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On September 29, 2023, the Republic of Ecuador convened a meeting to address surgical system strengthening and urge political leaders to invest in surgical infrastructure. The meeting included experts in health diplomacy, innovative financing, implementation strategy and national surgical plans. The event occurred in parallel with the Sixtieth Directing Council of the Pan American Health Organization, Seventy-fifth session of the World Health Organization Regional Committee for the Americas. The meeting centered around four major areas: (i) building surgical capacity as a means to develop universal health care and emergency preparedness; (ii) developing policies and strategies for strengthening surgical systems; (iii) developing models for financing, sustaining, and improving surgical systems in low- and middle-income countries; and (iv) evaluating implementation strategies for funding these endeavors. National surgical plans represent a critical opportunity to build resilient health care systems by establishing comprehensive and sustainable policies. This article highlights the key messages from the event, which focused on Latin America, to inform the broader global health community., Competing Interests: Conflicts of interest. ABV was the acting vice president of Ecuador and MJGF was employed by the office of the vice president at the time of this meeting. They have since founded and are on the executive board of the nonprofit organization Corporación Latinoamericana para la Salud. IAB and MMS are both ambassadors of Ecuador. REA is the chief of policy and advocacy for Operation Smile. GCI is the executive director of The Global Surgery Foundation. AM is the division director at UNITAR. LFF is the director of memberships for the World Federation of Societies of Anaesthesiologists, the chief medical officer at Anextesia, and the director of international affairs at the Brazilian Society of Anesthesiology. EB is the unit chief of Primary Health Care and Integrated Service Delivery at PAHO. JK serves part-time as senior adviser to the Coordinator for Global COVID-19 Response and Health Security at the U.S. Department of State. JM is the president of the Center for Global Health and Development. NK, GYH, AG, TW, TUL, SC, KBP, JGM, RR, and EM do not have any disclosures to declare.

Competing Interests: The authors declare no conflicts of interest.

On the sidelines of the 75th Session of the Regional Committee of the World Health Organization for the Americas, the Republic of Ecuador hosted an event to expand on National Surgical, Obstetric, and Anaesthesia Plans (NSOAPs). NSOAPs are policy frameworks that offer governments a pathway to incorporate surgical planning into their overall health strategies. In Latin America, Ecuador became the first country to lead the development of an NSOAP and is fostering regional efforts for other Latin American countries to have sustainable surgical strengthening plans. Brazil is a prominent candidate for enrolling in an NSOAP process to enhance its public health system's functionality. An NSOAP in Brazil can help mitigate social disparities, promote greater efficiency in allocating existing resources, and optimise public health system financing. This process can also encourage the creation of resources and distinct NSOAP vocabulary in Portuguese to facilitate the development of NSOAPs in other Portuguese-speaking and low- and middle-income countries. In this viewpoint, we explore why an NSOAP can benefit Brazil's surgical system, national features that enable surgical policymaking, and how multiple stakeholder engagement can contribute to the country's planning, validation, and implementation of an NSOAP., Competing Interests: LLF is a member of the World Federation Society of Anesthesiologists Council and Director of International Relations of the Brazilian Society of Anesthesiology. RC is a Board member of the Brazilian College of Digestive Surgery, the São Paulo Chapter of the Brazilian College of Surgeons, and the Brazilian Association of Gastric Cancer. All authors declare no competing interests., (© 2024 The Author(s).)

Background: Cytomegalovirus-specific T-cell-mediated immunity (CMV-CMI) protects from CMV infection in allogeneic hematopoietic cell transplantation (allo-HCT), but to date, there is no validated measure of CMV immunity for this population., Methods: In this prospective, observational, pilot study, CMV T-cell responses were evaluated monthly and at onset of graft-versus-host disease (GVHD) or CMV infection in CMV-seropositive allo-HCT recipients using a commercial flow cytometry assay, the CMV inSIGHT T-Cell Immunity Panel (CMV-TCIP). The primary endpoint was the time to first positive CMV-TCIP, defined as percentage of interferon-γ-producing CD4+ or CD8+ CMV-specific T cells >0.2%. Letermovir was prescribed from day +10 to ≥100., Results: Twenty-eight allo-HCT recipients were enrolled. The median time to first positive CMV-TCIP result was earlier for CD4+ (60 days [interquartile range, IQR 33‒148]) than for CD8+ T cells (96 days [IQR 33‒155]) and longer for haploidentical and mismatched transplant recipients (77 and 96 days, respectively) than for matched donors (45 and 33 days, respectively). CD4+ and CD8+ CMV-CMI recovery was sustained in 10/10 (100%) and 10/11 (91%) patients, respectively, without GVHD, whereas CD4+ and/or CD8+ CMV-CMI was lost in 4/6 and 2/6 patients, respectively, with GVHD requiring steroids. As a predictor of clinically significant CMV infection in patients with low-level CMV reactivation, the sensitivity and negative predictive value of CMV-TCIP were 90% and 87.5%, respectively, for CD4+ CMV-TCIP and 66.7% and 62.5%, respectively, for CD8+ CMV-TCIP., Conclusions: There was significant variability in time to CMV-CMI recovery post-HCT, with slower recovery after haploidentical and mismatched HCT. CD4+ CMV-CMI may protect against CS-CMVi, but immunity may be lost with GVHD diagnosis and treatment., (© 2024 Wiley Periodicals LLC.)

Purpose: Studies attempting to link dietary non-enzymatic antioxidant activity (NEAC) and colorectal cancer (CRC) risk have reported mixed results. We examined this association in the Spanish Multicase-Control Study considering the likely influence of coffee and other dietary factors., Methods: 1718 CRC cases and 3312 matched-controls provided information about diet through a validated 140-item food frequency questionnaire. Dietary NEAC was estimated for three methods [total radical-trapping antioxidant parameters (TRAP), ferric reducing/antioxidant power (FRAP) and TEAC-ABTS] using published values of NEAC content in food, with and without coffee's NEAC. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated through unconditional logistic regression models adjusted for lifestyle and dietary factors., Results: Overall dietary intake of NEAC was significantly lower in cases compared to controls and associated with a significantly reduced CRC risk, in both men (OR Q5vsQ1  = 0.67, 95% CI 0.47-0.96 for FRAP) and women (OR Q5vsQ1  = 0.53, 95% CI 0.32-085 for FRAP), in multivariate models with and without the antioxidant contribution from coffee. The effect was similar for all the NEAC methods evaluated and for both colon and rectum. The association between dietary NEAC and CRC risk became non-significant when adjusting for fiber intake. However, intakes of NEAC and fiber were correlated., Conclusion: This study indicates that intake of an antioxidant-rich plant-based diet, both with and without NEAC from coffee, is associated with decreased CRC risk.

Background: Sex hormones play a role in gastric cancer and colorectal cancer etiology, however, epidemiological evidence is inconsistent. This study examines the influence of menstrual and reproductive factors over the risk of both tumors., Methods: In this case-control study 128 women with gastric cancer and 1293 controls, as well as 562 female and colorectal cancer cases and 1605 controls were recruited in 9 and 11 Spanish provinces, respectively. Population controls were frequency matched to cases by age and province. Demographic and reproductive data were directly surveyed by trained staff. The association with gastric, colon and rectal cancer was assessed using logistic and multinomial mixed regression models., Results: Our results show an inverse association of age at first birth with gastric cancer risk (five-year trend: OR = 0.69; p-value = 0.006). Ever users of hormonal contraception presented a decreased risk of gastric (OR = 0.42; 95%CI = 0.26-0.69), colon (OR = 0.64; 95%CI = 0.48-0.86) and rectal cancer (OR = 0.61; 95%CI = 0.43-0.88). Postmenopausal women who used hormone replacement therapy showed a decreased risk of colon and rectal tumors. A significant interaction of educational level with parity and months of first child lactation was also observed., Conclusion: These findings suggest a protective role of exogenous hormones in gastric and colorectal cancer risk. The role of endogenous hormones remains unclear., Competing Interests: The authors have declared that no competing interests exist.

Background: Colonic fermentation produces hydrogen (H2 ), and also produces methane (CH4 ) in subjects with methanogenic flora (M+). Methane production has been associated with chronic constipation (CC) and with changes in gut motility. To determine CH4 production in CC compared to controls, and to assess whether the therapeutic response to Ispaghula husk in CC differs between CH4 -producers and non-producers., Methods: Forty-eight patients with functional constipation or irritable bowel syndrome-constipation and 19 healthy age-and-sex-matched volunteers (HV) filled in a 1-week symptom diary and a dietary questionnaire. They then underwent a lactulose breath test (LBT) to measure H2 and CH4 production (peak and area under the time-concentration curve, AUC-) and a colonic transit time (CTT) assessment. In patients, measurements were repeated after a 4-week treatment with Ispaghula husk., Key Results: Prevalence of M+ in patients was 60.5% vs 52.6% in HV (p = 0.37). Patients had significantly longer CTT and greater production of both H2 and CH4 during LBT. There was a significant correlation between CH4 production and CTT (r = 0.51; p = 0.07). Treatment response rate was similar for M+ and M- patients (58.3% vs 52.9%; p = 0.76) as were the increases in bowel movements and Bristol score, changes in abdominal discomfort and bloating. In M+, treatment reduced CTT (-10 ± 35 h; p = 0.029 vs baseline) and CH4 levels: peak CH4 (-13 ± 24 ppm; p = 0.014) and CH4 -AUC (-817 ± 3100 ppm/min; p = 0.04)., Conclusions & Inferences: Although CH4 production has been associated with CC pathophysiology, we found that CH4 status did not negatively affect the response to Ispaghula husk treatment. The measurement of CH4 levels as a biomarker tool for CC requires further appraisal., (© 2015 John Wiley & Sons Ltd.)

Neuroendocrine tumors of the gastrointestinal tract are highly infrequent. We report the case of a 57-year-old woman who presented with toxic syndrome, vomiting and a 3-month history diarrhea, with a final diagnosis of poorly-differentiated neuroendocrine tumor. Based on this case, we review the clinical characteristics, diagnostic procedures, prognostic factors and therapeutic possibilities in this type of tumor. Neuroendocrine tumors should be considered in the diagnosis of colonic tumors with hyperechoic liver metastases., (Copyright © 2011 Elsevier España, S.L. y AEEH y AEG. All rights reserved.)

We report the case of a 40-year-old man with underlying alcoholic liver disease who presented with prolonged fever, jaundice and liver failure associated with Coxiella burnetii infection. After diagnosis and appropriate antibiotic treatment, the patient made a complete recovery. We describe aspects of this case and provide a practical review of the literature on the topic. We also discuss the importance of this infection and the need for its inclusion in the differential diagnosis of this clinical picture., (Copyright © 2010 Elsevier España, S.L. All rights reserved.)

Two methods, one to determine ascorbic acid and one to determine lycopene and beta-carotene, in vegetables and fruits by liquid chromatography coupled with mass spectrometry (LC-MS) have been established. The chromatographic separation of the studied compounds and their MS parameters were optimized to improve selectivity and sensitivity. In both methods, separation was carried out with two coupled columns, first a C(18) and then a dC(18), using as mobile phase 70% methanol (0.005% acetic acid) and 30% acetic acid 0.05% for ascorbic acid determination and a mixture of methanol, tetrahydrofuran, and acetonitrile (60:30:10 v/v/v) for carotenoid analysis in isocratic mode. The molecular ion was selected for the quantification in selective ion monitoring (SIM) mode. Ascorbic acid was detected with electrospray ionization probe (ESI) in negative mode, while chemical ionization atmospheric pressure (APCI) in positive mode was used for the target carotenoids. The methodology for ascorbic acid analysis is based on an extraction with polytron using methanol and a mixture of methaphosphoric acid and acetic acid. Extraction of the carotenoids was carried out with tetrahydrofuran/methanol (1:1) (v/v). The proposed methods were applied, after their corresponding validations, to the analysis of four varieties of tomatoes, tomato in tin enriched and dried tomato, and to the analysis of mango and kiwi fruits, to compare the content in these compounds. Moreover, the influence of the process of freezing and the effect that the manipulation/preservation has in the content of ascorbic acid in tomato have also been studied.

A method has been developed for the simultaneous determination of paraquat (PQ), deiquat (DQ), chlormequat (CQ) and mepiquat (MQ) in water samples by liquid chromatography (LC) coupled with electrospray ionization mass spectrometry (MS). The LC separations of the target compounds, as well as their MS parameters, were optimized in order to improve selectivity and sensitivity. Separation was carried out in a Xterra C8 column, using as mobile phase methanol-heptafluorobutyric acid (HFBA) in isocratic mode. The molecular ion was selected for the quantitation in selected ion monitoring (SIM) mode. Off-line solid-phase extraction (SPE) was applied with silica cartridges in order to preconcentrate the compounds from waters. Detection limits were in the range 0.02-0.40 microg l(-1). Recovery range varied between 89 and 99.5% with precision values lower than 6%. The method has been applied successfully to the analysis of both surface and groundwater samples from agricultural areas of Andalusia (Spain), using well defined internal quality control (IQC) criteria. The results revealed the presence of deiquat and paraquat in some samples.

A rapid method was developed to allow the analysis of triazamate and the hydrolysis product triazamate acid in apples, peas and Brussels sprouts. The procedure was based on acidified methanol extraction with quantification by liquid chromatography coupled with tandem mass spectrometry detection. The detection limit, based on the lowest calibration level, was 0.005 mg kg(-1). The method was validated at 0.05 and 0.01 mg kg(-1), and was used for screening of triazamate acid in the surveillance of apples as part of the UK pesticide monitoring programme. Calibrations were linear over the range 0.004-0.080 microg ml(-1) (equivalent to 0.005-0.11 mg kg(-1)), with a minimum correlation coefficient of 0.95. The detection response showed some matrix-dependent variation. Mean recoveries were in the range 70-108% with associated per cent coefficient of variations of less than 20%.

A fast method for the determination of eight organotin compounds (OTs), monobutyltin (MBT), dibutyltin (DBT), tributyltin (TBT), tetrabutyltin (TeBT), monophenyltin (MPhT), diphenyltin (DPhT), triphenyltin (TPhT) and tetraphenyltin (TePhT), in water, sediments and mussels, was developed using low-pressure gas chromatography/tandem mass spectrometry (LPGC/MS/MS). The method is based on sodium diethyldithiocarbamate (DDTC) complexation of the ionic organotins, followed by extraction of the target matrices and derivatization by a Grignard reagent, as described in a previously published method for water samples. Solid-phase extraction was selected as extraction method from water samples after comparison with liquid-liquid extraction, but extraction of the OTs from sediment and mussel samples was performed using toluene. Matrix-matched calibration standards were used to minimize matrix effects. The analytical process was validated by the analysis of spiked blank samples. Performance characteristics such as linearity, detection limit (LOD), quantitation limit (LOQ), precision, and recovery were determined. Recoveries of OTs in spiked matrices ranged from 86-108% in water and from 78-110% in sediments and mussels, with precision values lower than 18%. Detection limits ranged from 0.1-9.6 ng L(-1) in water, and 0.03-6.10 microg kg(-1) in the other matrices. The present implementation of LPGC rather than conventional capillary GC permitted use of large-volume injection and reduced analysis time by a factor of two. The proposed methodology was applied to the determination of OTs in real samples of water, marine sediments and mussels from the west coast of the Mediterranean Sea (Spain)., (Copyright 2003 John Wiley & Sons, Ltd.)