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The management of urinary tract infection (UTI) in infants and children has changed significantly over the past few decades based on scientific evidence that questioned the efficacy of strategies used to prevent kidney injury and subsequent progression to chronic kidney disease, which is very unlikely in most paediatric cases. However, there is still substantial heterogeneity in its management and uncertainty regarding the diagnosis, indication of imaging tests, treatment or follow-up in these patients. The Spanish clinical practice guideline has been updated through the review of the literature published since 2009 and a rigorous evaluation of current clinical practice aspects, taking into account the evidence on the benefits of each intervention in addition to its risks and drawbacks to attempt to provide more precise recommendations. Resumen: En las últimas décadas, se han producido profundos cambios en el manejo de la infección urinaria en pediatría, a partir de estudios que cuestionaban la eficacia de las estrategias para prevenir el daño renal y la evolución posterior a enfermedad renal crónica, muy poco probable en la mayoría de casos. No obstante, todavía existe una gran variabilidad clínica en el manejo e incertidumbre en cuestiones relativas al diagnóstico, la indicación de una exploración radiológica, el tratamiento o el seguimiento de estos niños. La actualización de la guía de práctica clínica española ha examinado en la literatura publicada desde el año 2009 y de modo riguroso aspectos de la práctica actual, considerando la evidencia de los beneficios de cada intervención, junto con los riesgos asociados y desventajas, para intentar delimitar las pautas de actuación más precisas.

Objectives: The main objective was to investigate the incidence of transfusion-associated graft-versus-host disease (TA-GVHD) in patients who underwent haploidentical hematopoietic cell transplants (HCT) and received non-irradiated leukoreduced blood components. The secondary objective was to describe our leukodepletion results in blood products obtained by the filters employed at our center.Study Design and Methods: Clinical records from 2018 to 2023 were retrospectively analyzed, along with a prospective evaluation of residual leukocytes in blood components from June to November 2023 in order to confirm effectivity of our leukodepletion method.Results: 150 patients were included, no cases of TA-GVHD were reported after using non-irradiated blood products. The incidence of grade 3–4 acute and moderate-severe chronic GVHD was 12.7% (n = 19) and 2.7% (n = 4), respectively. The cumulative incidence of death was 39.3% (n = 52) with a 3.7-year overall survival (CI 95%, 3.3- 4.1 years). Leukodepletion analysis showed a reduction of 99.93% in platelet concentrates and 99.98% in packed red blood cells.Discussion: TA-GVHD in HCT remains a concern traditionally mitigated using blood product irradiation. Recent evidence obtained in favor of leukoreduction techniques question this need, especially in resource-limited settings.Conclusion: These findings support leukoreduction as a primary TA-GVHD preventive measure,along with the advantage in cost reduction.

Objectives: Primary graft failure (pGF) after hematopoietic stem-cell transplant is associated with considerable morbidity and mortality. The incidence in haplo-HSCT has been reported to be between 0% and 30%. In 2018, we identified a pGF incidence of 35% in our pediatric haplo-HSCT recipients with hematologic malignancies, which motivated us to enact changes to the conditioning regimen.Methods: We performed a single-center prospective, pre–post study of consecutive patients under 16 years with hematologic malignancies, from January 2015 to December 2022 who received a haplo-HSCT. Twenty-six pediatric patients received a haplo-HSCT before September 2018 (G1) and 36 patients after (G2). The main conditioning regimen for G1 was myeloablative with Flu/Cy/Bu, and for G2 the main regimen was reduced intensity Flu/Cy/Mel/TBI2.Results: Nine patients (35%) in G1 had primary graft failure, while in G2 there were no patients with pGF. The median follow-up for G1 was 15.9 months, and for G2 was 24.8 months, with an estimated overall survival at 12 months of 63% (95% CI 47–76) versus 85% (95% CI 73–93), and at 24 months of 47% (95% CI 31–64) versus 70% (95% CI 54–82) respectively (p = .007).Conclusion: After September 2018 conditioning regimen modifications were implemented with the objective of reducing primary failure, consisting mainly of switching from busulfan to melphalan as the alkylating agent of choice, and adding, when clinically possible TBI. Primary failure has been significantly reduced in our institution since then.

BackgroundHematopoietic cell transplantation (HCT) increases survival for acute leukemia. Outpatient allogeneic HCT reduces costs and increases transplant rates in developing countries. We report outcomes of outpatient HLA-identical and haploidentical HCT in acute leukemia.MethodsThis single-center retrospective cohort study analyzed 121 adult patients with acute myeloblastic (AML) and acute lymphoblastic leukemia (ALL) receiving an outpatient allogeneic HCT with peripheral blood allografts after reduced-intensity conditioning (RIC) from 2012-2022.ResultsThere were 81 (67%) haploidentical and 40 (33%) HLA-identical transplants. Complete chimerism (CC) at day +100 was not different in HLA-identical compared to haploidentical HCT (32.5% and 38.2%, P=0.054). Post-HCT complications, including neutropenic fever (59.3% vs. 40%), acute graft-versus-host-disease (aGVHD) (46.9% vs. 25%), cytokine release syndrome (CRS) (18.5% vs. 2.5%), and hospitalization (71.6% vs 42.5%) were significantly more frequent in haploidentical HCT. Two-year overall survival (OS) was 60.6% vs. 46.9%, (P=0.464) for HLA-identical and haplo-HCT, respectively. There was no difference in the 2-year disease-free-survival (DFS) (33.3% vs. 35%, P=0.924) between transplant types. In multivariate analysis, positive measurable residual disease (MRD) at 30 days (HR 8.8, P=0.018) and 100 days (HR 28.5, P=0.022) was associated with lower OS, but not with non-relapse mortality (NRM) (P=0.252 and P=0.123, univariate). In univariate analysis, both 30-day and 100-day MRD were associated with lower DFS rates (P=0.026 and P=0.006), but only day 30 MRD was significant in multivariate analysis (P=0.050). In the case of relapse, only MRD at day 100 was associated with increased risk in the univariate and multivariate analyses (HR 4.48, P=0.003 and HR 4.67, P=0.008). Chronic graft-versus-host-disease (cGVHD) was protective for NRM (HR 0.38, P=0.015). There was no difference in cumulative incidence of relapse (CIR) between transplant types (P=0.126). Forty-four (36.4%) patients died, with no difference between HCT type (P=0.307). Septic shock was the most frequent cause of death with 17 cases, with no difference between transplant typesConclusionsOutpatient peripheral blood allogenic HCT after RIC is a valid and effective alternative for adult patients suffering acute myeloblastic or lymphoblastic leukemia in low-income populations.

Trypanosoma cruzi, the causative agent of Chagas disease, is primarily transmitted to humans by hematophagous bugs of the Triatominae subfamily. In the Colombian Caribbean region, particularly on Margarita Island, T. cruzi transmission is highly endemic and associated with vectors such as Triatoma maculata and Rhodnius pallescens. Additionally, T. cruzi-infected Didelphis marsupialis are commonly found in close proximity to human dwellings. Given the complex transmission dynamics involving various domestic and non-domestic hosts, this study aimed to analyze 145 T. cruzi clones from twelve strains isolated from T. maculata, R. pallescens, and D. marsupialis using spliced leader intergenic region (SL-IR) sequences and nine polymorphic microsatellite loci. The results indicate the presence of a single polymorphic T. cruzi population, suggesting sustained local transmission dynamics between triatomines adapted to A. butyracea forests and peridomestic areas inhabited by synanthropic mammal reservoir such as D. marsupialis. Notably, this population appears to lack substructure, highlighting the importance of adopting an alternative eco-health approach to complement traditional chemical vector control methods for more effective and sustainable interruption of transmission.

Abstract Trypanosoma cruzi causes Chagas disease and has a unique extranuclear genome enclosed in a structure called the kinetoplast, which contains circular genomes known as maxi- and minicircles. While the structure and function of maxicircles are well-understood, many aspects of minicircles remain to be discovered. Here, we performed a high-throughput analysis of the minicirculome (mcDNA) in 50 clones isolated from Colombia’s diverse T. cruzi I populations. Results indicate that mcDNA comprises four diverse subpopulations with different structures, lengths, and numbers of interspersed semi-conserved (previously termed ultra-conserved regions mHCV) and hypervariable (mHVPs) regions. Analysis of mcDNA ancestry and inter-clone differentiation indicates the interbreeding of minicircle sequence classes is placed along diverse strains and hosts. These results support evidence of the multiclonal dynamics and random bi-parental segregation. Finally, we disclosed the guide RNA repertoire encoded by mcDNA at a clonal scale, and several attributes of its abundance and function are discussed.

This study evaluated the adsorbent capacity of the Ecuadorian avocado (Persea americana Hass.) seed and peel wastes as an alternative method for cadmium (Cd), mercury (Hg), lead (Pb), and nickel (Ni) ion removal from aqueous solutions. The laboratory microscale process was performed using fixed-bed columns containing 1 g of 600 μm particles of biomaterial pretreated with ethanol and ethylene glycol. Subsequently, metal solutions of different concentrations were eluted and measured by flame atomic absorption spectroscopy. Results showed that fixed-bed columns allow efficient adsorption of Pb (2.6 mg/g) with ethanol pretreatment. Lower adsorption capacity was achieved for Cd, Hg, and Ni ions. Favorable adsorption with high retention capacity was found for Pb+2 for the ethanol pretreated bio-adsorbent at higher concentrations (120 mg/L). Lower removal percentages were found for Cd+2, Hg+2, and Ni+2; Ni showed the lowest adsorption capacities and negative RL values, suggesting inefficient adsorbent development. Regeneration of Cd, Hg, and Pb ions from avocado peel and seed showed the highest recovery when 1 mol/L HCl solution was used. Regarding the adsorption isotherms, the Langmuir model was the one that best fit our data, demonstrating that adsorption takes place in a uniform monolayer and that each contaminant ion occupies a single site.

Este artículo se aproxima a la forma en la cual categoría legal de utilidad pública e interés social se presenta entre la minería, la infraestructura vial y el ambiente en Colombia desde la óptica que supone la confrontación y un falso equilibrio entre el desarrollo económico y la protección del ambiente. La metodología de aproximación lleva a cabo un análisis doctrinal y jurisprudencial abordando la cuestión desde el interés jurídico que supone la protección del ambiente y, a través una lógica constitucional respecto a la imposibilidad de asignar a un decálogo de actividades al apelativo de utilidad pública e interés social. Sin embargo, el escrito propone intentar aproximarse a preguntas poco realizadas en el estudio de la utilidad pública y por ello los argumentos presentados son circulares e insistentes.

Chimeric Antigen Receptor T-cell (CAR-T) therapies are transforming the treatment of B-cell lymphoproliferative disorders and multiple myeloma, yet global access challenges and barriers for their implementation persist. Global access disparities persist, particularly for persons living in low and middle-income countries and for underserved populations in high income countries. In this review we address patient-related factors including age, comorbidities, fitness, race and ethnicity, and geographic location for CAR-T access. Also, we review disease-related and health system barriers like disease biology, potential for short and long-term toxicity, insurance access, referrals, supply and manufacturing, regulation, costs and treatment center capacity. Lastly, alternatives for overcoming these barriers exemplified by research efforts worldwide are discussed, emphasizing the need for a multifaceted approach from all stakeholders to improve global accessibility and ensure equitable access and improved outcomes for patients worldwide.

Introduction: Pain catastrophizing is a powerful factor that can affect health care outcomes as well as emotional and physical well-being. The Pain Catastrophizing Scale for Children (PCS-C) is widely used, but it is not validated in Spanish. The aim of the study was to translate the PCS-C to Spanish and assess the validity and reliability of the translated version. Patients and methods: This study was carried out in two phases: (a) instrument translation (via a translation-back-translation process) and (b) psychometric analysis (construct validity: exploratory and confirmatory factor analysis, internal consistency, floor and ceiling effects and convergent validity). It had a cross-sectional design and was conducted on a sample of children aged 8–18 years was selected by convenience in a paediatric hospital. The study followed the STARD checklist. Results: The sample included 150 children and adolescents (mean age, 12.45 years; 63.8% male) and their parents. The exploratory and the confirmatory analysis showed a good adjustment of the model to the original 3-model structure with 13 items. The internal consistency of the scale was excellent (Cronbach α, 0.904), and no floor or ceiling effects were detected. In the convergent validity analysis, the Spanish version of the PCS-C showed a moderate correlation with pain interference (r = 0.400) and with health-related quality of life (r = 0.217–0.303). Conclusions: These results show that the Spanish version of the PCS-C is a valid and reliable scale to assess pain catastrophizing in children and adolescents. Resumen: Introducción: El catastrofismo relacionado con el dolor es un factor influyente en el pronóstico del tratamiento, así como en el bienestar emocional y físico. La escala pediátrica Pain Catastrophizing Scale for Children (PCS-C) es ampliamente utilizada, pero no está validada en español. Este estudio tuvo como objetivo traducir la PCS-C al español y evaluar su validez y fiabilidad. Pacientes y métodos: Este estudio se llevó a cabo en dos fases: a) traducción del instrumento (mediante un proceso de traducción directa e inversa) y b) análisis psicométrico (validez de constructo: análisis factorial exploratorio y confirmatorio, consistencia interna, efectos suelo y techo, y validez convergente) a través de un estudio transversal con una muestra seleccionada por conveniencia, de un hospital pediátrico compuesta por niños de 8 a 18 años. Este estudio siguió la lista de verificación STARD. Resultados: En el estudio se incluyó a 150 niños y adolescentes (edad media = 12,45; 63,8% varones) y sus padres. El análisis exploratorio y posteriormente el análisis confirmatorio mostraron un buen ajuste del modelo a la estructura original de tres modelos con 13 ítems. La consistencia interna de la escala resultó excelente (α de Cronbach = 0,904) y no se detectaron efectos techo ni suelo. En cuanto al análisis de validez convergente, la PCS-C en español mostró una correlación moderada con la interferencia del dolor (r = 0,400) y con la calidad de vida relacionada con la salud (r = 0,217–0,303). Conclusiones: Estos resultados demuestran que la versión en español de la PCS-C es una escala válida y fiable para evaluar el catastrofismo relacionado con el dolor en niños y adolescentes.

Introduction: Pre-apheresis peripheral blood CD34+ cell count (PBCD34+) is the most important predictor of good cell mobilization before hematopoietic stem cell transplantation, albeit flow cytometry is not always immediately available. Identification of surrogate markers can be useful. The CD34+ cells proliferate after mobilization, resulting in elevated lactate dehydrogenase (LDH) activity and correlating with the PBCD34+ count. Objective: To determine the LDH cut-off value at which adequate CD34+ cell mobilization is achieved and its diagnostic yield. Materials and methods: A total of 103 patients who received an autologous stem cell transplantation (ASCT) between January 2015 and January 2020 were included. Demographic and laboratory characteristics were obtained, including complete blood count, pre-apheresis PBCD34+ and LDH levels. Receiver operating characteristic (ROC) curves were performed to identify the optimal serum LDH activity cut-off points for ≥ 2 and ≥ 4 × 106 cells/kg post-mobilization CD34+ count and their diagnostic yield. Results: A post-mobilization serum LDH cut-off value of 462 U/L yielded a sensitivity (Se) = 86.8% (positive predictive value [PPV] = 72.7%), a pre- and post-mobilization serum LDH difference cut-off value of 387 U/L, an Se = 45.7% (PPV = 97%) and an LDH ratio of 2.46, with an Se = 47.1% (PPV = 97%) for an optimal mobilization count (CD34+ ≥ 4 × 106). Conclusion: The LDH measurement represents a fast and affordable way to predict PBCD34+ mobilization in cases where flow cytometry is not immediately available. According to the LDH diagnostic yield, it could be used as a surrogate marker in transplant centers, supporting the CD34+ count, which remains the gold standard.

Abstract Variational Quantum Algorithms (VQAs) are among the most promising NISQ-era algorithms for harnessing quantum computing in diverse fields. However, the underlying optimization processes within these algorithms usually deal with local minima and barren plateau problems, preventing them from scaling efficiently. Our goal in this paper is to study alternative optimization methods that can avoid or reduce the effect of these problems. To this end, we propose to apply the Differential Evolution (DE) algorithm to VQAs optimizations. Our hypothesis is that DE is resilient to vanishing gradients and local minima for two main reasons: (1) it does not depend on gradients, and (2) its mutation and recombination schemes allow DE to continue evolving even in these cases. To demonstrate the performance of our approach, first, we use a robust local minima problem to compare state-of-the-art local optimizers (SLSQP, COBYLA, L-BFGS-B and SPSA) against DE using the Variational Quantum Eigensolver algorithm. Our results show that DE always outperforms local optimizers. In particular, in exact simulations of a 1D Ising chain with 14 qubits, DE achieves the ground state with a 100% success rate, while local optimizers only exhibit around 40%. We also show that combining DE with local optimizers increases the accuracy of the energy estimation once avoiding local minima. Finally, we demonstrate how our results can be extended to more complex problems by studying DE performance in a 1D Hubbard model.

Abstract Background Importance of helix valgus lies in the psychological and social effect it could have on the patient. Our objective was to assess the impact of otoplasty on the quality of life of children with prominent ears and to establish possible predictors of post-surgical outcomes. Material and methods A retrospective review of children with prominent ears who underwent otoplasty between 2016 and 2018 was conducted. Demographical information, medical history, characteristics of helix valgus, motivations for surgery, complications, and post-surgical satisfaction were collected. To assess changes in parent-reported quality of life and patient satisfaction following surgery, the validated Glasgow Children’s Benefit Inventory (GCBI) and Patient Outcomes of Surgery-Head/Neck (POS-Head/Neck) surveys were used, respectively. Results Fifty-three patients responded to the survey (64.6%). From those, 90.6% of parents reported an improvement in health-related quality of life after otoplasty, with a 24.6 ± 20.6 average score on the global GCBI scale. The post-surgical score on the POS-Head/Neck surveys was significantly higher than the pre-surgical score (p

Background: Bladder exstrophy-epispadias complex (BEEC) is the most severe congenital anomaly involving the urinary tract. Currently, there is a growing interest in the long-term outcomes and their impact on quality of life (QoL). Methods: Our aim was to determine the incidence of urinary incontinence and whether it affects sexual function. The study population included BEEC patients >18 years treated at a specialized third-level hospital. We contacted them via telephone and emailed a voluntary online questionnaire which was anonymously self-completed. The online test included validated questionnaires to assess the following parameters: incontinence (ICIQ-SF), LUTS (ICIQ-FLUTS/IPSS) and sexual function (FSH/FSM2). Answers of the questionnaires were collected into a database for further evaluation. Statistical significance was defined by p

ABSTRACTObjective to review the current diagnostic and therapeutic landscape of AML in Latin America as a reflection of other low- and middle-income countries and regions of the world. Encompassing both acute promyelocytic and non-promyelocytic disease types.Methods We reviewed the literature and study registries concerning epidemiological features of patients with AML/APL treated in Latin America, as well as evaluated diagnostic and genetic stratification and patient fitness assessment challenges, the importance of early mortality and supportive care capacity, intensive and non-intensive chemotherapy alternatives, consolidation, and maintenance strategies including novel agents and hematopoietic stem cell transplantation.Results Although most of the current technologies and treatment options are available in the region, a significant fraction of patients have only limited access to them. In addition, mortality in the first weeks from diagnosis is higher in the region compared to developed countries.Conclusions Disparities in access to technologies, supportive care capacity, and availability of novel agents and HSCT hinder results in our region, reflecting barriers common to other LMICs. Recent developments in the diagnosis and treatment of this disease must be implemented through education, collaborative clinical research, and advocacy to improve outcomes.

IntroductionWellbeing policy analysis is often criticized for requiring a cardinal interpretation of measurement scales, such as ranking happiness on an integer scale from 0-10. The commonly-used scales also implicitly constrain the human capacity for experience, typically that our most intense experiences can only be at most ten times more intense than our mildest experiences. This paper presents the alternative “heavy-tailed valence” (HTV) hypothesis: the notion that the accessible human capacity for emotional experiences of pleasure and pain spans a minimum of two orders of magnitude.MethodsWe specify five testable predictions of the HTV hypothesis. A pilot survey of adults aged 21-64 (n = 97) then tested two predictions, asking respondents to comment on the most painful and most pleasurable experiences they can recall, alongside the second most painful and pleasurable experiences.ResultsThe results find tentative support for the hypothesis. For instance, over half of respondents said their most intense experiences were at least twice as intense as the second most intense, implying a wide capacity overall. Simulations further demonstrate that survey responses are more consistent with underlying heavy-tailed distributions of experience than a “constrained valence” psychology.DiscussionA synthesis of these results with prior findings suggests a “kinked” scale, such that a wide range of felt experience is compressed in reports at the high end of intensity scales, even if reports at lower intensities behave more cardinally. We present a discussion of three stylized facts that support HTV and six against, lessons for a future survey, practical guidelines for existing analyses, and implications for current policy. We argue for a dramatic increase in societal ambition. Even in high average income countries, the HTV hypothesis suggests we remain far further below our wellbeing potential than a surface reading of the data might suggest.

ABSTRACTObjective: To analyze the number of HSCTs performed in 2019 vs. 2020 and report the status of transplant centers (TCs) during and a year after the COVID-19 pandemic.Methods: We performed a comprehensive cross-sectional nationwide study including active TCs interrogating HSCT activity from 2019 through September 2021. An electronic survey was sent to TCs and consisted of items regarding the number and characteristics of procedures performed and were compared yearly. Changes to their institutions’ transplant policies and practices during the COVID19 pandemic were also documented. Fifty centers were invited to participate, 33 responded.Results: Most TCs were part of the public health system (63.7%). Almost half are in the country’s capital, Mexico City (45.5%). Most centers performed

Objectives: Venetoclax combinations are a new standard for patients with acute myeloid leukemia (AML). We aimed to evaluate the safety and efficacy of these combinations in a period of accelerated approval in Latin-America. Methods: This observational study evaluated adults with acute myeloid leukemia who received venetoclax-based therapy in 11 public or private centers in Mexico and Peru for both newly diagnosed or relapsed and refractory AML. Results: Fifty patients were included; 28 with newly diagnosed (ND) AML and 22 with relapsed/refractory (RR) disease. ND patients were older (64 vs. 40 years; p < 0.001) with a lower functional capacity (ECOG ≥2 64.3% vs 9%; p < 0.001). Venetoclax was frequently combined with azacytidine (60%) and prophylactic azoles (82%) with a median maximum dose of 200 mg (range, 100–600 mg). Hematologic toxicities were common. Complete response rates including patients with incomplete hematopoietic recovery were 78.6% in ND and 45.5% in RR patients, with a median overall survival of 9.6 (95% CI 3.7–15.5) and 8 months (95% CI 4.8–11.2). Discussion: Our study showed a preferred use of venetoclax plus azacytidine over cyatrabine. Patients in the first-line setting were similar to those in the landmark studies, while most patients with relapsed disease had received prior intensive therapies. Responses were favorable, with a median survival in agreement to other reports, albeit shorter than that observed in the randomized phase-3 trials. Conclusion: Venetoclax-based therapy in AML was effective despite dose reductions and prophylactic antifungals in two middle-income countries outside of a clinical trial setting.

Objective to discuss the status and challenges associated with the management of acute lymphoblastic leukemia (ALL) in Latin America.Methods This review summarizes various insights gained from information regarding diagnostic approaches and treatment strategies in adult patients with ALL in Latin American Countries.Results Information regarding ALL in Latin America is scarce; however, many efforts have been made to overcomes these barriers. Nevertheless, major obstacles to successful treatment in Latin America and LMIC remain poor adherence, abandonment of treatment, and lack of supportive therapy and new therapeutic agents.Conclusion Further improvements in survival should be pursued by developing more Latin American registries, forming cooperative groups, developing educational models to facilitate earlier diagnosis and prevention of complications, better support therapy and management of infections, and adapting treatment strategies.

Objetivo: El objetivo principal de este estudio es evaluar la concordancia del reporte de la clasificación Vesical Imaging-Reporting and Data System (VI-RADS®) en resonancia magnética (RM) y el reporte de patología del espécimen de cistectomía y definir si este estudio puede considerarse un estándar en el proceso de estadificación en el paciente con diagnóstico clínico de cáncer de vejiga. Método: Estudio analítico retrospectivo de corte transversal, se incluyeron 34 pacientes llevados a cistectomía radical o parcial a quienes se realizó RM multiparamétrica prequirúrgica y se realizó un estudio de concordancia entre la clasificación VI-RADS® y el resultado de patología. Todas las resonancias fueron leídas y revisadas por un único radiólogo institucional. Resultados: El estudio de concordancia como resultado principal mostró un área bajo la curva para VI-RADS® ≥ 4 y resultado patológico positivo para compromiso muscular de 0,84, con una sensibilidad del 89.3% y especificidad del 50%, demostrando la adecuada precisión diagnóstica de la prueba. Conclusiones: La clasificación VI-RADS® es una herramienta de diagnóstico caracterizada por un excelente rendimiento diagnóstico cuando se evalúa la concordancia con el reporte de la patología final en el espécimen de la cistectomía.

The boundary problem is related to the binding problem, part of a family of puzzles and phenomenal experiences that theories of consciousness (ToC) must either explain or eliminate. By comparison with the phenomenal binding problem, the boundary problem has received very little scholarly attention since first framed in detail by Rosenberg in 1998, despite discussion by Chalmers in his widely cited 2016 work on the combination problem. However, any ToC that addresses the binding problem must also address the boundary problem. The binding problem asks how a unified first person perspective (1PP) can bind experiences across multiple physically distinct activities, whether billions of individual neurons firing or some other underlying phenomenon. To a first approximation, the boundary problem asks why we experience hard boundaries around those unified 1PPs and why the boundaries operate at their apparent spatiotemporal scale. We review recent discussion of the boundary problem, identifying several promising avenues but none that yet address all aspects of the problem. We set out five specific boundary problems to aid precision in future efforts. We also examine electromagnetic (EM) field theories in detail, given their previous success with the binding problem, and introduce a feature with the necessary characteristics to address the boundary problem at a conceptual level. Topological segmentation can, in principle, create exactly the hard boundaries desired, enclosing holistic, frame-invariant units capable of effecting downward causality. The conclusion outlines a programme for testing this concept, describing how it might also differentiate between competing EM ToCs.

Reseña de Lois, M. y Akkaya, A. (2021). Estrategias descoloniales en comunidades sin estado. Madrid: Catarata, 213 pp.

Abstract Background Extracranial congenital skin defects, defined as aplasia cutis congenita (ACC), are a rare clinical entity. The form of presentation varies among patients according to the causal agent and the point during pregnancy at which the defect occurs. We present a series of cases of noncranial ACC, analysing its possible etiopathogenesis and the evolution of the lesions. Materials and methods This is a retrospective review of cases of extracranial ACC at a tertiary hospital. Case presentation Patient 1 is a full-term newborn of a monochorionic diamniotic gestation with the death of one foetus at 14 weeks of gestational age. Physical examination revealed two skin defects located on the posterior aspect of both thoraco-abdominal flanks. Patient 2 is a full-term newborn presenting with an ulcer on the nasal tip and cephalic extension on a follow-up pregnancy ultrasound. Patient 3 is a full-term newborn of a monochorionic diamniotic gestation with twin feticide due to encephalocele, presenting an ulcer on the lateral aspect of the proximal third of her right leg. The gestation associates severe oligohydramnios due to premature rupture of the membranes and breech presentation. Patient 4 is a full-term newborn with an ulcer on the left antecubital fossa with no relevant gestational history. Conclusion The analysis of the obstetric history and the clinical presentation of the lesions helps to guide the aetiopathogenic diagnosis of congenital skin defects. The increased intracompartment pressure in the limbs is related to the increased severity of skin lesions and musculoskeletal and nerve involvement. Conservative treatment is related to a good prognosis for the lesions.

At the intersection between sociology, anthropology and law, this article analyses the various legal instruments for the protection of the natural environment in Colombia. In their application, these instruments have produced a range of conflicts, stemming from ecosystem conservation strategies, legal complexity and disregarded social realities. Based on the analysis of the situation in the Ciénaga Grande de Santa Marta, the paper argues that the interaction of the different environmental protection and conservation measures is generating a tension between guaranteeing protection for human rights, people’s well-being and the ecosystems themselves.

Dung beetles are one of the most representative groups of insects associated with livestock, as they take advantage of the manure of livestock for food and reproduction. They have been widely used as a bio-indicator group to evaluate their responses to land-use change and other environmental disturbances by analyzing species diversity at different spatial and temporal scales. However, the impacts of livestock management practices, forms, and history on dung beetle diversity are still poorly understood. This paper is an exhaustive and systematic review of the existing peer-reviewed and indexed literature on the taxonomic diversity (species richness and composition), functional diversity, and ecological functions of dung beetles from different provinces and biogeographic domains in tropical grazing lands of the Neotropics. We analyzed the timeline of the studies conducted so far, and we detected increasing literature produced mainly in South America. We included the most frequent objectives, tendencies, software, and statistical analyses. Given the significant heterogeneity of livestock landscapes in the Neotropics, the reviewed studies have conceptualized broadly what a pasture is, and the authors have used different descriptions of other grazing lands. Additionally, management data and livestock practices vary widely among studies, and management history is poorly described. In future research, it is relevant to include as much information as possible and the consequences of different livestock management practices on additional ecological attributes of dung beetle assemblages at different landscape scales (spatial and temporal) to predict how ecological processes change in Neotropical landscapes. Considering the importance of the data to be included in future work, we propose a collection format to unify the information collected in the field when conducting ecological studies in grazing lands. Moreover, we define a classification system to homogenize the features that distinguish the multiple tropical grazing lands reported in the literature. Preserving dung beetle diversity and associated ecological functions is urgent for maintaining ecosystem services in grazing lands. The challenge for research institutions is to continue filling gaps in knowledge to help those who work in transferring knowledge, to help ranchers exercise better options for more sustainable livestock farming, and to publish results for conservation decision-making.

PURPOSE:Establishing research capacity in low- and middle-income countries (LMICs) is key for improving the outcomes of patients with hematologic diseases globally. Few studies have analyzed the contributions of LMICs to global hematology. The American Society of Hematology Meeting (ASH) is the largest international academic event where peer-reviewed contributions in our field are presented.METHODS:In this cross-sectional analysis, all abstracts accepted to ASH 2018 selected for a poster or oral presentation were reviewed. Those that had a contributing author from an LMIC were identified. The proportion of LMIC abstracts across categories was analyzed. Country of origin, high-income country participation, the presence of a conflict of interest (COI), and sponsorship were determined.RESULTS:From 4,871 abstracts reviewed, 506 had a contributing author from an LMIC (10.4%), with 277 (54.7%) contributions in partnership with a high-income country. LMIC-independent contributions corresponded to 19 of 1,026 oral abstracts (1.9%) and 209 of 3,845 posters (5.4%). Most abstracts from LMICs were clinical (n = 311; 61.5%) and multicentric in nature (n = 353; 69.8%). COI statements with the pharmaceutical industry were common (n = 214; 42.3%). Collaboration between LMICs was infrequent (n = 33; 6.5%). Upper-middle–income countries had 466 participations (81.5%), in comparison with 96 (16.8%) in low-middle–income and 10 (1.7%) in low-income countries.CONCLUSION:LMICs were responsible for a small fraction of abstracts at ASH18; low-income countries were practically absent. Almost half of accepted works represented a form of international collaboration, with clinical, multicenter studies predominating and COI disclosures a frequent and unexpected feature, reflecting the instrumental nature of LMIC participation and a lack of independent, robust, locally developed hematology research.

PURPOSEThe COVID-19 pandemic is a colossal challenge for global health; nonetheless, specific subgroups face considerably higher risks for infection and mortality. Among patients with malignant diseases, those with hematologic neoplasms are at a higher risk for poor outcomes. The objective of this study was to register treatment modifications associated with the COVID-19 pandemic and their short-term consequences in Latin America.METHODSMulticenter, prospective, observational, cohort study including patients older than 14 years from 14 centers in four countries (Mexico, Peru, Guatemala, and Panama) who had a confirmed diagnosis of acute leukemia, and who were undergoing active treatment since the first COVID-19 case in each country until the cutoff on July 15, 2020.RESULTSWe recruited 635 patients. Treatment modifications because of the COVID-19 pandemic were reported in 40.8% of cases. The main reason for such modifications was logistic issues (55.0%) and the most frequent modification was chemotherapy delay (42.0%). A total of 13.1% patients developed COVID-19 disease, with a mortality of 37.7%. Several factors were identified as independently associated with mortality, including a diagnosis of acute myeloid leukemia (odds ratio 2.38 [95% CI, 1.47 to 3.84]; P < .001), while the use of telemedicine was identified as a protective factor (odds ratio 0.36 [95% CI, 0.18 to 0.82]; P = .014).CONCLUSIONThese results highlight the collateral damage of COVID-19 in oncology patients.

Abstract Background The real-world application of maintenance in organisations brings together a number of maintenance policies in order to achieve the desired availability, efficiency and profitability. However, the literature mostly chooses a single maintenance policy, and so the decision process is not suited to the real conditions in the company to which it is applied. Our study takes a combination of maintenance policies as alternatives, and so conforms to the actual practice of maintenance in organisations. Furthermore, it introduces the possibility of including extra spare parts, or outsourcing maintenance policies. Although the selection of maintenance policies has been applied to many kinds of business and of machine, there is almost no instance of its application to hospitals, and it has never been applied to delivery systems for cytostatic drugs. Methods The model uses the fuzzy Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS), which is recognised as being highly suitable for solving group decision-making problems in a fuzzy environment. Fuzzy set theory is also considered to be more proficient than crisp numbers for handling the ambiguity, imprecisions, data scarcity, and uncertainty inherent in decisions made by human beings. The judgements required were obtained from a decision group comprising the heads of facilities maintenance, maintenance of medical equipment, health and safety at work, environment, and programming-admission. The group also included care staff; specifically, the heads of the main clinical services, and the medical supervisors. The model includes original criteria, such as Quality of health care, which measures impact on care as a function of mean availability of each alternative. It also considers Impact on hospital management via the criteria: Working environment in the organisation and Impact on health care; the former criterion measures equality among care services in the hospital, while the latter assesses the effect on regional health cover. The model was built using real data obtained from a state hospital in Spain. The model can also be easily applied to other national and international healthcare organisations, providing weights specific to the criteria. These are produced by a decision group from each healthcare organisation and the alternatives are updated in accordance with what is considered important in each hospital. Results The results obtained from the model recommend changing the alternative that is currently in use, Corrective and Preventive Maintenance, to Corrective and Preventive Maintenance plus two spare hoods. This alternative would lead to an availability of 1 (the highest possible) in the systems for preparing personalised cytotoxic drugs, and so the quality of service is therefore very high. Additionally, it could offer services to all the users of the hospital, and also offer cover in the preparation of cytotoxic medicines to other hospitals in the catchment area. Conclusions The results suggest the possibility that improvements to the support and logistical systems, which include maintenance, traditionally held to have no effect on quality of care, may be key to improving care quality, but also in reducing risk to patients, care and non-care staff, and the environment.

El objetivo de este artículo es discutir cómo los derechos de la naturaleza han sido juridificados y disciplinados por los jueces colombianos. Para lograrlo, utilizamos una metodología con dos componentes: un análisis del discurso de sentencias judiciales y un examen de doctrina y teoría sobre el origen y los pilares del movimiento de los derechos de la naturaleza. A lo largo del texto analizamos cómo su lectura desde nociones tradicionales jurídicas como propiedad y bien común limita las aspiraciones transformadoras que inspiran el movimiento de los derechos de la naturaleza.

El presente artículo presenta el rol que el principio de precaución ha venido adquiriendo en el ordenamiento como un criterio jurídico vinculante. Para lograr este objetivo propuesto se lleva a cabo un estudio de línea jurisprudencial tomando como caso de referencia la invocabilidad del principio en casos de contaminación electromagnética; acompañado de un barrido dogmático sobre las cuestiones bases de la problemática descrita. El artículo se plantea en tres grandes partes, en la primera, se presentan conceptos clave para el desarrollo del mismo, en la segunda se lleva a cabo el estudio de la citada línea jurisprudencial y, por último, se proponen unos criterios de invocabilidad a manera de ejercicio propositivo.

The CPT odd contribution to the effective electromagnetic action deriving from the vacuum polarization tensor in a large class of fermionic systems exhibiting Lorentz invariance violation (LIV) is calculated using thermal field theory methods, focusing upon corrections depending on the chemical potential. The systems considered exhibit the axial anomaly and their effective actions are described by axion electrodynamics whereby all the LIV parameters enter in the coupling Θ(x) to the unmodified Pontryagin density. A preliminary application to type-I tilted Weyl semimetals is briefly presented.

Reseña de: Rifkin, J. (2019). El Green New Deal global. Por qué la civilización de los combustibles fósiles colapsará en torno a 2028 y el audaz plan económico para salvar la vida en la tierra. Barcelona: Paidós.

Introducción. Los trastornos linfoproliferativos después de un trasplante se caracterizan por la proliferación descontrolada de linfocitos como consecuencia del tratamiento inmunosupresor posterior a este. Objetivo. Caracterizar clínica y patológicamente los casos de trastornos linfoproliferativos después de trasplante (Post-Transplant Lymphoproliferative Disorders, PTLD) en una cohorte de pacientes adultos con trasplante de hígado atendidos a lo largo de 15 años en el Hospital Universitario Fundación Santa Fe de Bogotá. Materiales y métodos. Se hizo un estudio observacional retrospectivo a partir de la revisión de las bases de datos de la Unidad de Trasplante Hepático y del Departamento de Patología del Hospital en busca de los casos de PTLD diagnosticados durante el periodo de estudio. Se recolectó la información epidemiológica, clínica y patológica, y se adelantaron los análisis estadísticos. Resultados. Durante el periodo de estudio, hubo 572 pacientes con trasplante de hígado, la incidencia de trastornos linfoproliferativos fue de 2,44 %, el 79 % en hombres, y la edad promedio en el momento del diagnóstico fue de 62,5 años. El 71 % de los casos se presentó durante los primeros 12 meses después del trasplante y el mismo porcentaje fue seropositivo para el virus de Epstein-Barr (EBV). El fenotipo patológico más frecuente fue el monomorfo y la mayoría de los tumores se detectaron en el hilio hepático. La supervivencia al año fue del 50 %. Conclusiones. Llamó la atención el alto porcentaje de casos de presentación temprana, así como la gran frecuencia de seropositividad para el EBV tanto en los donantes como en los receptores. Deben adelantarse estudios más detallados para una mejor comprensión de esta enfermedad en el país. Este es el primer análisis clínico y patológico de PTLD en pacientes con trasplante de hígado adelantado en Colombia hasta la fecha.

ABSTRACT Medical and surgical priorities have changed dramatically at the time of this pandemic. Scientific societies around the World have provided rapid guidance, underpinned by the best knowledge available, on the adaptation of their guidelines recommendations to the current situation. There are very limited scientific evidence especially in our subspecialty of pediatric urology. We carry out a review of the little scientific evidence based mainly on the few publications available to date and on the recommendations of the main scientific societies regarding which patients should undergo surgery, when surgery should be performed and how patient visits should be organize.

El accionar de la subversión en el Perú y el rol de las Fuerzas Armadas para combatirla, con base en la escuela francesa antisubversiva, se desarrollaron en un contexto de ausencia del Estado en las zonas más empobrecidas, donde cada bando se disputaba ganarse a la población. El objetivo de este artículo es adentrarse en los orígenes, la formación y la influencia militar francesa de la contrainteligencia peruana, para comprender su accionar en ese contexto. A través de una investigación cualitativa, con base en un enfoque histórico, se busca comprender el accionar de la contrainteligencia peruana y establecer los orígenes y la evolución de la subversión en el país –dirigida a ganarse a la población para fomentar el terrorismo– al igual que cómo se plasmó esto en la doctrina primigenia de contrainteligencia. Parte fundamental de la investigación son los datos sobre contrainteligencia contenidos en el Informe Final de la Comisión de la Verdad y Reconciliación. Las conclusiones plantean la relación entre los orígenes subversivos, la doctrina y las excusas del terrorismo, de Walzer, por lo cual este estudio constituye un asidero importante para próximas investigaciones. Abstract The actions of subversion in Peru and the role of the Armed Forces to combat them based on the French anti-subversive school developed in a context of absence from the State in the most impoverished areas, where each side disputed to win over the population. The objective of this article is to delve into the origins, training and French military influence of the Peruvian counterintelligence and understand its actions in that context. Through a qualitative research, based on a historical approach, we seek to understand the actions of the Peruvian counterintelligence and establish the origins and evolution of subversion in the country -directed at gaining the population to promote terrorism- as well as how this was embodied in the original counterintelligence doctrine. A fundamental part of this investigation is the data regarding counterintelligence contained in the Final Report of the Comisión de la Verdad y Reconciliación. The conclusions point out the relationship between the subversive origins, the doctrine and the excuses of terrorism, by Walzer. The study is an important support for further investigations.

Hematopoietic stem-cell transplantation (HSCT) is usually performed in well-equipped units inside a hospital. The cost of this in-hospital transplant is usually very high; therefore, this procedure is more difficult to perform in low- and middle-income countries. Autologous outpatient HSCT is now a common procedure; however, outpatient allogeneic transplants are more complicated. Only a few centers in the world have incorporated outpatient HSCT. This transplant requires special adaptation, like a day hospital, careful selection of patients, oral medications, and the patient must live relatively close to the hospital. The results until now suggest that this outpatient transplant is factible and similar to inpatient HSCT. The objective was to review and describe the different methods and results following an outpatient allogeneic-HSCT strategy.

Aedes spp. comprise the primary group of mosquitoes that transmit arboviruses such as dengue, Zika, and chikungunya viruses to humans, and thus these insects pose a significant burden on public health worldwide. Advancements in next-generation sequencing and metagenomics have expanded our knowledge on the richness of RNA viruses harbored by arthropods such as Ae. aegypti and Ae. albopictus. Increasing evidence suggests that vector competence can be modified by the microbiome (comprising both bacteriome and virome) of mosquitoes present in endemic zones. Using an RNA-seq-based metataxonomic approach, this study determined the virome structure, Wolbachia presence and mitochondrial diversity of field-caught Ae. aegypti and Ae. albopictus mosquitoes in Medellín, Colombia, a municipality with a high incidence of mosquito-transmitted arboviruses. The two species are sympatric, but their core viromes differed considerably in richness, diversity, and abundance; although the community of viral species identified was large and complex, the viromes were dominated by few virus species. BLAST searches of assembled contigs suggested that at least 17 virus species (16 of which are insect-specific viruses [ISVs]) infect the Ae. aegypti population. Dengue virus 3 was detected in one sample and it was the only pathogenic virus detected. In Ae. albopictus, up to 11 ISVs and one plant virus were detected. Therefore, the virome composition appears to be species-specific. The bacterial endosymbiont Wolbachia was identified in all Ae. albopictus samples and in some Ae. aegypti samples collected after 2017. The presence of Wolbachia sp. in Ae. aegypti was not related to significant changes in the richness, diversity, or abundance of this mosquito’s virome, although it was related to an increase in the abundance of Aedes aegypti To virus 2 (Metaviridae). The mitochondrial diversity of these mosquitoes suggested that the Ae. aegypti population underwent a change that started in the second half of 2017, which coincides with the release of Wolbachia-infected mosquitoes in Medellín, indicating that the population of wMel-infected mosquitoes released has introduced new alleles into the wild Ae. aegypti population of Medellín. However, additional studies are required on the dispersal speed and intergenerational stability of wMel in Medellín and nearby areas as well as on the introgression of genetic variants in the native mosquito population.

Background: This study investigates the associations between the presence of suicidal ideation (SI), depressive symptoms and potential biomarkers in a sample with treatment-naïve first episode restrictive eating disorder Method: The observational study included 77 patients and 53 controls matched by age and socioeconomic status. We used the Beck Depressive Inventory focusing particularly on item 9, which measure the severity of SI. Results: We found high rates of SI (40.8%) and depression (52.9%). Serum ​​levels of homocysteine were significantly higher among patients who reported SI compared with patients without SI (t = 2.47; p = .016; d = 0.595). Greater depressive symptoms were significantly correlated to lower levels of vitamin B12 (t = 2.08; p = .041; d = -0.504) and folic acid (U = 403.5; p = .015; d = -0.039). Serum levels of homocysteine were inversely correlated to those of vitamin B12 ​​(rho = -0.310; p

El sistema de puntuación de Gleason es el más utilizado para diagnosticar y cuantificar la agresividad del cáncer de próstata, estratificando regionalmente patrones anormales en imágenes histológicas. A pesar de ello, estudios recientes han reportado valores moderados de concordancia de 0.55, según el valor kappa en el diagnóstico de la enfermedad. Este estudio introduce una representación convolucional para la segmentación y estratificación semántica de regiones en imágenes histológicas implementando la puntuación de Gleason y tres niveles de representación. Para ello, en un primer nivel, se entrenó una red regional de tipo Mask R-CNN con anotaciones completas, lo que permitió definir delineaciones regionales, siendo efectivo en localizaciones con estructuras generales. En un segundo nivel, usando la misma arquitectura, se entrenó un modelo únicamente con anotaciones superpuestas del primer esquema, y que constituyen regiones con dificultad de clasificación. Finalmente, un tercer nivel de representación permitió una descripción más granular de las regiones, considerando las regiones resultantes de las activaciones del primer nivel. La segmentación final resultó de la superposición de los tres niveles de representación. La estrategia propuesta se validó y entrenó en un conjunto público con 886 imágenes histológicas. Las segmentaciones así generadas alcanzaron una media del Área Bajo la Curva de Precisión-Recalificación (AUPRC) de 0.8 ± 0.18 y 0.76 ± 0.15 respecto a los diagnósticos de dos patólogos, respectivamente. Los resultados muestran niveles de intersección regional cercanos a los de los patólogos de referencia. La estrategia propuesta es una herramienta potencial para ser implementada en el apoyo y análisis clínico.

Pathological voice characterization has received increasing attention over the last 20 years. Hundreds of studies have been published showing inventive approaches with very promising findings. Nevertheless, methodological issues might hamper performance assessment trustworthiness. This study reviews some critical aspects regarding data collection and processing, machine learning-oriented methods, and grounding analytical approaches, with a view to embedding developed clinical decision support tools into the diagnosis decision-making process. A set of 26 relevant studies published since 2010 was selected through critical selection criteria and evaluated. The model-driven (MD) or data-driven (DD) character of the selected approaches is deeply examined considering novelty, originality, statistical robustness, trustworthiness, and clinical relevance. It has been found that before 2020 most of the works examined were more aligned with MD approaches, whereas over the last two years a balanced proportion of DD and MD-based studies was found. A total of 15 studies presented MD characters, whereas seven were mainly DD-oriented, and four shared both profiles. Fifteen studies showed exploratory or prospective advanced statistical analysis. Eighteen included some statistical validation to avail claims. Twenty-two reported original work, whereas the remaining four were systematic reviews of others’ work. Clinical relevance and acceptability by voice specialists were found in 14 out of the 26 works commented on. Methodological issues such as detection and classification performance, training and generalization capability, explainability, preservation of semantic load, clinical acceptance, robustness, and development expenses have been identified as major issues in applying machine learning to clinical support systems. Other important aspects to be taken into consideration are trustworthiness, gender-balance issues, and statistical relevance.

Si bien hay antecedentes empíricos acerca de la medición de la calidad de vida relacionada con la salud (cvrs) en niños, no hay evidencia de estudios similares en Colombia. Por tal motivo, el objetivo de la investigación fue describir las propiedades psicométricas iniciales de la versión en español del tapqol 2 en una muestra de 229 cuidadores de niños preescolares entre tres y seis años de edad, de ambos sexos, residentes en el departamento de Córdoba, Colombia. Se realizó un análisis factorial con extracción de componentes principales y rotación Varimax, así como un análisis de consistencia interna por alfa de Cronbach para la escala general y cada factor obtenido, corre­laciones inter-elemento y estadísticos total-elemento. Los resultados mostraron que el cuestionario tapqol 2 presenta un alfa de Cronbach de 0.81, explica una varianza acumulada del 66.44% y correlaciones positivas entre todos los reactivos. Con relación al instrumento original, el cuestionario tapqol 2 mantiene 12 factores, pero se diferencia en que se fusionan los factores emociones positivas y vitalidad, mientras que emerge un nuevo factor relacionado con el control comportamental del niño. Se encuentra que los indicadores psicométricos del cuestionario son consistentes con investigaciones previas sobre los componentes del bienestar en los niños.