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This study focuses on passive measures for thermal comfort in social interest housing in the Departamento del Magdalena, Colombia. The global context emphasises the importance of energy savings, especially in the construction sector, responsible for 40% of global energy use. Despite advances in sustainable construction, social housing in Latin America, particularly in Colombia, neglects thermal efficiency. This paper addresses the lack of regulations and climatic considerations in social housing construction in Colombia, proposing the adoption of passive climate control to improve thermal comfort and air quality. Climate Consultant and EnergyPlus were used to evaluate bioclimatic strategies and local climate impact. Climatic characterisation reveals hot and humid conditions, demanding strategies such as solar protection, cross-ventilation and adaptive measures. Simulations suggest a 61.3% improvement in the annual comfort rate. The study highlights the need to consider the local climatic context and construction strategies to improve energy efficiency and well-being in social housing.

Due to its excellent potential, wind power has gained importance as a renewable energy source in Colombia, especially in the offshore Caribbean region. However, one of the main challenges in the development of offshore wind projects is the analysis of the wind resource. This study presents the generation of a specific typical meteorological year (TMY) for wind energy in the Colombian Caribbean region, known in the literature as Reference Wind Year (RWY). The methodology used was based on the Sandia method, widely accepted in the analysis of wind resources. A comparison between the cumulative distribution function (CDF) and the statistic approach Finkelstein-Schafer (FS) was applied to evaluate multiple meteorological parameters in the study area associated with wind resource potential assessment, such as wind speed and direction, temperature and atmospheric pressure, compiled for 10 years (2012-2021). The representative years were weighted according to their importance and combined into a dataset. The results indicated that the proposed method was able to generate highly representative and accurate data for the case study in La Guajira, Colombia, guaranteeing its suitability for implementation in other locations with different climatic conditions.

This paper presents projections on the reduction of CO2 emissions through the implementation of off-grid PV systems on 33 farms located in rural areas of the Departamento del Magdalena, where horticultural activities are performed by small local producers. To achieve this, the emission reduction was estimated for a period of 25 years using the installed PV peak power on each farm, data from the Global Solar Atlas, the emission factor in Colombia for electricity generation and information established in the harmonization project of the National Renewable Energy Laboratory (NREL). In order to compare the estimations, temperature and solar irradiance data were obtained from 10 farms near the installations, located in 8 municipalities within the department. With these data and through mathematical modeling, the energy generated by each PV system and the projection of non-emitted CO2 emissions were calculated. The results obtained demonstrated that, in both cases, the projections for emission reduction are similar, highlighting that the municipalities of Ciénaga and Sitio Nuevo contribute the highest amount of saved CO2 due to the projections of higher energy production in these locations.

El propósito de esta investigación fue analizar la confiabilidad y validez de la escala de trabajo decente para trabajadores en México, con un estudio de diseño instrumental en una muestra de 1 192 colaboradores de empresas medianas. El análisis factorial confirmatorio apoyó el modelo teórico original, reportando índices de ajuste, cargas factoriales estimadas y confiabilidad adecuados. La escala puede ser utilizada en el diagnóstico para la implementación de acciones para el cumplimiento del objetivo de desarrollo sostenible 8 (ODS08) sobre trabajo decente y productivo de la Agenda 2030.

Background and Aims: Digital single-operator cholangioscopy (DSOC) plays a critical role in directly visualizing and treating the bile duct system. Although various cholangioscopes with different external diameters are available for DSOC, certain challenging scenarios persist in which existing scopes fail to complete a thorough evaluation of the bile ducts. To overcome these limitations, we aimed to introduce and highlight the application of a novel 7F cholangioscope. Methods: In this review article we describe the novel 7F cholangioscope, provide its assembly and setup, and review cases in which the 7F cholangioscope was used for diagnostic and therapeutic guidance. Results: Four cases involving challenging biliary assessments were presented, all of which achieved technical and clinical success. No procedure-related adverse events were reported in any of these cases. Conclusions: The 7F cholangioscope can provide additional information regarding the biliary tree and guidance for treatment, overcoming the challenging assessment of small pancreatobiliary ducts and its strictures. Its potential use in cases of severe bile duct stenosis is recommended. However, further studies evaluating safety and efficacy are needed.

IntroductionThere are several risk factors associated with developing mental disorders among people over 60 years of age. Mental health encompasses multiple domains or capacities, which can comprise the psychological wellbeing of older people. Therefore, resilient coping, self-compassion, self-esteem, hopelessness, quality of life, and depression are considered the characteristics and adaptive mechanisms that bring together the main risk and protective factors for imbalance in mental wellbeing.ObjectiveThis study aimed to establish the demographic, social, and family factors, as well as the clinical characteristics and lifestyle habits that influence the mental health of the elderly people in the city of Medellín, in the year 2021, to build a mental health index.MethodologyThis study adopts a quantitative approach, employs retrospective temporality, and utilizes secondary sources. A cross-sectional survey was carried out with the SABAM Project (health and mental wellbeing of older adults from five cities in Colombia in 2021 by its Spanish acronym) database (secondary source), which is part of the research group “Public Health Observatory” of CES University (Medellín, Colombia). The database comprised 500 records of people aged over 60 years from the city of Medellín in 2021. While constructing the index, a principal component analysis was used, along with the Varimax method for factor analysis rotation.ResultsThe median age of the general population was 67 years (IQR 63–72); for men, the median age was 66 years (IQR 63–71) and for women, the median age was 67 years (IQR 63–72). An association was found between low socioeconomic levels, alcohol consumption, and the level of higher education (university—postgraduate) with low levels of the Mental Health Index in people over 60 years of age in Medellín during the year 2021.ConclusionA quantitative model was developed to predict either a positive or negative prognosis in the mental wellbeing of the population over 60 years of age in the city of Medellín. The model was also used for the development of a sociodemographic profile highlighting the impact on mental health among people over 60 years of age with limited economic resources.

El propósito de este trabajo fue identificar diferencias en la percepción de la responsabilidad social empresarial (RSE) en colaboradores de tres pequeñas empresas de manufactura, comercialización y servicios de la zona oriente del Estado de México. Se aplicó una escala de percepción de la RSE en una muestra de 90 sujetos. Los resultados indican que la percepción de las prácticas de RSEes adecuada y que existen diferencias estadísticamente significativas dependiendo del tipo de organización, siendo la empresa de servicios en la que se presenta la mejor percepción. Abstract The purpose of this research was to identify differences in the perception of corporate social responsibility (CSR) in employees of three small manufacturing, marketing and services companies in the eastern area of ​​the State of Mexico. A CSR perception scale was applied to a sample of 90 subjects. The results indicate that the perception of CSR practices is adequate and that there are statistically significant differences depending on the type of organization, with the service company having the best perception.

El estudio se llevó a cabo en la localidad de Miraflores del Departamento General Güemes Chaco, Argentina. Se seleccionaron 7 establecimientos caprinos de pequeños productores con alta prevalencia serológica de brucelosis caprina. Se trabajó con un total de 436 cabras, de las cuales se tomaron muestras de sangre entera con y sin anticoagulante para seleccionar aquellas con serología positiva a Brucella spp. determinada mediante las técnicas de cribado de Antígeno Tamponado en Placa (BPA) y como técnica confirmatoria se utilizó el ensayo de Fluorescencia Polarizada (FPA). De las hembras en lactancia se tomaron muestras de leche de ambas glándulas y de aquellas parturientas que habían abortado en los 15 días previos al muestreo, se tomaron además muestras de hisopados vaginales para cultivos bacteriológicos dentro de las 48 hs. de obtenidas. Luego del cribado serológico se seleccionaron para cultivo 98 muestras de sangre, 20 muestras de leche y 7 hisopados vaginales, de los que se obtuvieron 8 cultivos positivos (3 vaginales y 5 cultivos a partir de la fracción leucocitaria) en 3 establecimientos. Posteriormente, los aislamientos logrados fueron identificados mediante tipificación tradicional. Se determinó la presencia de B. melitensis biovar 1 en los establecimientos visitados de la localidad de Miraflores, coincidente con reportes previos para la región. El aislamiento de B. melitensis y su relación con abortos en cabras confirma el alto impacto de esta enfermedad en la producción caprina y recuerda su peligro potencial para otras especies animales y el riesgo zoonótico para las familias rurales.

Neuroendocrine neoplasms (NENs) are mutationally quiet (low number of mutations/Mb), and epigenetic mechanisms drive their development and progression. We aimed at comprehensively characterising the microRNA (miRNA) profile of NENs, and exploring downstream targets and their epigenetic modulation. In total, 84 cancer‐related miRNAs were analysed in 85 NEN samples from lung and gastroenteropancreatic (GEP) origin, and their prognostic value was evaluated by univariate and multivariate models. Transcriptomics (N = 63) and methylomics (N = 30) were performed to predict miRNA target genes, signalling pathways and regulatory CpG sites. Findings were validated in The Cancer Genome Atlas cohorts and in NEN cell lines. We identified a signature of eight miRNAs that stratified patients in three prognostic groups (5‐year survival of 80%, 66% and 36%). Expression of the eight‐miRNA gene signature correlated with 71 target genes involved in PI3K–Akt and TNFα–NF‐kB signalling. Of these, 28 were associated with survival and validated in silico and in vitro. Finally, we identified five CpG sites involved in the epigenetic regulation of these eight miRNAs. In brief, we identified an 8‐miRNA signature able to predict survival of patients with GEP and lung NENs, and identified genes and regulatory mechanisms driving prognosis in NEN patients.

Planning a wind power generation project is intricate, considering the number of variables to be careful in the acceptable zone selection for its siting. One of the difficulties of developing a wind farm is finding the most satisfactory location to build it; this can take years of feasibility studies. The main objective of this research is to use the Analytic Hierarchy Process (AHP) to prioritize a group of criteria and sub-criteria as decision-making support for the selection of suitable areas in which implementing wind energy projects in the Colombian Caribbean Sea. The criteria to be applied in this study were selected based on the most recurrently employed criteria in other research papers and the experience of the authors. Thus, a hierarchical structure with 4 criteria (technical, environmental, social, and economic) and 14 subcriteria was implemented. All criteria were prioritized using the methodology proposed by AHP, for which 10 experts with experience in offshore wind projects were consulted, through a form designed with a matrix structure. The results allowed prioritizing a set of criteria necessary for offshore energy planning projects, in which the criteria of Protected Area (19.62%), Wind Speed (13.84%) and Military Areas (9.79%) were the most relevant.

El propósito de esta investigación es el análisis de la posible relación que existe entre las percepciones del liderazgo transformacional y transaccional con la satisfacción laboral. Se estudió una muestra de 69 trabajadores de dos organizaciones privadas de la zona de Ecatepec de Morelos, Estado de México. Se trata de un estudio cuantitativo correlacional y transaccional. Para medir los estilos de liderazgo se utilizó el cuestionario CELID de Castro et al., (2007) y para satisfacción laboral el cuestionario de Littlewood et al., (2006). El resultado del análisis de correlaciones sugiere que tanto el liderazgo transformacional como el transaccional tienen un impacto positivo directo sobre la satisfacción laboral.

This paper presents the implementation of an intelligent real-time single-channel electromyography (EMG) signal classifier based on open-source hardware. The article shows the experimental design, analysis, and implementation of a solution to identify four muscle movements from the forearm (extension, pronation, supination, and flexion), for future applications in transradial active prostheses. An EMG signal acquisition instrument was developed, with a 20–450 Hz bandwidth and 2 kHz sampling rate. The signals were stored in a Database, as a multidimensional array, using a desktop application. Numerical and graphic analysis approaches for discriminative capacity were proposed for feature analysis and four feature sets were used to feed the classifier. Artificial Neural Networks (ANN) were implemented for time-domain EMG pattern recognition (PR). The system obtained a classification accuracy of 98.44% and response times per signal of 8.522 ms. Results suggest these methods allow us to understand, intuitively, the behavior of user information.

Introduction and Objectives: The diagnostic work-up of chronic liver disease includes less invasive procedures such as transient elastography (TE), abdominal ultrasonography, esophagogastroduodenoscopy, and more invasive procedures, mainly portal gradient pressure measurement and liver biopsy. Endoscopic ultrasound (EUS) recently included shear-wave elastography (tissue elasticity), defined as the elastic modulus by measuring shear-wave velocity. This study aimed to evaluate EUS shear-wave of the liver to predict liver cirrhosis. Materials and Methods: a single-center, diagnostic cohort study. Consecutive patients with a history of chronic liver disease were evaluated with an EUS shear-wave elastography of the right and left hepatic lobes. Patients without any medical condition history despite subepithelial lesions were included as a control. A TE was performed to study and control patients to correlate with elastography. We calculated the overall accuracy of EUS shear-wave elastography of the liver in the prediction of liver cirrhosis. Results: Among the 28 patients included, 14 had liver cirrhosis. Baseline data is described in table 1. EUS shear-wave elastography of the right hepatic lobe has a direct, proportional and significant correlation (r=0.693 [95% CI 0.431 – 0.847; P

Aims: Lumen-apposing metal stents (LAMSs) in ultrasonography-guided gallbladder drainage (EUS-GBD) have become increasingly important for high-risk surgical patients. Our study aims to evaluate the technical and clinical success, safety, and feasibility of endoscopic ultrasonography-guided gallbladder drainage using a new dedicated LAMS. Methods: This is a retrospective multicenter study that included all consecutive patients not suitable for surgery who were referred to a tertiary center for EUS-GBD using a new dedicated electrocautery LAMS for acute cholecystitis at eight different centers. Results: Our study included 54 patients with a mean age of 76.48 years (standard deviation: 12.6 years). Out of the 54 endoscopic gallbladder drainages performed, 24 (44.4%) were cholecysto-gastrostomy, and 30 (55.4%) were cholecysto-duodenostomy. The technical success of LAMS placement was 100%, and clinical success was achieved in 23 out of 30 patients (76.67%). Adverse events were observed in two patients (5.6%). Patients were discharged after a median of 5 days post-stenting. Conclusions: EUS-GBD represents a valuable option for high-surgical-risk patients with acute cholecystitis. This new dedicated LAMS has demonstrated a high rate of technical and clinical success, along with a high level of safety.

Background/Aims Peroral endoscopic myotomy (POEM) has been increasingly used for achalasia in Latin America, where Chagas disease is prevalent, and this makes POEM more challenging. The aim of this study was to determine the learning curve for POEM in Latin America. Method: Patients undergoing POEM in Latin America with a single operator were included from a prospective registry over 4 years. Non-linear regression and cumulative sum control chart (CUSUM) analyses were conducted for the learning curve. Results A total of 125 patients were included (52% male; mean age, 59 years), of which 80 had type II achalasia (64%), and 38 had Chagas disease (30%). The average pre-procedure and post-procedure Eckardt scores were 6.79 and 1.87, respectively. Technical success was achieved in 93.5% of patients, and clinical success was achieved in 88.8%. Adverse events occurred in 27 patients (22%) and included bleeding (4 patients), pneumothorax (4 patients), mucosal perforation (13 patients), mediastinitis (2 patients), and leakage (4 patients). The CUSUM chart showed a median procedure time of 97 min (range, 45-196 min), which was achieved at the 61st procedure. Procedure duration progressively decreased, with the last 10 procedures under 50 min approaching a plateau (p-value

The type of controller implemented in a photovoltaic system is of vital importance, since these devices control the energy input coming from the solar modules to regulate the batteries charge. An efficient controller makes it possible to take full advantage of the solar modules power, maximizing the energy obtained. In this paper a techno-economic analysis to measure the performance of MPPT and PWM controllers in a low power off-grid PV system is presented. To achieve this objective, the modeling of a 65 W PV system was performed, which is composed of a solar module, a DC-DC converter, a controller, and a 12 V battery. The modeling was performed in Matlab-Simulink, with which the power data and average monthly energy generated were obtained, using the city of Santa Marta Colombia as a case study. The technical results show that the MPPT controller generates a higher amount of monthly average energy (10.5 kWh) compared to the PWM controller (7.19 kWh) and the data estimated in the Global Solar Atlas (8.22 kWh). From the economic perspective, it was shown that it is possible to implement MPPT controllers in low-power PV systems, due to the energy surpluses obtained and the investment recovery time.

The implementation of electrification programs in non-interconnected rural areas in Colombia is a challenge for the country in order to reduce the social gap in these regions. This task is responsibility of the Mining and Energy Planning Unit (UPME), which has as challenges the implementation of renewable energy projects that allow diversifying the national energy matrix. For this reason, this paper proposes a support framework for multicriteria decision-making in the electricity supply of non-interconnected rural areas for the Colombian Caribbean Region. The multicriteria method of the Fuzzy Analytical Hierarchical Process (FAHP) was used, which allows the incorporation of a fuzzy triangular scale to improve the imprecision in the judgments made by experts. A hierarchical structure with 6 renewable energy alternatives, 4 criteria and 16 sub-criteria was designed, which allowed the implementation of a paired comparison survey that was answered by 10 experts from the region. The results obtained show the relevance of all alternatives, which is evidenced by a percentage difference of less than 5% between all the options. The best alternative was solar PV (20,27%). Regarding the criteria, the most relevant were economic (39,6%) and environmental (30,8%). The most relevant sub-criterion was the renewable fraction, related to the possible reuse of equipment (20,2%).

RESUMEN Introducción y objetivos: Conocer el beneficio clínico del cierre percutáneo de la orejuela izquierda (OI) en nuestro medio; en concreto, la reducción de eventos tromboembólicos y hemorrágicos, que permitiría un mejor posicionamiento de esta intervención. Métodos: Estudio retrospectivo que recoge la actividad del cierre de OI en un centro durante 9 años. Se registraron la tasa de éxito del dispositivo y del procedimiento, así como las tasas de eventos tromboembólicos y de hemorragia mayor. Resultados: Se evaluaron 260 procedimientos de cierre de OI en una población con fibrilación auricular no valvular y puntuación en las escalas CHA2DS2-VASc de 4,3 ± 1,6 y HAS-BLED de 3,7 ± 1,2. El éxito del procedimiento fue del 98,8%, y la tasa de eventos adversos graves en los primeros 7 días fue del 2,3%. Con un seguimiento medio de 2,5 ± 1,9 años y una población de 637,9 pacientes-año, la tasa de eventos tromboembólicos fue de 1,4 por 100 pacientes-año (75,5% de reducción del riesgo) y la de hemorragia mayor fue de 3,0 por 100 pacientes-año (58,5% de reducción del riesgo), ambas significativamente menores que las predichas. Las tasas de eventos por 100 pacientes-año en los pacientes con seguimiento muy largo (más de 4 años) mostraron tendencia a ser menores que en el resto de la población (0,7 frente a 2,0, con p = 0,17, para evento tromboembólico, y 1,7 frente a 4,0, con p = 0,09, para hemorragia mayor). Conclusiones: En nuestra población, el cierre de la OI mostró un elevado éxito del procedimiento y una baja tasa de eventos inmediatos. El cierre de la OI indujo una significativa reducción en la tasa prevista de eventos tromboembólicos y hemorrágicos, y dicha reducción se mantuvo a muy largo plazo.

ABSTRACT Introduction and objectives: A better positioning of left atrial appendage closure (LAAC) requires assessment of its clinical benefits to reduce thromboembolic and bleeding events in a real-word population. Methods: Single-center retrospective study of our consecutive LAAC activity for 9 years. Both the device success and procedural success were registered as well as the reduction of the expected rates of thromboembolic and major bleeding events. Results: A total of 260 LAAC procedures were performed in a population with nonvalvular atrial fibrillation with CHA2DS2-VASc and HAS-BLED scores of 4.3 ± 1.6 and 3.7 ± 1.2, respectively. Procedural success was 98.8%, and the rate of serious adverse events within the first 7 days was 2.3%. At a median follow-up of 2.5 ± 1.9 years and an estimated population of 637.9 patients-year, the thromboembolic event rate was 1.4 per 100 patients-year (75.5% risk reduction) and the rate of major bleeding was 3.0 per 100 patients-year (58.5% risk reduction), which was significantly lower than anticipated. The thromboembolic and major bleeding events per 100 patients-year showed a lower tendency for patients with very long follow-up (over 4 years) compared to the remaining of the population (0.7 vs 2.0 with P = .17, and 1.7 vs 4.0 with P = .09, respectively). Conclusions: In our population, the LAAC showed high procedural success and a low rate of periprocedural adverse events. LAAC induced a significant reduction in the rate of predicted thromboembolic and hemorrhagic events, and this reduction was maintained even at very long follow-up.

La pandemia del COVID-19 ha traído cambios en las condiciones laborales de los trabajadores cuyos efectos se aprecian desde sus ingresos hasta su salud, considerando esta situación, el propósito de esta investigación fue examinar la influencia de la carga de trabajo y el clima laboral en el burnout de trabajadores en empresas manufactureras bajo el contexto de SARS-CoV-2, que permitan proponer acciones con efectos concatenados. Los datos se colectaron a través de un instrumento en una muestra de 350 trabajadores de ocho empresas medianas establecidas en la zona conurbada a la Ciudad de México. Se probaron las hipótesis a través de un modelo de ecuaciones estructurales por medio del software AMOS 20. Los resultados indican que, bajo las circunstancia de pandemia, el clima organizacional y las cargas laborales tienen comportamientos relacionados entre sí; sin embargo, estas variables se relaciona negativamente con el burnout, esto significa que las variaciones que puedan sufrir, producto de la pandemia, no tienen efectos significativos en el burnout de los trabajadores; por lo tanto, el burnout tendrá su origen en otros factores circunstanciales.

Algunas personas en procesos de reintegración mayores (PPRM) que participaron en la guerra presentan alteraciones mentales explicadas por el largo tiempo desescolarizados y las situaciones vividas, que le disminuyen la posibilidad de acceso al campo laboral y a la sociedad, el funcionamiento cognitivo alterado fue más prevalente en personas sin educación formal, sin pareja o vivir en familias no funcionales. Entre los factores demográficos de las PPRM que aumentan la probabilidad de tener un síntoma depresivo fue pertenecer al sexo masculino, tener más de 65 años, no contar con apoyo de una pareja y disminuye esta probabilidad si se cuenta con algún grado de escolaridad. De los factores familiares y sociales que se analizaron, solo se encontró que vivir con una familia no funcional aumenta el riesgo de sufrir síntomas depresivos. Por lo que se requiere acompañamiento para la aceptación de su proceso de envejecimiento, el aprovechamiento de experiencias y el ejercicio de la ciudadanía.

La innovación y la tecnología juegan un papel importante en la educación actual desde el ámbito de las nuevas formas de conocer y comunicar dentro del aula; por lo que es necesario, implementar estrategias didácticas innovadoras a través del uso de las tecnologías de la información. De ahí que el presente estudio se trabaja desde lo teórico educativo y tiene como objetivo, identificar las prácticas académicas que los docentes desarrollan al utilizar las nuevas tecnologías, para crear ambientes creativos de aprendizaje. La metodología que se utilizó en la investigación fue de tipo mixta, cuantitativa -cualitativa, mediante el instrumento investigativo de la encuesta, aplicado a los docentes de la Unidad Educativa 5 de junio-jardín de la ciudad de Manta. Los hallazgos de esta investigación permiten conocer el tipo de prácticas académicas que se desarrollan durante la interacción didáctica que media el docente entre los nuevos escenarios de aprendizajes que se crean con el uso de las nuevas tecnologías; el estudiante aprende de forma más atractiva, amena, divertida y sencilla. El presente trabajo concluye que las prácticas didácticas ejecutadas a través del uso de las Tics generan ambientes creativos de aprendizajes, desde la motivación para aprender, la interacción sin barreras geográficas, hasta la participación creativa del trabajo grupal; lo que les permite experimentar dentro y fuera del aula de clases.

El termino envejecimiento activo es relativamente novedoso y muy poco conocido a pesar de que en los últimos tiempos se ha hablado mucho de esto. El presente trabajo tiene como objetivo revisar la literatura frente a la atención en salud del adulto mayor. El método que se utilizó fue una revisión narrativa a través de una exploración de artículos científicos en las bases de datos: Science direct, Pubmed y Scielo. En los resultados se encontró que en varios artículos los adultos mayores no se encontraban satisfechos con la atención que recibían en salud. Como conclusiones según lo referido por las personas mayores, hay una brecha grande entre lo que se dice en las políticas públicas de envejecimiento y lo que realmente se está haciendo en la prestación de servicios. En cuanto a la percepción que tienen los adultos mayores de su salud en Antioquia, hay un porcentaje muy alto que cree que la atención en salud no es la adecuada.

Al analizar la Ruta de reintegración de la Agencia para la Reincorporación y la Normalización (ARN) para las Personas mayores en Colombia que han hecho parte de grupos armados al margen de la ley e inician procesos de reintegración a la vida civil, en el Estado Colombiano, se deja entrever por una lado que, esta población es especialmente vulnerable en tanto tienen más dificultad para adaptarse a la vida civil, advierte de la necesidad de reconocer los vacíos que exigen emplear enfoques diferenciales para abordar de forma adecuada las condiciones y necesidades particulares de este conjunto poblacional, destaca además, la importancia de aumentar y/o mejorar la oferta pública y privada de servicios que permitan una atención integral y sostenible.

Background and study aims Probe-based confocal laser endomicroscopy (pCLE) can provide high magnification to evaluate chronic atrophic gastritis (CAG), but the current pCLE criteria are qualitative and prone to variability. We aimed to propose a quantitative CAG criterion based on pCLE to distinguish non-atrophic gastritis (NAG) from CAG. Patients and methods This observational, exploratory pilot study included patients with NAG and CAG evaluated via esophagogastroduodenoscopy, pCLE, and histology. We measured the gastric glands density, gastric gland area, and inter-glandular distance during pCLE. Results Thirty-nine patients (30/39 with CAG) were included. In total, 194 glands were measured by pCLE, and 18301 were measured by histology, with a median of five glands per NAG patient and 4.5 per CAG patient; pCLE moderately correlate with histology (rho = 0.307; P = 0.087). A gland area of 1890–9105 µm2 and an inter-glandular distance of 12 to 72 µm based on the values observed in the NAG patients were considered normal. The proposed pCLE-based CAG criteria were as follows: a) glands density 1/4 the pCLE field area (> 9105 µm2); or c) inter-glandular distance 72 µm; CAG was diagnosed by the presence of at least one criterion. The proposed criteria discriminated CAG with a ranged sensitivity of 76.9 % to 92.3 %, a negative predictive value of 66.6 % to 80.0 %, and 69.6 % to 73.9% accuracy. Conclusions The proposed pCLE criteria offer an accurate quantitative measurement of CAG with high sensitivity and excellent interobserver agreement. Larger studies are needed to validate the proposed criteria.

Introducción: Recientes investigaciones nos animan a profundizar en el desarrollo de las capacidades de las herramientas que el uso del debate y la oratoria nos proporcionan para el fortalecimiento del pensamiento crítico. Somos conscientes de la necesidad que tenemos en los tiempos actuales post-pandémicos de facilitar a nuestros estudiantes una visión más rica de la realidad. Interpretar esta realidad con un mayor acierto nos capacita en las decisiones personales y sociales a ser más autónomos y responsables y por tanto alcanzar mayores cotas de libertad. Objetivos: Profundizar en los conceptos oratoria y debate como disciplinas adecuadas al fortalecimiento del pensamiento crítico. Relacionar el pensamiento crítico y la libertad individual como conceptos esenciales del desarrollo personal y social. Método: En nuestra comunicación se pretende valorar y analizar el mayor número de variables implicadas en la disciplina del debate y la oratoria que nos conduzcan a un desarrollo más profundo del pensamiento crítico. Esta comunicación tiene como objetivo establecer las bases de un análisis estadístico que nos permita relacionar oratoria y debate y sus implicaciones en la mejora del pensamiento crítico.

Objetivo: Identificar los factores asociados a la capacidad laboral de las personas mayores de 50 años, excombatientes de los grupos al margen de la ley, adscritos a la Agencia para la Reincorporación y la Normalización. Metodología: Estudio observacional, analítico de fuente de información primaria, con 239 personas mayores en proceso de reintegración, encuestados en cinco lugares de Colombia. Se calculó la razón de prevalencia cruda y ajustada, mediante una regresión logística no condicional, con valor de p < 0,05, considerada una asociación estadísticamente significativa. Resultados: El 71,5 % de las personas mayores de 50 años se encuentran laborando, principalmente, en el sector informal. La dependencia funcional se asocia, aunque no de forma significativa, con ser hombre, soltero, no tener limitaciones para ver o moverse, y mostrar habilidades en la conducción de vehículos y el manejo de computadores. Presentaron mayor limitación en el campo laboral los que tienen dificultades para hablar y un menor nivel educativo. Conclusión: La adaptación a la vida laboral de las personas mayores excombatientes de los grupos al margen de la ley puede facilitarse con la implementación de enfoques diferenciales, programas educativos formales e informales, el uso de ayudas ortopédicas, la generación de estrategias de acceso al empleo y estrategias saludables que promuevan su salud y atención a los efectos de la guerra.

ABSTRACT BACKGROUND: Bougies dilation is considered an effective technique for the treatment of simple benign esophageal strictures. The “rule of three” has been advocated to prevent reported adverse events such as bleeding and perforation. However, adherence to this rule has increased the cost and duration of treatment. OBJECTIVE: To demonstrate the safety and long-term benefits of progressive bougie dilations until reaching 15 mm (45Fr) in one single session endoscopy with non-adherence to the rule of three. METHODS: A retrospective analysis of a prospectively collected data of patients with simple benign esophageal strictures treated with multiple progressive bougie dilators until reaching 15 mm (45Fr) in one single session. RESULTS: The median age was 58 years (range 28-89), and 83.3% of patients were female. The main presenting symptom was dysphagia for solids in 11/12 cases (91.6%). The cause of their simple benign esophageal stricture was distributed as follows: 7/12 esophageal webs, 2/12 peptic stenosis, 2/12 Schatzki rings and one caustic injury. 75% required only one session for clinical success. No serious adverse events were described. No recurrence of symptoms was noted in a median follow-up of 20 months. CONCLUSION: The rule of three in patients with simple benign esophageal strictures secondary to esophageal webs, Schatzki rings and peptic strictures treated with Savary-Gilliard dilators is not necessary, showing good clinical results. Prospective studies with more patients are necessary.

Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard procedure for malignant jaundice palliation; however, it can be challenging when a duodenal self-expandable metal stent (SEMS) is already in place. Patients and methods The primary aim of our study was to evaluate the technical feasibility of the placement of a lumen apposing metal stent (LAMS) through the mesh (TTM) of duodenal stents. The secondary aims were to evaluate clinical outcomes and adverse events (AEs) related to the procedures. Results Data from 23 patients (11 F and 12 M; mean age: 69.5 ± 11 years old) were collected. In 17 patients (73.9 %) TTM LAMS placement was performed as first intention, while in six patients (26.1 %) it was performed after a failed ERCP. Thirteen patients (56.5 %) underwent the procedure due to advanced pancreatic head neoplasia. One technical failure was experienced (4.3 %). The TTM LAMS placement led to a significant decrease in the serum levels of bilirubin, ALP, GGT, WBC and CRP. No cases of duodenal SEMS occlusion occurred and no other AEs were observed during the follow-up. Conclusions Concomitant malignant duodenal and biliary obstruction is a challenging condition. Palliation of jaundice using TTM LAMS in patients already treated with duodenal stent is associated to promising technical and clinical outcomes.

Background and study aims The use of fluoroscopy during pregnancy should be minimized given that a clear-cut safe radiation dose in pregnancy is unknown. The role of digital single-operator cholangioscopy (D-SOC) as an alternative to standard enodoscopic retrograde cholangiopancreatography (ERCP) in pregnant patients has not been comprehensively studied. This study assessed 1 Technical success defined as performance of ERCP with D-SOC without the use of fluoroscopy in pregnant patients; 2 safety of D-SOC in pregnancy; and 3 maternal and neonatal outcomes after D-SOC during/after pregnancy. Patients and methods This was an international, multicenter, retrospective study at 6 tertiary centers. Pregnant patients who underwent D-SOC for the treatment of bile duct stones and/or strictures were included. Results A total of 10 patients underwent D-SOC. Indications for ERCP were choledocholithiasis, strictures, previous stent removal, and choledocholithiasis/stent removal. Bile duct cannulation without fluoroscopy was achieved in 10 of 10 patients (100 %). Moreover, 50 % of patients (5/10) completed a fluoroless ERCP with D-SOC. Mean fluoroscopy dose and fluoroscopy time were 3.4 ± 7.2 mGy and 0.5 ± 0.8 min, respectively. One case of mild bleeding and one case of moderate post-ERCP pancreatitis occurred. The mean gestational age at delivery was 36.2 ± 2.6 weeks. Median birth weight was 2.5 kg [IQR: 2.2–2.8]. No birth defects were noted. Conclusion ERCP guided by D-SOC appears to be a feasible and effective alternative to standard ERCP in pregnant patients. It enables avoidance of radiation in half of cases.

Aim. To assess procedural and long-term efficacy and safety of two alternative methods for appendage closure, conscious sedation with standard transoesophageal echo and procedure guided by rotational angiography. Background. Demand for appendage closure is increasing, and a reasonable time-response should be given to nonvalvular atrial fibrillation patients not suitable to receive anticoagulation. General anesthesia and the need for an anesthesiologist are limiting factors to improve procedure availability; it is time to introduce simpler approaches. Methods. Single center experience in appendage closure during 9 years, using three different procedural approaches: general anesthesia with echo guidance, conscious sedation with echo guidance, and rotational angiography guidance. Conscious sedation and rotational angiography-guided procedures were performed in the absence of an anesthesiologist. Procedural characteristics and follow-up events were recorded. Results. 260 consecutive appendage closure procedures were reviewed: 155 were performed under general anesthesia (59.6%), 71 were performed with conscious sedation (27.3%), and 34 were rotational angiography guided (13.1%). Device success rate for procedures guided by rotational angiography was significantly lower than that for general anesthesia and conscious sedation (91.2% versus 100% versus 98.6%, p=0.001) because there was a greater need to recapture and change device size. However, final procedural success was high and without difference between approaches (98.8% versus 97.2% versus 100%, for general anesthesia, conscious sedation, and rotational angiography, respectively); with a median follow-up of 17 months (CI 95% 13–23 month) (637.9 patients-year), there was no difference among approaches for thromboembolic (1.3 versus 1.8 versus 1.8) and major bleeding events (3.2 versus 2.8 versus 1.8), respectively. Conclusions. Appendage closure performed, either with conscious sedation with echo guidance or rotational angiography guided, is feasible, with no difference in procedural success and follow-up events compared with general anesthesia and without the limitation of the need for an anesthesiologist on-site.

Background and study aims Assessment of endoscopic ultrasonography (EUS)-elastography of the liver and spleen may identify patients with portal hypertension secondary to chronic liver disease. We aimed to evaluate use of EUS-elastography of the liver and spleen in identification of portal hypertension in patients with chronic liver disease. Patients and methods This was a single-center, diagnostic cohort study. Consecutive patients with liver cirrhosis and portal hypertension underwent EUS-elastography of the liver and spleen. Patients without a history of liver disease were enrolled as controls. The primary outcome was diagnostic yield of liver and spleen stiffness measurement via EUS-elastography in prediction of portal hypertension secondary to chronic liver cirrhosis. Cutoff values were defined through Youden’s index. Overall accuracy was calculated for parameters with an area under the receiver operating characteristic (AUROC) curve ≥ 80 %. Results Among the 61 patients included, 32 had cirrhosis of the liver. Liver and spleen stiffness was measured by the strain ratio and strain histogram, with sensitivity/(1 − specificity) AUROC values ≥ 80 %. For identification of patients with cirrhosis and portal hypertension, the liver strain ratio (SR) had a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 84.3 %, 82.8 %, 84.4 %, and 82.8 %, respectively; the liver strain histogram (SH) had values of 87.5 %, 69.0 %, 75.7 %, and 83.3 %, respectively. EUS elastography of the spleen via the SR reached a sensitivity, specificity, PPV, and NPV of 87.5 %, 69.0 %, 75.7 %, and 83.3 %, respectively, whereas the values of SH were 56.3 %, 89.7 %, 85.7 %, and 65.0 %, respectively. Conclusion Endoscopic ultrasonographic elastography of the liver and spleen is useful for diagnosis of portal hypertension in patients with cirrhosis.

This paper presents a detailed description of the data obtained as a result of the computational simulations and experimental tests of an MPPT controller based on an ADALINE artificial neural network with FIR architecture, trained with the RTRL and LMS algorithms that were used as mechanisms of control in an off-grid photovoltaic system. In addition to the data obtained with the neural control method, the data for the MPPT controller based on the traditional Perturb and Observe (P&O) algorithm are presented. The simulations were performed in MATLAB/Simulink software without using the Neural Network Toolbox for controller training. The experimental tests were performed in an open space without shaded areas, exposing the neurocontroller to varying environmental conditions. Additionally, the scripts developed in MATLAB for the neural training algorithms used in the simulations are presented. These computational simulations were structured in five test cases to represent the behavior of each controller under varying environmental conditions. The codes developed in C are part of the implementation of the MPPT neurocontroller in the PIC18F2550, from which the experimental data were obtained. The data and codes presented in this research are available in the Mendeley Data repository, which allows evaluating the performance and optimizing the training algorithms with the purpose of improving the control methods applied to photovoltaic systems.

Background and study aims The aim of thi systematic review and consensus report is to standardize the practice of endoscopic ultrasound (EUS-guided needle-based confocal laser endomicroscopy (nCLE) for pancreatic cystic lesion (PCL) evaluation. Methods We performed an international, systematic, evidence-based review of the applications, outcomes, procedural processes, indications, training, and credentialing of EUS-nCLE in management of PCLs. Based on available clinical evidence, preliminary nCLE consensus statements (nCLE-CS) were developed by an international panel of 15 experts in pancreatic diseases. These statements were then voted and edited by using a modified Delphi approach. An a priori threshold of 80 % agreement was used to establish consensus for each statement. Results Sixteen nCLE-CS were discussed. Thirteen (81 %) nCLE-CS reached consensus addressing indications (non-communication PCL meeting criteria for EUS-FNA or with prior non-diagnostic EUS-FNA), diagnostic outcomes (improved accuracy for mucinous PCLs and serous cystadenomas with substantial interobserver agreement of image patterns), low incidence of adverse events (fluorescein-associated and pancreatitis), procedural processes (nCLE duration, manipulation of needle with probe), and training (physician knowledge and competence). Conclusion Based on a high level of agreement pertaining to expert consensus statements, this report standardizes the practice of EUS-nCLE. EUS-nCLE should be systematically considered when EUS-FNA is indicated for PCL evaluation.

Background and study aims Both Heller myotomy (HM) and per-oral endoscopic myotomy (POEM) are efficacious therapies for achalasia. The efficacy and safety of POEM vs HM in Latin America and specifically in patients with Chagas disease is unknown. Patients and methods Consecutive patients undergoing either HM or POEM for achalasia were included from nine Latin American centers in a prospective registry over 5 years. Technical success was defined as undergoing a successful myotomy. Clinical success was defined as achieving an Eckardt score

Background and study aims Pancreatic cancer represents the fourth most common cause of cancer-related deaths in Western countries and the need of a low-risk investigation to obtain an accurate histopathological diagnosis has become increasingly pressing. Endoscopic ultrasonography (EUS) with fine-needle aspiration (FNA) is the standard method for obtaining samples from pancreatic masses. In recent years, there has been an increasing need to obtain histological specimens during EUS procedures, rather than cytological ones, to guide oncological treatment options, leading to the so-call “FNB concept.” Different needles have been developed for fine-needle biopsy (FNB) in recent years, enabling acquisition of larger specimens on which to perform histological and molecular analyses. The aim of this narrative review was to assess the role of EUS-guided FNA and FNB in patients with pancreatic masses, and to identify which needle and which acquisition technique should be used to improve tissue acquisition.