliníferas (9%). La mayoría de los árboles florece durante los meses de marzo a mayo, y en los arbustos la floración predomina en los meses de octubre a diciembre. Asimismo, el mayor número de especies de árbo- les se encuentra dentro de la selva mediana subcaducifolia y baja caducifolia; y en el caso de arbustos, en la selva baja caducifolia y bosques de encino. Existe diversidad y abundancia de especies que favorece el desarrollo apícola en el estado, así como una floración diferenciada que permite tener alimento para las abejas la mayor parte del año.

El objetivo del presente trabajo fue evaluar los costos de producción de vaquillas Holstein mediante la comparación de dos sistemas de alimentación, basados en ensilado de caña de azúcar (ECA) vs el sistema tradicional del rancho basado en ensilado de maíz (EM). En ambos casos, con suplementación a los animales. Se utilizaron 28 becerras posterior al destete, con una edad promedio de 80±16 días y un peso inicial de 79.5 ± 12.9 kg. El estadístico fue un análisis de varianza para un diseño en bloques al azar, en donde el peso fue el factor de bloqueo y se dividieron en tres grupos dentro de cada tratamiento. Cada 30 días se midió la ganancia diaria de peso GDP (kg), la condición corporal CC, la conversión alimenticia CA (kg), el consumo de forraje CF (kg), de suplemento CS (kg), costo de alimentación/ día y la determinación del costo de producción de los reemplazos ($). Las vaquillas tuvieron una GDP 0.666 y 0.743 kg/día, CC 3.1b y 3.7a, CA 7.4a y 9.8b, CF 3.2 y 5.3, CS 1.8 y 1.5, costo de alimentación/día 9.4a y 11.4b y costo de la vaquilla $6,986.82 y $8,034.39, para ECA y EM, respectivamente. La alimentación fue el rubro que mayor impacto tuvo en la obtención de vaquillas de reemplazo, con 67 a 71% de los costos totales y la etapa de mayor inversión en la producción de vaquillas correspondió a la fase del nacimiento al destete. La alimentación basada en ensilaje de caña de azúcar permitió un mejor comportamiento económico para la producción de vaquillas de reemplazo, comparado con el sistema tradicional con ensilado de maíz.

La población ovina de la Isla Socorro es un recurso biológico que, probablemente, por su aislamiento genético de más de 135 años, y por el proceso de adaptación a las condiciones ambientales insulares en las que ha vivido, hoy en día podría poseer características de resis-tencia y rusticidad importantes desde el punto de vista productivo para la ganadería ovina mexicana. Por lo anterior, y dado el inminente peligro de extinción debido a la existencia de un programa gubernamental para su erradica-ción, se considera necesario rescatar, preservar e iniciar una serie de estudios que permitan evaluar sus potencialidades productivas, así como su conservación genética. Motivo por el cual, el presente trabajo busca dar a conocer a la comunidad académica y al público en general, elementos de relevancia científica para sumar esfuerzos y rescatar este banco de germoplasma ovino.

In the present paper the addition of a commercial fat substitute based on whey proteins, alone or in combination with goat rennet and with a food grade protease, is analyzed. Six different cheeses were produced: a control with whole milk (3.3 % of fat), and five experimental with partially skimmed milk (1.8 % of fat) without additions and with different combinations of the fat substitute, the goat rennet and the food grade protease. Results of analytical controls performed at the beginning and at the end of ripening show that low fat cheese without additions was the best of experimental. Addition of fat substitute, alone or in different combinations with goat rennet or with food grade protease, was negative for the sensory characteristics.

En el presente trabajo se resalta la presencia de árboles en los sistemas ganaderos del estado de Colima, México; lugar en donde las características climáticas predominantes son de trópico seco. Se enfatiza la importancia de la vegetación arbórea nativa, tanto de especies leguminosas como no leguminosas, manejadas ya sea en forma empírica como científica de algunos sistemas silvopastoriles (SSP) presentes en la región. Destacan las características nutricionales tanto del follaje como de los frutos, con la descripción de algunos SSP; entre ellos, el manejo del cocotero en la región costera, los árboles en los potreros, experiencias con el manejo de los bancos de proteína, la utilización de cercas vivas y algunas asociaciones forrajeras. Destaca la diversidad de árboles susceptibles de ser incorporados en el desarrollo de sistemas silvopastoriles, así como la necesidad de generar una cultura para la conservación y multiplicación de estas especies, sobre todo en ambientes en donde la deforestación y la erosión son una amenaza.

El siguiente apartado es el producto de una mesa redonda denominada Experiencias editoriales en revistas académicas multidisciplinares, que se verificó el viernes 19 de marzo de 2004 en el Museo Regional de Historia de la ciudad de Colima. En ella participaron varios coordinadores y miembros de los consejos editoriales de publicaciones académicas de la Universidad de Colima para ofrecernos sus experiencias en este rubro. La mesa surgió bajo la necesidad de compartir frente a un grupo de pares los problemas centrales de revistas de este tipo en México. La reflexión giro en torno a las circunstancias específicas en las que se producen las revistas académicas, se revisaron sus problemáticas, sus limitantes y se compartieron estrategias para potenciar la gestión de recursos.

Se asoció Cenchrus ciliaris (Cc) y Gliricidia sepium (Gs) para evaluar la producción de biomasa y la composición química de los forrajes en la fase de establecimiento, en el estado de Morelos, México, en condiciones de trópico seco. Se empleó un análisis de varianza con diseño en bloques al azar, en donde T1 fue pasto solo, T2 Cc más Gs con 5,000 plantas ha-1 y el T3 Cs más Gs con 14,285 plantas ha-1. Se midió la producción de forraje individual y asociado con materia seca (t MS/Ha), la altura (A) en cm, la proteína cruda (PC%), las fracciones de fibra (FDN% y FDA%) y la digestibilidad in vitro de la materia seca (DIVMS%). El T3 tuvo una mejor producción de biomasa (P0.05). La asociación de 14,285 plantas ha-1 de G. sepium con pasto Cenchrus ciliaris mejoró la producción de biomasa y la disponibilidad total de nutrientes por superficie cultivada al establecimiento

Se analizan los depósitos de tormenta de dos secciones estratigráficas de la Formación Vaca Muerta (Tithoniano-Valanginiano) en el área de Bardas Blancas, sur de la provincia de Mendoza. Estos depósitos incluyen: a) depósitos con estratificación entrecruzada de bajo ángulo; b) depósitos con estratificación entrecruzada hummocky de pequeña y gran escala; y c) depósitos laminados con gradación normal intralámina. Las secuencias completas con HCS están compuestas por tres unidades (Sa, Sb y Sc) asociadas al evento de tormenta y una unidad que incluye depósitos de post-tormenta y de buen tiempo (Sd). La comparación con ejemplos actuales y ejemplos del registro, permite estimar un rango batimétrico de 25 a 50 m para los depósitos con estratificación entrecruzada hummocky. Asimismo se discuten posibles orígenes alternativos relacionados con inestabilidades en la interfase de la picnoclina y los efectos de la compactación sobre la preservación de las texturas y estructuras primarias de los depósitos de la Formación Vaca Muerta.

Mundialmente se han reconocido diversas problemáticas que afectan la salud sexual de las mujeres lesbianas y bisexuales, pero poco se conoce sobre la realidad en Colombia. Factores como la homofobia y el heterosexismo en la atención en salud retrasan el diagnóstico y el tratamiento, e impiden el acceso a este servicio. Por tanto, es importante comprender las perspectivas de los proveedores. Este estudio cualitativo explora los discursos y las prácticas de seis profesionales de la salud en Cali, Colombia sobre la salud sexual de esta población. Los participantes, provenientes de diferentes áreas de la salud, tenían entre 15 y 30 años de experiencia en su campo. Los resultados señalan brechas en el conocimiento y en la praxis en la atención en salud, que deben ser fortalecidas para proveer una atención de calidad y que reconozca las necesidades de las poblaciones diversas.

Several strategies and guidelines for HIV prevention in different population groups have been established throughout the epidemic. However, there is an urgent need to include lesbian and bisexual women (LB women) in prevention programs and address their particular health care needs. This paper discusses key aspects that must be considered in the design of HIV prevention programs oriented toward this specific population. Due to the lack of research assessing prevention strategies for LB women, these reflections emerged by reviewing literature in similar groups and by the direct work of the authors within this group. Their inclusion in the HIV prevention agenda is essential to safeguard their right to health care in terms of receiving accurate information about sexuality and health, participating in health care programs and being treated equally and without any discrimination.

La percepción de riesgo es un proceso cognitivo que permite organizar y evaluar la exposición a una amenaza. Por tanto, el objetivo de este estudio es describir la percepción de riesgo frente al VIH de un grupo de mujeres homosexuales de Cali, Colombia. En esta investigación, con diseño narrativo, participaron seis mujeres homosexuales. Los datos fueron recogidos usando entrevistas semi estructuradas y analizados a través de un análisis temático. Los resultados indican que las mujeres tienen un bajo nivel de conocimientos sobre VIH y no se reportó el uso de medidas preventivas. Se encontró que sus creencias sobre el VIH se habían construido en la interacción con sus pares y sus proveedores de servicios de salud. Estos resultados proveen una comprensión inicial de cómo y porqué se deben desarrollar estrategias de intervención adecuadas para esta población.

El castillo de Constantina es una construcción realizada de un solo impulso, pero partiendo de una construcción previa (la camisa o antemural) y con algunas fases constructivas posteriores de menor relevancia, la datación de este edificio hay que situarla entre 1466 y 1474 años en los que Rodrigo Ponce de León fue alcaide de este castillo. La intervención arqueológica del año 2006 significó el diagnóstico de este yacimiento a nivel arquitectónico, arqueológico e histórico. Por todo ello, estimamos que se trata de un ejemplo excelente para documentar gráficamente la geometría de los restos arqueológicos encontrados y su relación con el entorno de la manera más fidedigna posible. Estas posibilidades en alza han estimulado la exigencia cada vez mayor en la toma de datos geomáticos de levantamientos topoarqueológicos.

Introducción: el síndrome del intestino irritable (SII) es una patología controvertida, donde ante la escasez de evidencia científica las recomendaciones sobre su manejo clínico y su definición vienen determinadas por métodos de consenso de expertos. Objetivo: obtener la opinión de los médicos de nuestro país implicados en el manejo de pacientes con SII y conocer los puntos de acuerdo en las principales cuestiones clínicas que plantea. Material y métodos: se realizó un estudio Delphi a nivel nacional mediante dos envíos a 100 médicos de atención primaria y gastroenterólogos. El cuestionario incluía preguntas sobre el concepto, diagnóstico y tratamiento del SII, evaluando el grado de acuerdo entre los participantes. Resultados: el 55% de los encuestados completó los dos envíos. Se obtuvo acuerdo respecto a los síntomas que caracterizan al SII y los de alarma. No existió una actitud clara ante el paciente sin síntomas de alarma, pero sí acuerdo respecto a la realización de colonoscopia en su presencia. Se señaló la necesidad de realizar estudios complementarios en mayores de 40 años. En el tratamiento no encontramos una actitud uniforme, aunque parece existir una orientación diferente según el síntoma predominante. Conclusiones: los médicos participantes en el estudio demuestran a través de sus respuestas un buen conocimiento conceptual del SII, si bien las discrepancias observadas en las cuestiones sobre diagnóstico y tratamiento demuestran la complejidad y falta de uniformidad que existe en el manejo diario de este síndrome.Introduction: lack of evidence in most clinical situations regarding irritable bowel syndrome (IBS) enhances the importance of an expert's opinion, which will guide management and even the concept underlying the disease. Objective: to delve into the knowledge and degree of agreement on main clinical skills for this syndrome among physicians involved in its management. Material and method: two rounds of a Delphi survey were conducted on 100 physicians: general practitioners (GPs) and gastroenterologists. The questionnaire evaluated agreement among participants in some aspects regarding the definition, diagnosis, and treatment of IBS. Results: fifty-five percent of participants completed the two-round survey. Agreement was achieved regarding the definition of typical symptoms and red flags characterizing IBS. Although there was no consensus regarding the appropriate management of patients without alarm symptoms, the performance of a colonoscopy on any patient presenting red flags was suggested. Patients were thought to require a wider examination when older than 40. A well defined line of IBS treatment was not found, albeit most physicians tended to choose it depending on the main complaint. Conclusion: interviewed physicians showed adequate theoretical knowledge of IBS, but lack of uniformity on diagnosis and treatment approach reflects the controversial day-by-day management of this syndrome.

La aplicación de materiales orgánicos al suelo es una práctica habitual en sistemas de agricultura sostenible. El objetivo de este trabajo fue: i) estudiar el efecto de la incorporación al suelo de material orgánico obtenido en diferentes etapas del proceso de compostaje sobre el crecimiento de raygrass e ii) determinar el efecto que causa el material orgánico incorporado sobre la nutrición nitrogenada en las plantas. Se armaron 4 pilas integradas por el mismo material inicial las cuales fueron monitoreadas en las siguientes etapas del proceso de compostaje: a- material inicial (T1), b- al final de la fase activa, 2 meses (T2), c- al promediar la fase de maduración, 7 meses (T3) y d- al finalizar la fase de maduración, 12 meses (T4). Se sembró raygrass sobre estos materiales y los mismos mezclado con suelo. La producción de materia seca de raygrass en los materiales T1 y T2 fue significativamente menor que en los restantes tratamientos. Resultados similares fueron cuantificados cuando los mismos materiales se incorporaron al suelo. El contenido de N en planta fue menor al incorporar al suelo los materiales T1 y T2 indicando inmovilización de este nutriente. Al adicionar los materiales T3 y T4 al suelo se comprobó que no hubo diferencias significativas entre ellos, en consecuencia, el empleo del material T3 puede considerarse una buena opción ya que puede utilizarse anticipadamente lográndose beneficios económicos y medioambientales.Land application of organic materials is a common practice in sustainable agriculture. Our aim was i) to study the effect of the incorporation of organic material at different maturity stages on the ryegrass (Lolium perenne L.) growth, and ii) to estimate the stage capable to produce the product more efficient in providing nitrogen to the plant nutrition. Four compost samples consisted of pruning waste, leaves and grass clippings were selected from four different piles at different stages of the composting process: initial non-decomposed material, 2 months old at the end of the bio-oxidative stage, 7 months old during the maturation phase, and 12 months old at the end of the maturation phase. These compost samples were used to ryegrass growing assays, and they were also added to a clay silty soil. Dry matter values were lower in T1 and T2 than in T3 and T4.Similar results were quantified when the same materials were incorporated to a soil. Nitrogen leaf content revealed that soil N immobilization had ocurred in T1 and T2 treatments. A compost, which had 7 months old during the maturation phase, did not cause any negative effect on the evaluated parameters. This compost seems to be sufficiently stable and its use would save time in compost process, compared with a compost 12 months old.

Introduction: This study was promoted by Sociedad Castellano-Manchega de Endocrinología, Nutrición y Diabetes to ascertain the characteristics of patients seen at the outpatient clinics of endocrinology and nutrition of the Castilla-La Mancha Health Authority and the case mix of diagnoses., Patients and Methods: This was a retrospective, cross-sectional study of the activity of the endocrinology and nutrition outpatient clinics of public hospitals of Castile-La Mancha during 2018. All visits made on 10% of the working days were analyzed. Data collected comprised patient age and sex, whether a first or subsequent had been made, and whether this was face-to-face or not, and up to five diagnoses per visit., Results: A total of 10,709 visits with a subsequent/first visit ratio of 3.4 were analyzed. Patient age was 52.1 ± 18.2 years, and 67.1% were women. Type 2 diabetes mellitus, primary hypothyroidism, thyroid nodular disease, and obesity/overweight were the most common conditions recorded as first diagnosis, accounting for more than half of the total number of visits. Type 1 diabetes mellitus and thyroid cancer were the diagnoses in which the subsequent/first visit ratio was greater. Type 2 diabetes mellitus, obesity, and primary hypothyroidism accounted for almost half of the first visits., Conclusions: A wide variety of conditions were seen, some of which are among the most prevalent in the general population, while others are not so prevalent, but are complex and difficult to manage by other specialties. Improved knowledge and analysis of the data should allow for the identification of opportunities for improvement and for the implementation of specific actions., (Copyright © 2020 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: The tools for analyzing the case-mix in outpatient clinics are scarce few and unsatisfactory. The objective of this study conducted by Sociedad Castellano Manchega de Endocrinología, Nutrición y Diabetes (SCAMEND) was to develop a tool that allows for analyzing the case-mix in outpatient endocrinology and nutrition clinics, considering bearing in mind the complexity of the conditions seen., Material and Methods: Using the Delphi method, the SCAMEND index of complexity in outpatient endocrinology and nutrition clinics (ISCCE-EyN) was developed by endocrinologists in two rounds, comparing the complexity of each condition being compared with that of a review visit of primary hypothyroidism., Results: The first visits were considered more complex than the subsequent visits. Non-neoplastic thyroid disease and uncomplicated overweight/obesity were considered as the least complex diseases, while metabolic diseases, multiple endocrine neoplasia syndromes, and adrenal carcinoma were considered as the most complex. The degree of agreement was high in most of the diseases analyzed., Conclusions: This tool allows for analyzing the case-mix in outpatient endocrinology and nutrition clinics, based on the inherent complexity of the disease of the patient is reported. This tool may be used for comparisons between centers, to better allocate resources within a given service, or for self-evaluation., (Copyright © 2020 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Coal workers’ pneumoconiosis is a chronic and irreversible disease representing a public health problem. Objective: To estimate the prevalence of pneumoconiosis and its associated factors among underground coal miners in the Colombian departments of Boyacá, Cundinamarca and Norte de Santander. Materials and methods: We conducted a cross-sectional study of 476 miners to measure the prevalence of pneumoconiosis and its associated factors such as coal dust and silica levels, as well as the occupational conditions. The medical assessment and a chest x-ray were performed according to the International Labor Organization criteria, along with spirometry and the identification of glutathione S-transferase and repair enzyme polymorphisms.The associations were explored using Cox regression models. Results: We performed a total of 479 environmental monitoring sessions in 31 companies and we evaluated 476 workers with 10 to 57 years of mining work experience. The prevalence of pneumoconiosis was 33.8% (95% CI: 27.0 - 41.3%). In the Cox multivariate regression model with a constant risk time, pneumoconiosis was significantly associated with working in medium-sized companies (PR=2.00, 95% CI: 0.995 - 2.690; p=0.052), the level of severe exposure to coal dust (PR=2.055, 95% CI: 1.043 - 4.048; p=0.038), and working in underground mining for 25 years or more (for those with 25.0-29.9 years: PR=2.199, 95% CI: 1.449 - 3.338; p=0.001). Conclusions: The prevalence of pneumoconiosis was very high and was found to be associated with severe exposure to coal dust, work exposure for 25 years or more and working in medium-sized enterprises

Sarocladium kiliense is a saprophyte fungus that can cause opportunistic infections associated to invasive procedures. We report a multi-hospital nosocomial outbreak of fungemias due to this agent. Patients with positive blood culture to this agent were studied after six bloodstream infections identified in three Chilean hospitals in July 2013 were reported to Ministry of Health National Infection and Prevention Control Program. In general, there were mild clinical manifestations, without deaths attributable to the infection. Epidemiological and micro-biological study identified 65 cases in 8 hospitals, mostly pediatric patients in chemotherapy. Initial studies of 94 different drugs and medical devices had negative results, until a second analysis of specific blisters and their pharmaceutical matrix selected by epidemiological criteria identified an intrinsic contamination of ondansetron blisters from a specific producer used in all the patients. A recall of contaminated ondansetron blisters was performed in all the country, after which the outbreak was contained. Surveillance and response of local and national infection prevention and control programs and laboratory support were key to control of a national multi-hospital common source outbreak due to contamination of a drug by an unusual fungus.

Introduction: Painters of automobiles are exposed to pure and mixed solvents that have been associated with neurological effects and carcinogenic mutations., Objective: To characterize the health and work conditions of individuals who are occupationally exposed to organic solvents used in sheet metal and auto body shops in Bogota., Materials and Methods: Descriptive, cross-sectional study that characterizes the health and work conditions of individuals exposed to organic solvents in sheet metal and auto body shops in Bogota. A group exposed to the solvents was compared to an unexposed group. Air concentrations of benzene, toluene and xylene (BTX) were determined, individual questionnaires were administered and phenylmercapturic, hippuric and ortho- and para-methylhippuric acids were measured in urine. The results of the measurements and the questionnaires were correlated to determine the exposure panorama., Results: For the three BTX metabolites, statistically significant differences (p<0.001) were found between the population exposed to the solvents and the unexposed population. For the exposed population, positive correlations were found between toluene in air and hippuric acid in urine (rho=0.82) and between xylene in air and o-methylhippuric acid in urine (rho=0.76). Hippuric acid values exceeded permissible levels in 11 workers and p-methylhippuric acid exceeded permissible levels in 8 workers. None of the phenylmercapturic values exceeded the limit., Conclusion: Auto painters are exposed to high levels of organic solvents at the workplace and do not have adequate industrial health and safety conditions to perform their jobs.

Objective: To provide practical recommendations for evaluation and treatment of osteoporosis associated to endocrine diseases and nutritional conditions., Participants: Members of the Bone Metabolism Working Group of the Spanish Society of Endocrinology, a methodologist, and a documentalist., Methods: Recommendations were formulated according to the GRADE system (Grading of Recommendations, Assessment, Development, and Evaluation) to describe both the strength of recommendations and the quality of evidence. A systematic search was made in MEDLINE (Pubmed), using the following terms associated to the name of each condition: AND "osteoporosis", "fractures", "bone mineral density", and "treatment". Papers in English with publication date before 18 October 2011 were included. Current evidence for each disease was reviewed by two group members, and doubts related to the review process or development of recommendations were resolved by the methodologist. Finally, recommendations were discussed in a meeting of the Working Group., Conclusions: The document provides evidence-based practical recommendations for evaluation and management of endocrine and nutritional diseases associated to low bone mass or an increased risk of fracture. For each disease, the associated risk of low bone mass and fragility fractures is given, recommendations for bone mass assessment are provided, and treatment options that have shown to be effective for increasing bone mass and/or to decreasing fragility fractures are listed., (Copyright © 2012 SEEN. Published by Elsevier Espana. All rights reserved.)

Objective: The management of incidentally discovered adrenal masses (incidentalomas) remains controversial. Our objective was to describe the demographic and clinical characteristics of a series of patients with adrenal incidentalomas attended in several hospitals of Castilla-La Mancha, and their diagnostic and therapeutic management., Material and Methods: Data were obtained by reviewing the patients' medical charts., Results: A total of 270 patients were included (28.1% from Toledo, 25.9% from Albacete, 24.1% from Ciudad Real, 15.9% from Cuenca and 5.9% from Guadalajara). The mean age was 60.3 +/- 12 and 53.3% were women. Overweight or obesity were found in 80.6%, hypertension in 55.8%, diabetes mellitus in 25.6%, impaired fasting glucose or impaired glucose tolerance in 15.6%, osteopenia in 31.5% and osteoporosis in 20.4%. These percentages were similar in patients with subclinical Cushing's syndrome. Diameter was less than 3 cm in 66% of the tumors, and more than 4 cm in 14.3%. Eighty-five percent of the tumors were detected by computed tomography. After a median follow-up of 28.8 months, 6% of nonfunctioning adenomas progressed to subclinical Cushing's syndrome, tumoral enlargement of more than 1 cm was found in 9.4% and a contralateral mass developed in 8.9%. Surgical adrenalectomy was performed in 14.4% of the patients., Conclusions: Our study confirms the favorable outcome in most patients with adrenal incidentalomas and contributes to a better understanding of this clinical entity.

Objectives: To systematize all the information published on the status of and progress made toward the Health-related Millennium Development Goals (HMDGs), as well as to understand associations with certain economic factors and the potential for success., Methods: A search was conducted for all scientific articles covering the Millennium Development Goals in general, published from 1 January 2000 to 31 August 2006, in the electronic databases of the EBSCO, CSA Illumina, Thomson Gale, SwetsWise, and BIREME. All original articles in English or Spanish that evaluated HMDG status, progress, and determinants were selected. The analysis evaluated the distribution of determinants of HMDG status or progress, the HMDGs referred to, the study type, the relationship between economic indicators and health, the study location, and the status and potential for attaining the HMDGs. The quality of the articles was also rated., Results: Of the 304 original articles found, 114 (37.5%) covered one or more HMDGs. The most frequently addressed goals were those concerning infant and maternal mortality. Of the 39 articles that evaluated HMDGs and their association with economic variables, 13 dealt with economic factors related to equity, policy, or globalization. Economic and policy factors were most frequently associated with HMDG status or progress., Conclusions: There is a definitive trend toward measuring HMDG status and progress according to economic factors that reflect the population's condition. There is an information gap regarding government spending, international commerce, international aid, and global economic policy. The potential for achieving HMDGs in poor countries is low.

Background and Objective: Lung cancer causes high morbimortality in Spain and is currently experiencing a significant increase in women. The aim of this study was to describe differential clinical and health care characteristics by sex, as well as factors associated with and geographic differences of in-hospital mortality., Material and Method: Descriptive study of episodes registered in the National Hospital Discharge Minimum Basic Data Set for admission type and gender in 2005. Two logistic regression models by sex were built in order to explain the individual influence of variables on in-hospital mortality. Using predictive values of the models, standardized mortality rates were calculated to study the variation between Spanish regions., Results: Women presented a lower mean age, smoking habit and in-hospital mortality than men. However, women presented more adenocarcinomas, greater care in high volume centers, more surgery in readmissions and were subjected to chemotherapy more often in new admissions than men. Adenocarcinoma in men and no specific location in women were associated with higher mortality. Smoking habit and lung diagnosis procedures in men, and middle lobe location and bronchoscopy in women were associated with lower mortality. The geographical mortality pattern detected was similar in both sexes only in some regions of Spain., Conclusions: Differential clinical characteristics, health care and overall results appear to exist depending on individuals' gender. Recognition of these differences are crucial in order to improve the effectiveness and equity of our health care system.

The Millennium Development Goals (MDGs) are now at the midterm of their target period, as 2015 is the date scheduled by the United Nations Organisation (UN) for their attainment. The purpose of this article is to review the current situation of the MDGs worldwide and to analyse the barriers which are preventing them from being attained in each of the MDG areas, as well as to assess a number of the indicators evaluated. In order to do so, a review has been made of the scientific literature published on the MDGs in the principal health sciences and social sciences databases, as well as the most significant reports on the issue drawn up by the United Nations. The scientific studies on the 8 MDGs and their 18 Targets make it possible to undertake a critical analysis of the situation in which each of these Goals are found at the present time, identifying the determinants that are preventing the attainment of the Goals and the actions considered necessary in order to achieve progress. Although there have been improvements in some of the goals on a world level, the research carried out to date reveals barriers to the attainment of the MDGs, as well as the insufficient weight of the developing countries in the economic and political decision-making processes, together with the incoherence between the economic policies and the social and health policies. Furthermore, Sub-Saharan Africa constitutes the most disadvantaged region, which means that it will not attain the majority of the MDGs. Spain and the developed countries, in addition to contributing resources, can also contribute to the MDGs by means of the identification and eradication of the barriers preventing attainment. This involves promoting international economic relations under conditions of social justice, by supporting a greater decision-making power for developing countries and denouncing actions that increase social inequalities and the impoverishment of the population.

Background: Pancreatic cancer is becoming an increasingly important health problem in Spain. This study aimed to analyze the hospital management of this process and the factors associated with mortality by using an administrative data base., Material and Method: We performed a descriptive study. Socio-demographic, clinical, diagnostic, and therapeutic variables of episodes registered in the national Hospital Discharge Minimum Data Set for 2004 were gathered. Comorbidity was assessed with the Charlson index. A logistic regression model was built to explain the individual influence of variables on in-hospital mortality. Mortality in the 17 autonomous regions of Spain was analyzed by using standardized mortality rates, through predicted mortality obtained from the multivariate model., Results: The mean age was 68 years and men represented 56%. Readmissions accounted for 80% of the cases. The most frequent localization was in the pancreatic head and the most frequently employed procedures were computed tomography and surgery. In-hospital mortality was 25%, was higher in men, and increased with age. Mortality was higher in new admissions than in readmissions. Factors associated with higher mortality in the multivariate analysis were male sex, age, unspecified location or location in the tail, emergency admission, hospital stay, and comorbidity. Observed mortality was higher than expected in the Canary Islands and Madrid and was lower than expected in Catalonia and the Valencian Community., Discussion: Future studies with more detailed information should be performed to allow the factors associated with in-hospital mortality from pancreatic cancer to be confirmed and to clarify the reasons for the geographical differences identified.

Objective: To provide an overview of decision trees based on CART (Classification and Regression Trees) methodology. As an example, we developed a CART model intended to estimate the probability of intrahospital death from acute myocardial infarction (AMI)., Method: We employed the minimum data set (MDS) of Andalusia, Catalonia, Madrid and the Basque Country (2001-2002), which included 33,203 patients with a diagnosis of AMI. The 33,203 patients were randomly divided (70% and 30%) into the development (DS; n = 23,277) and the validation (VS; n = 9,926) sets. The CART inductive model was based on Breiman's algorithm, with a sensitivity analysis based on the Gini index and cross-validation. We compared the results with those obtained by using both logistic regression (LR) and artificial neural network (ANN) (multilayer perceptron) models. The developed models were contrasted with the VS and their properties were evaluated with the area under the ROC curve (AUC) (95% confidence interval [CI])., Results: In the DS, the CART showed an AUC = 0.85 (0.86-0.88), LR 0.87 (0.86-0.88) and ANN 0.85 (0.85-0.86). In the VS, the CART showed an AUC = 0.85 (0.85-0.88), LR 0.86 (0.85-0.88) and ANN 0.84 (0.83-0.86)., Conclusions: None of the methods tested outperformed the others in terms of discriminative ability. We found that the CART model was much easier to use and interpret, because the decision rules generated could be applied without the need for mathematical calculations.

Introduction: lack of evidence in most clinical situations regarding irritable bowel syndrome (IBS) enhances the importance of an expert s opinion, which will guide management and even the concept underlying the disease., Objective: to delve into the knowledge and degree of agreement on main clinical skills for this syndrome among physicians involved in its management., Material and Method: two rounds of a Delphi survey were conducted on 100 physicians: general practitioners (GPs) and gastroenterologists. The questionnaire evaluated agreement among participants in some aspects regarding the definition, diagnosis, and treatment of IBS., Results: fifty-five percent of participants completed the two-round survey. Agreement was achieved regarding the definition of typical symptoms and red flags characterizing IBS. Although there was no consensus regarding the appropriate management of patients without alarm symptoms, the performance of a colonoscopy on any patient presenting red flags was suggested. Patients were thought to require a wider examination when older than 40. A well defined line of IBS treatment was not found, albeit most physicians tended to choose it depending on the main complaint., Conclusion: interviewed physicians showed adequate theoretical knowledge of IBS, but lack of uniformity on diagnosis and treatment approach reflects the controversial day-by-day management of this syndrome.

Background: Methylation is an inactivation mechanism for tumor suppressor genes, that can have important clinical implications., Aim: To analyze the methylation status of 11 tumor suppressor genes in pathological samples of diffuse gastric cancer., Material and Methods: Eighty three patients with diffuse gastric cancer with information about survival and infection with Epstein Barr virus, were studied. DNA was extracted from pathological slides and the methylation status of genes p14, p15, p16, APC, p73, FHIT, E-cadherin, SEMA3B, BRCA-1, MINT-2 y MGMT, was studied using sodium bisulphite modification and polymerase chain reaction. Results were grouped according to the methylation index or Hierarchical clustering (TIGR MultiExperiment Viewer)., Results: Three genes had a high frequency of methylation (FHIT, BRCA1, APC), four had an intermediate frequency (p15, MGMT, p14, MINT2) and four had a low frequency (p16, p73, E-cadherin, SEMA3B). The methylation index had no association with clinical or pathological features of tumors or patients survival. Hierarchical clustering generated two clusters. One grouped clinical and pathological features with FHIT, BRCA1, and APC and the other grouped the other eight genes and Epstein Barr virus infection. Two significant associations were found, between APC and survival and p16/p14 and Epstein Barr virus infection., Conclusions: Hierarchical clustering is a tool that identifies associations between clinical and pathological features of tumors and methylation of tumor suppressor genes.