Gobierno-ELN: 30 años de diálogos y fracasos

Este especial es un recorrido por los intentos de llegar a la paz con la segunda guerrilla más importante en la actualidad de Colombia: el Ejército de Liberación Nacional. El ELN se ha acercado, aunque esquivamente, a proceso de paz con los gobiernos de turno, pero en algún punto del camino ha retrocedido. Aquí, se recogen estos acercamientos, desde Belisario Betancur hasta Juan Manuel Santos, también se le abre el espacio a su historia e ideología, para entender por qué es tan complicado negociar con este grupo armado.This special is a tour for the attempts to reach peace with the second most important guerrilla in Colombia today: the Army of National Liberation. The ELN has approached, although elusively, to peace process with the Colombian governments since 1982, but at some point along the way it has receded. Here, these approaches are collected, from Belisario Betancur to Juan Manuel Santos, also opens the space to its history and ideology, to understand why it is so complicated to negotiate with this armed group

Análisis histológico de la inserción del fascículo superior del músculo pterigoideo externo al disco articular

The inclusion of the fascicle higher external pterygoid muscle (Lateral Pterigoid) disk articulate occurs from the middle third of the central region and contributes to the displacement of the disc and its alteration help discal displacement. On the insertion, there are differences of opinion; some consider that only a small portion of fiber is inserted into the anterior capsule and thus directly and indirectly to the disk; other researchers point out that it is directly inserted the disk and the condyle or only on the anterior edge of the capsule and the disc. The objective of the study was a histological analysis of the insertion of this muscle to differentiate the type of fibres that reach the disk articulate (proportion of collagen fibers and muscle fibers) and determine the type of union between the muscle and the disc articulate. The sample of this study of transverse and exploratory type, was constituted by prepared diesiseis anatomical joint, temporomandibular, proceding for his histological reading with stains Hematoxylin and Eosin, Van Guiesson and Mallory, having found that the largest proportion of fibers reaching insert disk articulate are collagen and type of Union between the muscle and the disc articulate is sandwiched in a longitudinal way.La inserción del fascículo superior del músculo pterigoideo externo (Pterigoideo Lateral) en el disco articular se presenta a partir del tercio medio de la región central de este y contribuye al desplazamiento del disco y su alteración contribuiría al desplazamiento discal. Sobre la inserción existen diferencias de opinión; unos consideran que solo una pequeña porción de fibras se inserta en la parte anterior de la cápsula y por ende directa e indirectamente al disco; otros investigadores señalan que se encuentra directamente insertado al disco y al cóndilo o solo en el borde anterior de la cápsula y el disco. El objetivo del estudio fue realizar un análisis histológico de la inserción de este músculo para diferenciar el tipo de fibras que llegan al disco articular (proporción de fibras colágenas y fibras musculares) y determinar el tipo de unión entre el músculo y el disco articular. La muestra de este estudio de tipo transversal y exploratorio estuvo constituido por diesiséis preparados anatómicos de articulaciones temporomandibulares, procesándose para su lectura histológica, con colorantes hematoxilina y eosina, Van Guiesson y Mallory, habiéndose encontrado que la mayor proporción de fibras que llegan a insertarse en el disco articular son colágenas y el tipo de unión entre el musculo y el disco articular es en forma intercalada en forma longitudinal

Population-based colorectal cancer screening programmes using a faecal immunochemical test:Should faecal haemoglobin cut-offs differ by age and sex?

Abstract Background The Basque Colorectal Cancer Screening Programme has both high participation rate and high compliance rate of colonoscopy after a positive faecal occult blood test (FIT). Although, colorectal cancer (CRC) screening with biannual (FIT) has shown to reduce CRC mortality, the ultimate effectiveness of the screening programmes depends on the accuracy of FIT and post-FIT colonoscopy, and thus, harms related to false results might not be underestimated. Current CRC screening programmes use a single faecal haemoglobin concentration (f-Hb) cut-off for colonoscopy referral for both sexes and all ages. We aimed to determine optimum f-Hb cut-offs by sex and age without compromising neoplasia detection and interval cancer proportion. Methods Prospective cohort study using a single-sample faecal immunochemical test (FIT) on 444,582 invited average-risk subjects aged 50–69 years. A result was considered positive at ≥20 μg Hb/g faeces. Outcome measures were analysed by sex and age for a wide range of f-Hb cut-offs. Results We analysed 17,387 positive participants in the programme who underwent colonoscopy. Participation rate was 66.5%. Men had a positivity rate for f-Hb of 8.3% and women 4.8% (p < 0.0001). The detection rate for advanced neoplasia (cancer plus advanced adenoma) was 44.0‰ for men and 15.9‰ for women (p < 0.0001). The number of colonoscopies required decreased in both sexes and all age groups through increasing the f-Hb cut-off. However, the loss in CRC detection increased by up to 28.1% in men and 22.9% in women. CRC missed were generally at early stages (Stage I-II: from 70.2% in men to 66.3% in women). Conclusions This study provides detailed outcomes in men and women of different ages at a range of f-Hb cut-offs. We found differences in positivity rates, neoplasia detection rate, number needed to screen, and interval cancers in men and women and in younger and older groups. However, there are factors other than sex and age to consider when consideration is given to setting the f-Hb cut-off

Recomendaciones de manipulación doméstica de frutas y hortalizas para preservar su valor nutritivo

The health benefits of daily consumption of at least 5 portions of a variety of fruit and vegetables are well documented. The World Health Organization (WHO) public health goal, established in 600 grams per person/day, is not achieved in Spain, so it is important to improve access to these foods, maintain their potential nutritive value and overcome barriers for their consumption. The objectives of this paper are: facilitate responsible decision-making regarding health; maximize the nutritional value of fruit and vegetables, help overcome barriers for fruit and vegetables consumption and report on how their storage at home, their handling and cooking affect to nutritional value of fruit and vegetables.In order to minimize nutrients loss and improve their bioavailability during fruit and vegetables handling, the Association for the promotion of fruit and vegetables “5 a day” (Spain) recommends: avoid prolonged storage of fruit and vegetables in the fridge; use layers and outer leaves; peel and/or cut them just before consumption; wash the whole pieces and then chop them; controlling the soaking time of cut pieces; prefer cooking techniques that do not require direct contact with water; a shorter cooking time, less loss of nutrients; the correct frying retains nutrients very well, although it is a technique of which should not be abused; add a few drops of vinegar or lemon juice to the cooking water if it does not change the taste and dish acceptance; use the water of cooking to elaborate other foods (e.g. sauces, soups, purees, etc.) except those coming from chard, spinach or beets. The “5 a day” Association (Spain) recommends increasing consumption of fruit and vegetables, and state that theloss of nutrients during their home handling should not be understood as a barrier for their consumption.El beneficio para la salud del consumo diario de al menos 5 raciones entre frutas y hortalizas está bien documentado. En España no se alcanzan los 600 gramos por persona y día que recomienda la Organización Mundial de la Salud (OMS) en sus objetivos de salud pública, por lo que es importante mejorar el acceso a estos alimentos, aprovechar su potencial nutritivo y salvar las barreras para su consumo. Los objetivos de este documento son: facilitar la toma de decisiones responsables con la salud; aprovechar al máximo el valor nutritivo de frutas y hortalizas; ayudar a salvar las barreras para su consumo e informar sobre cómo afecta la conservación, manipulación y cocinado domésticos a su valor nutritivo.Para minimizar la pérdida de nutrientes y mejorar su biodisponibilidad durante la manipulación de frutas y hortalizas, la Asociación para la promoción del consumo de frutas y hortalizas “5 al día” (España) recomienda: evitar almacenamientos prolongados en el refrigerador; aprovechar las capas y hojas exteriores; pelar y/o cortar el alimento justo antes de consumirlo; lavar las piezas enteras y trocearlas posteriormente; controlar el tiempo de remojo de las piezas cortadas; preferir técnicas de cocinado que no requieran contacto directo con el agua; a menor tiempo de cocción, menor pérdida de nutrientes; la fritura correcta conserva muy bien los nutrientes, aunque no debe abusarse de esta técnica; añadir un chorrito de vinagre o de zumo de limón al agua de cocción; aprovechar el agua de los vegetales cocidos para elaborar otros alimentos (ej.: salsas, sopas, purés, etc.), excepto la de acelgas, espinacas o remolacha. La Asociación “5 al día” recomienda aumentar el consumo de frutas y hortalizas, y considera que la pérdida de nutrientes durante su manipulación doméstica no debe entenderse como una barrera para su consumo

Recomendaciones de manipulación doméstica de frutas y hortalizas para preservar su valor nutritivo

El beneficio para la salud del consumo diario de al menos 5 raciones entre frutas y hortalizas está bien documentado. En España no se alcanzan los 600 gramos por persona y día que recomienda la Organización Mundial de la Salud (OMS) en sus objetivos de salud pública, por lo que es importante mejorar el acceso a estos alimentos, aprovechar su potencial nutritivo y salvar las barreras para su consumo. Los objetivos de este documento son: facilitar la toma de decisiones responsables con la salud; aprovechar al máximo el valor nutritivo de frutas y hortalizas; ayudar a salvar las barreras para su consumo e informar sobre cómo afecta la conservación, manipulación y cocinado domésticos a su valor nutritivo. Para minimizar la pérdida de nutrientes y mejorar su biodisponibilidad durante la manipulación de frutas y hortalizas, la Asociación para la promoción del consumo de frutas y hortalizas"5 al día" (España) recomienda: evitar almacenamientos prolongados en el refrigerador; aprovechar las capas y hojas exteriores; pelar y/o cortar el alimento justo antes de consumirlo; lavar las piezas enteras y trocearlas posteriormente; controlar el tiempo de remojo de las piezas cortadas; preferir técnicas de cocinado que no requieran contacto directo con el agua; a menor tiempo de cocción, menor pérdida de nutrientes; la fritura correcta conserva muy bien los nutrientes, aunque no debe abusarse de esta técnica; añadir un chorrito de vinagre o de zumo de limón al agua de cocción; aprovechar el agua de los vegetales cocidos para elaborar otros alimentos (ej.: salsas, sopas, purés, etc.), excepto la de acelgas, espinacas o remolacha. La Asociación"5 al día" recomienda aumentar el consumo de frutas y hortalizas, y considera que la pérdida de nutrientes durante su manipulación doméstica no debe entenderse como una barrera para su consumo

Development and validation of a nomogram to predict kidney survival at baseline in patients with C3 glomerulopathy

10 p.-4 fig.-2 tab. 1 graph. abst.Background: C3 glomerulopathy is a rare and heterogeneous complement-driven disease. It is often challenging to accurately predict in clinical practice the individual kidney prognosis at baseline. We herein sought to develop and validate a prognostic nomogram to predict long-term kidney survival.Methods: We conducted a retrospective, multicenter observational cohort study in 35 nephrology departments belonging to the Spanish Group for the Study of Glomerular Diseases. The dataset was randomly divided into a training group (n = 87) and a validation group (n = 28). The least absolute shrinkage and selection operator (LASSO) regression was used to screen the main predictors of kidney outcome and to build the nomogram. The accuracy of the nomogram was assessed by discrimination and risk calibration in the training and validation sets.Results: The study group comprised 115 patients, of whom 46 (40%) reached kidney failure in a median follow-up of 49 months (range 24–112). No significant differences were observed in baseline estimated glomerular filtration rate (eGFR), proteinuria or total chronicity score of kidney biopsies, between patients in the training versus those in the validation set. The selected variables by LASSO were eGFR, proteinuria and total chronicity score. Based on a Cox model, a nomogram was developed for the prediction of kidney survival at 1, 2, 5 and 10 years from diagnosis. The C-index of the nomogram was 0.860 (95% confidence interval 0.834–0.887) and calibration plots showed optimal agreement between predicted and observed outcomes.Conclusions: We constructed and validated a practical nomogram with good discrimination and calibration to predict the risk of kidney failure in C3 glomerulopathy patients at 1, 2, 5 and 10 years.Work on this study was supported by the Instituto de Salud Carlos III / Fondo Europeo de Desarrollo Regional (ISCIII/FEDER; grants PI16/01685 and PI19/1624) and Red de Investigación Renal (RD12/0021/0029; to M.P.) and the Autonomous Region of Madrid (S2017/BMD-3673; to M.P.). S.R.d.C. is supported by the Ministerio de Economia y Competitividad (grant PID2019-104912RB-I00) and the Autonomous Region of Madrid (grant S2017/BMD-3673).Peer reviewe

Longitudinal change in proteinuria and kidney outcomes in C3 glomerulopathy

11 p.-4 fig.-4 tab.Introduction: The association between a change in proteinuria over time and its impact in kidney prognosis has not been analyzed in C3 glomerulopathy. This study aims to investigate the association between the longitudinal change in proteinuria and the risk of kidney failure.Methods: Retrospective, multicenter observational cohort study in 35 nephrology departments belonging to the Spanish Group for the Study of Glomerular Diseases (GLOSEN). Patients diagnosed with C3 glomerulopathy between 1995 and 2020 were enrolled. A joint modeling of linear mixed-effects models was applied to assess the underlying trajectory of a repeatedly measured proteinuria, and a Cox model to evaluate the association of this trajectory with the risk of kidney failure.Results: The study group consisted of 85 patients, 70 C3 glomerulonephritis and 15 dense deposit disease, with a median age of 26 years (range 13-41). During a median follow-up of 42 months, 25 patients reached kidney failure. The longitudinal change in proteinuria showed a strong association with the risk of this outcome, with a doubling of proteinuria levels resulting in a 2.5-fold increase of the risk. A second model showed that a ≥ 50% proteinuria reduction over time was significantly associated with a lower risk of kidney failure (HR: 0.79; 95% CI : 0.56-0.97; p < 0.001). This association was also found when the ≥50% proteinuria reduction was observed within the first 6 and 12 months of follow-up.Conclusion: The longitudinal change in proteinuria is strongly associated with the risk of kidney failure. The change in proteinuria over time can provide clinicians a dynamic prediction of kidney outcomes.This study was supported by the Instituto de Salud Carlos III/Fondo Europeo de Desarrollo Regional (ISCIII/FEDER) grant PI16/01685 and PI19/1624, and Red de Investigación Renal (RedInRen) (RD12/0021/0029) (to M.P.), the Autonomous Region of Madrid (S2017/BMD-3673) (to M.P.); E.G.d.J. was supported by the Spanish ‘Ministerio de Ciencia, Innovación y Universidades’ (RYC-2013-13395 and RTI2018-095955-B-100); S.R.d.C. was supported by Ministerio de Economía y Competitividad/FEDER grant SAF2015-66287R and Autonomous Region of Madrid grant S2017/BMD3673.Peer reviewe

Evidence of spatial clustering of childhood acute lymphoblastic leukemia cases in Greater Mexico City: report from the Mexican Inter-Institutional Group for the identification of the causes of childhood leukemia

BackgroundA heterogeneous geographic distribution of childhood acute lymphoblastic leukemia (ALL) cases has been described, possibly, related to the presence of different environmental factors. The aim of the present study was to explore the geographical distribution of childhood ALL cases in Greater Mexico City (GMC).MethodsA population-based case-control study was conducted. Children &lt;18 years old, newly diagnosed with ALL and residents of GMC were included. Controls were patients without leukemia recruited from second-level public hospitals, frequency-matched by sex, age, and health institution with the cases. The residence address where the patients lived during the last year before diagnosis (cases) or the interview (controls) was used for geolocation. Kulldorff’s spatial scan statistic was used to detect spatial clusters (SCs). Relative risks (RR), associated p-value and number of cases included for each cluster were obtained.ResultsA total of 1054 cases with ALL were analyzed. Of these, 408 (38.7%) were distributed across eight SCs detected. A relative risk of 1.61 (p&lt;0.0001) was observed for the main cluster. Similar results were noted for the remaining seven ones. Additionally, a proximity between SCs, electrical installations and petrochemical facilities was observed.ConclusionsThe identification of SCs in certain regions of GMC suggest the possible role of environmental factors in the etiology of childhood ALL

Gestión del conocimiento. Perspectiva multidisciplinaria. Volumen 7

El libro “Gestión del Conocimiento. Perspectiva Multidisciplinaria”, volumen 7, de la Colección Unión Global, es resultado de investigaciones. Los capítulos del libro, son resultados de investigaciones desarrolladas por sus autores. El libro es una publicación internacional, seriada, continua, arbitrada de acceso abierto a todas las áreas del conocimiento, que cuenta con el esfuerzo de investigadores de varios países del mundo, orientada a contribuir con procesos de gestión del conocimiento científico, tecnológico y humanístico que consoliden la transformación del conocimiento en diferentes escenarios, tanto organizacionales como universitarios, para el desarrollo de habilidades cognitivas del quehacer diario. La gestión del conocimiento es un camino para consolidar una plataforma en las empresas públicas o privadas, entidades educativas, organizaciones no gubernamentales, ya sea generando políticas para todas las jerarquías o un modelo de gestión para la administración, donde es fundamental articular el conocimiento, los trabajadores, directivos, el espacio de trabajo, hacia la creación de ambientes propicios para el desarrollo integral de las instituciones