Teamwork assessment in order to promote engineering students innovative attitude

This paper presents an outline of the evaluation of the active learning taking place in an engineering course1 in the Universidad de los Andes in Colombia. The course intends to contribute to the development of the innovative attitude of Systems and Computing Engineering and Industrial Engineering students (average age is 20), through the development of competences such as: - Engineering teamwork - Effective communication in engineering processes - Engineering systems design - Management of engineering projects Throughout the course the students work in interdisciplinary teams (5 students each). Each team has the following of the teachers (One Computing Engineering professor and one Industrial engineering professor) and one member of the entrepreneurs staff (ICT leaders). Each team should propose and develop an engineering project based on ICT innovation. This course is inspired on the CDIO proposal (Conceive, Design, Implement, Operate), with a particular emphasis in one additional first step: the Observe step. The OCDIO steps (observation, conception, design, implementation and operation) of the project are developed during two academic semesters. At the end of this process, the teams present their project in a fair that’s open for the business public and in a contest. The winners of the contest continue the next year with the implementation of the project [1]. So far, 20 groups have participated each semester and there have been 4 winning teams (20 students). We tried to assess the teamwork evolution along the process and its relation with the innovation attitude. In order to achieve this, we’ve had gathered information from the entrepreneurs, teachers and students who, through observation tools, have allowed us to define indicators related to teamwork. For the analysis we have relied on the different evaluation instances (oral presentations, papers, the fair, and the contest), the tools we have designed (surveys), and video recordings of different processes.Peer Reviewe

Análisis de corrosión en el acero 440c inoxidable con diésel y biodiesel.

Debido a la aplicación de nuevas fuentes de energía en el mundo gracias a los constantes avances de la tecnología y necesidades del planeta, ha surgido la utilización del Biodiesel como alternativa importante en la sustitución de combustible fósil en los motores Diésel ya que se vuelve un componente con grandes ventajas tanto para el equipo como para el medio ambiente. En esta tesis. Se realizo un estudio con una de las válvulas de un vehículo alimentado por combustible Diésel. (se escogió este tipo de motor debido al gran impacto que contraen estos buses en el sistema integrado de transporte de Bogotá “Sitp-Transmilenio”),esto con el fin de conocer la velocidad de corrosión que se genera en los componentes internos del motor que poseen las mismas caracterizas químicas, realizamos un estudio de corrosión en condiciones atmosféricas de presión y temperatura ambiente con los combustibles diésel y biodiesel grado 12 logrando identificar cuál de los dos es menos susceptible a la corrosión, conllevando así a lograr demostrar que el biodiesel al ser biodegradable tiende a tener menores efectos de corrosión en dicho material del cual están comprendidas estas válvulas referente al incrementando de la vida útil de las mismas y los componentes del motor que poseen los mismos elementos químicos. Para la búsqueda de dichos resultados nos proyectamos dos distintas pruebas para demostrar la afectación del material de estas válvulas con los combustibles elegidos. Se evaluó el comportamiento de este material con Diésel y Biodiesel para establecer la comparativa del accionar de cada uno. Se realizaron ensayos de inmersión a temperatura ambiente y ensayos de corrosión TAFEL. En los ensayos de inmersión, el material estuvo expuesto 720 horas, registrando periódicamente su peso con una balanza de precisión de resolución 0.00001 g.Due to the application of new energy sources in the world thanks to the constant advances in technology and needs of the planet, the use of Biodiesel has emerged as an important alternative in the replacement of fossil fuel in diesel engines as it becomes a component With great advantages for both the equipment and the environment. In this thesis, a study was carried out with one of the valves of a vehicle of the reference commercial brand --2M that is fueled by diesel fuel, (this type of engine was chosen due to the great impact that these buses contract on the system integrated transport in Bogotá "Sitp-Transmilenio"), in order to know the corrosion that occurs in the engine components that have the same characteristics of the chemical components, we conducted a study of corrosion in them with diesel fuels and Grade 12 biodiesel, identifying which of the two is more susceptible to corrosion, thus leading to demonstrate that biodiesel being biodegradable tends to have less corrosion effects on said material of which These valves are included referring to the increase of the useful life of the same and the components of the motor that it has in the same chemical elements. For the search of these results, two different tests are projected to demonstrate the involvement of the material of these valves with the chosen fuels. The behavior of this material with Diesel or Biodiesel was evaluated to establish the comparison of the actions of each one. Immersion tests at room temperature and TAFEL corrosion tests were performed. In the immersion tests, the material was exposed for 30 days or 720 hours, periodically recording its weight with a precision balance with a resolution of 0.00001 g. In addition to this

Producción orgánica de hortalizas bajo atmósferas controladas utilizando tecnologías de bajo costo

Historically, agriculture has undergone a series of revolutions that have increased efficiency, yield and profitability to previously unattainable levels. Market forecasts for the next decade suggest that a “digital agricultural revolution” will be the most innovative change that could help make agriculture meet the needs of the world’s population in the future (La, Las, & Rurales, 2019 , P 1). The adoption of agriculture 4.0 in the department of Quindío is low, which leads to the development of inefficient and profitable production models; The purpose of this project is the organic production of vegetables under controlled atmospheres, making use of low-cost measurement sensors (relative humidity, temperature, soil humidity), in order to validate their functionalityHistóricamente, la agricultura ha experimentado una serie de revoluciones que han incrementado la eficiencia, el rendimiento y la rentabilidad a niveles antes inalcanzables. Los pronósticos sobre los mercados para el próximo decenio sugieren que una “revolución agrícola digital” será el cambio más novedoso que podría ayudar a conseguir que la agricultura satisfaga las necesidades de la población mundial en el futuro. (La, Las, & Rurales, 2019,P 1).La adopción de la agricultura 4.0 en el departamento del Quindío es baja, lo cual lleva a desarrollar modelos de producción poco eficientes y rentables; el propósito de este proyecto es la producción orgánica de hortalizas bajo atmosferas controladas, haciendo uso de sensores de medición a bajo costo (humedad relativa, temperatura, humedad del suelo), con el fin de validar su funcionalidad

Alimentos funcionales, alfalfa y fitoestrógenos

Functional food development has been increased during the last years due to the population interest in foods that have not only a nutritional function but a health benefit as well reducing the risk of suffering several diseases. Alfalfa has been intended as cattle feed, although several investigations have reported that alfalfa contains bioactive compounds –phytochemicals- proteins with an estrogenic effect, and antimicrobial and antioxidant compounds, being classified as a functional food with protection against cancer, diabetes and cardiovascular and other diseases. The aim of the present study is to offer a general information outline, through a bibliographic review, of functional foods status, focusing on alfalfa and its phytochemicals (phytoestrogens), compounds that give it its functional food character and its adverse effects shown in the reproductive system of experimental animals as well. Such dichotomy between adverse and beneficial effects is the sign that shows that it is needed more information and more studies to be done in order to establish the effect of phytoestrogens in the development and reproductive function in animals, its agonistic and antagonistic effect and risk-benefit balance in its consumption.El desarrollo de alimentos funcionales en los últimos años ha ido en aumento debido principalmente, al interés de la población por alimentos que no solo cumplan con la función nutricional sino también por que tengan un efecto benéfico en salud reduciendo así el riesgo a padecer diversas enfermedades. La alfalfa ha sido generalmente un alimento destinado para la alimentación del ganado, sin embargo, en diversas investigaciones alrededor del mundo se ha reportado que contiene compuestos bioactivos –fitoquímicos– y proteínas con efecto estrogénico, antimicrobiano y antioxidante, así como también protector contra enfermedades cardiovasculares, cáncer y diabetes, entre otras, clasificándola potencialmente como un alimento funcional. El presente documento tiene como objetivo dar un bosquejo general informativo a través de la búsqueda y revisión bibliográfica acerca de los alimentos funcionales y en especial de la alfalfa y constituyentes fitoquímicos (fitoestrógenos) que la ubican dentro de este grupo de alimentos; así como los hallazgos que se han reportado como efectos adversos en animales experimentales específicamente en el aparato reproductivo debido al consumo de este tipo de fitocompuestos. Esta dicotomía entre los efectos adversos y benéficos no es más que la señalización de que aún falta mucha más información y estudios que realizar respecto al resultado que pueden tener los fitoestrógenos en el desarrollo y función reproductiva de animales, el agonismo y antagonismo de su efecto así como la concordancia en el riesgo-beneficio de su consumo

Ten simple rules for organizing a bioinformatics training course in low- And middle-income countries

© 2021 Moore et al.Bioinformatics training is required at every stage of a scientist’s research career. Continual bioinformatics training allows exposure to an ever-changing and growing repertoire of techniques and databases, and so biologists, computational scientists, and healthcare practitioners are all seeking learning opportunities in the use of computational resources and tools designed for data storage, retrieval, and analysis. There are abundant opportunities for accessing bioinformatics training for scientists in high-income countries (HICs), with well-equipped facilities and participants and trainers requiring minimal travel and financial costs alongside a range of general advice for developing short bioinformatics training courses [1–3]. However, regionally targeted bioinformatics training in low- and middle-income countries (LMICs) often requires more extensive local and external support, organization, and travel. Due to the limited expertise in bioinformatics in LMICs in general, most bioinformatics training requires a fair amount of collaboration with experts beyond the local community, country, or region. A common model of training, used as the basis of this article, includes a local host collaborating with local, regional, and international experts gathering to train local or regional participants. Recently, there has been a growth of capacity strengthening initiatives in LMICs, such as the Pan African Bioinformatics Network for Human Heredity and Health in Africa (H3ABioNet) Initiative [4–6], the Capacity Building for Bioinformatics in Latin America (CABANA) Project [7], the Asia Pacific BioInformatics Network (APBioNet) [8], and the Wellcome Connecting Science Courses and Conferences program [9]. One of the important strands of these initiatives is a drive to organize and deliver valuable bioinformatics training, but organizing and delivering short bioinformatics training workshops in an LMIC present a unique set of challenges. This paper attempts to build upon the sage advice for organizing bioinformatics workshops with specific guidance for organizing and delivering them in LMICs. It describes the processes to follow in organizing courses taking into consideration the low-resource setting. We should also note that LMICs are not a monolithic group and that setting, context, temporality, and specific location matters. LMICs are a complex regional grouping [10] and should be treated as such; however, we will present some common lessons that we hope will help organizers and trainers of bioinformatics training events in LMICs to navigate the often different, challenging, and rewarding experience.The authors who contributed to this manuscript are funded as follows: BM receives salary support from Wellcome Trust grants [WT108749/Z/15/Z, WT108749/Z/15/A], PC, VR, NM, AG’s salaries are funded in whole, or in part, by the NIH Common Fund H3ABioNet grant [U24HG006941], MC, SLFV, AR, PG, PCL’s salaries were partly funded by the UKRI-BBSRC ‘Capacity building for bioinformatics in Latin America’ (CABANA) grant, on behalf of the Global Challenges Research Fund [BB/P027849/1], JDLR is funded by ISCiii AES [ref. PI18/00591] at the CSIC/USAL (Spain) and by CYTED, RIABIO (Red Iberoamericana 521RT0118), AM’s salary is funded by [WT206194/Z/17/Z], GO is funded by the CABANA grant and SM is funded by the EMBL-EBI

Development and internal validation of a multifactorial risk prediction model for gallbladder cancer in a high-incidence country

Since 2006, Chile has been implementing a gallbladder cancer (GBC) prevention program based on prophylactic cholecystectomy for gallstone patients aged 35 to 49 years. The effectiveness of this prevention program has not yet been comprehensively evaluated. We conducted a retrospective study of 473 Chilean GBC patients and 2137 population-based controls to develop and internally validate three GBC risk prediction models. The Baseline Model accounted for gallstones while adjusting for sex and birth year. Enhanced Model I also included the non-genetic risk factors: body mass index, educational level, Mapuche surnames, number of children and family history of GBC. Enhanced Model II further included Mapuche ancestry and the genotype for rs17209837. Multiple Cox regression was applied to assess the predictive performance, quantified by the area under the precision-recall curve (AUC-PRC) and the number of cholecystectomies needed (NCN) to prevent one case of GBC at age 70 years. The AUC-PRC for the Baseline Model (0.44%, 95%CI 0.42-0.46) increased by 0.22 (95%CI 0.15-0.29) when non-genetic factors were included, and by 0.25 (95%CI 0.20-0.30) when incorporating non-genetic and genetic factors. The overall NCN for Chileans with gallstones (115, 95%CI 104-131) decreased to 92 (95%CI 60-128) for Chileans with a higher risk than the median according to Enhanced Model I, and to 80 (95%CI 59-110) according to Enhanced Model II. In conclusion, age, sex and gallstones are strong risk factors for GBC, but consideration of other non-genetic factors and individual genotype data improves risk prediction and may optimize allocation of financial resources and surgical capacity.Fil: Boekstegers, Felix. Ruprecht Karls Universitat Heidelberg; AlemaniaFil: Scherer, Dominique. Ruprecht Karls Universitat Heidelberg; AlemaniaFil: Barahona Ponce, Carol. Ruprecht Karls Universitat Heidelberg; AlemaniaFil: Marcelain, Katherine. Universidad de Chile; ChileFil: Gárate Calderón, Valentina. Universidad de Chile; ChileFil: Waldenberger, Melanie. No especifíca;Fil: Morales, Erik. Universidad Católica de Maule; ChileFil: Rojas, Armando. Universidad Católica de Maule; ChileFil: Munoz, César. Universidad Católica de Maule; ChileFil: Retamales, Javier. Instituto Nacional del Cáncer; ChileFil: de Toro, Gonzalo. Universidad Austral de Chile; ChileFil: Barajas, Olga. Universidad de Chile; ChileFil: Rivera, María Teresa. Hospital del Salvador; ChileFil: Cortés, Analía. Hospital del Salvador; ChileFil: Loader, Denisse. Hospital Padre Hurtado; ChileFil: Saavedra, Javiera. Hospital Padre Hurtado; ChileFil: Gutiérrez, Lorena. Hospital San Juan de Dios; ChileFil: Ortega, Alejandro. Hospital Regional; ChileFil: Bertrán, Maria Enriqueta. Hospital Base de Valdivia; ChileFil: Bartolotti, Leonardo. Hospital Base de Valdivia; ChileFil: Gabler, Fernando. Hospital Clínico San Borja Arriarán; ChileFil: Campos, Mónica. Hospital Clínico San Borja Arriarán; ChileFil: Alvarado, Juan. Hospital Regional de Concepción - Dr. Guillermo Grant Benavente; ChileFil: Moisán, Fabricio. Hospital Regional de Concepción - Dr. Guillermo Grant Benavente; ChileFil: Spencer, Loreto. Hospital Regional de Concepción - Dr. Guillermo Grant Benavente; ChileFil: Nervi, Bruno. No especifíca;Fil: Carvajal Hausdorf, Daniel. Universidad del Desarrollo; ChileFil: Losada, Héctor. Universidad de La Frontera; ChileFil: Almau, Mauricio. Hospital de Rancagua; ChileFil: Fernández, Plinio. Hospital de Rancagua; ChileFil: Olloquequi, Jordi. Universidad de Barcelona; EspañaFil: Fuentes Guajardo, Macarena. Universidad de Tarapacá; ChileFil: Gonzalez-Jose, Rolando. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Centro Nacional Patagónico. Instituto Patagónico de Ciencias Sociales y Humanas; ArgentinaFil: Bortolini, Maria Cátira. Universidade Federal do Rio Grande do Sul; BrasilFil: Acuña Alonzo, Victor. No especifíca;Fil: Gallo, Carla. Universidad Peruana Cayetano Heredia; PerúFil: Ruiz-Linares, Andres. Colegio Universitario de Londres; Reino UnidoFil: Rothhammer, Francisco. Universidad de Tarapacá; ChileFil: Lorenzo Bermejo, Justo. Ruprecht Karls Universitat Heidelberg; Alemani

Mendelian Randomization Analysis of the Relationship Between Native American Ancestry and Gallbladder Cancer Risk

Background A strong association between the proportion of Native American ancestry and the risk of gallbladder cancer (GBC) has been reported in observational studies. Chileans show the highest incidence of GBC worldwide, and the Mapuche are the largest Native American people in Chile. We set out to investigate the causal association between Native American Mapuche ancestry and GBC risk, and the possible mediating effects of gallstone disease and body mass index (BMI) on this association. Methods Markers of Mapuche ancestry were selected based on the informativeness for assignment measure and then used as instrumental variables in two-sample mendelian randomization (MR) analyses and complementary sensitivity analyses. Result We found evidence of a causal effect of Mapuche ancestry on GBC risk (inverse variance-weighted (IVW) risk increase of 0.8% for every 1% increase in Mapuche ancestry proportion, 95% CI 0.4% to 1.2%, p = 6.6×10-5). Mapuche ancestry was also causally linked to gallstone disease (IVW risk increase of 3.6% per 1% increase in Mapuche proportion, 95% CI 3.1% to 4.0%, p = 1.0×10-59), suggesting a mediating effect of gallstones in the relationship between Mapuche ancestry and GBC. In contrast, the proportion of Mapuche ancestry showed a negative causal effect on BMI (IVW estimate -0.006 kg/m2 per 1% increase in Mapuche proportion, 95% CI -0.009 to -0.003, p = 4.4×10-5). Conclusions The results presented here may have significant implications for GBC prevention and are important for future admixture mapping studies. Given that the association between Mapuche ancestry and GBC risk previously noted in observational studies appears to be causal, primary and secondary prevention strategies that take into account the individual proportion of Mapuche ancestry could be particularly efficient

Healthcare workers hospitalized due to COVID-19 have no higher risk of death than general population. Data from the Spanish SEMI-COVID-19 Registry

Aim To determine whether healthcare workers (HCW) hospitalized in Spain due to COVID-19 have a worse prognosis than non-healthcare workers (NHCW). Methods Observational cohort study based on the SEMI-COVID-19 Registry, a nationwide registry that collects sociodemographic, clinical, laboratory, and treatment data on patients hospitalised with COVID-19 in Spain. Patients aged 20-65 years were selected. A multivariate logistic regression model was performed to identify factors associated with mortality. Results As of 22 May 2020, 4393 patients were included, of whom 419 (9.5%) were HCW. Median (interquartile range) age of HCW was 52 (15) years and 62.4% were women. Prevalence of comorbidities and severe radiological findings upon admission were less frequent in HCW. There were no difference in need of respiratory support and admission to intensive care unit, but occurrence of sepsis and in-hospital mortality was lower in HCW (1.7% vs. 3.9%; p = 0.024 and 0.7% vs. 4.8%; p<0.001 respectively). Age, male sex and comorbidity, were independently associated with higher in-hospital mortality and healthcare working with lower mortality (OR 0.211, 95%CI 0.067-0.667, p = 0.008). 30-days survival was higher in HCW (0.968 vs. 0.851 p<0.001). Conclusions Hospitalized COVID-19 HCW had fewer comorbidities and a better prognosis than NHCW. Our results suggest that professional exposure to COVID-19 in HCW does not carry more clinical severity nor mortality

Colombian consensus on the treatment of Placenta Accreta Spectrum (PAS)

Introducción: el espectro de acretismo placentario (EAP) es una condición asociada a sangrado masivo posparto y mortalidad materna. Las guías de manejo publicadas en países de altos ingresos recomiendan la participación de grupos interdisciplinarios en hospitales con recursos suficientes para realizar procedimientos complejos. Sin embargo, algunas de las recomendaciones de estas guías resultan difíciles de aplicar en países de bajos y medianos ingresos. Objetivos: este consenso busca formular recomendaciones generales para el tratamiento del EAP en Colombia. Materiales y métodos: en el consenso participaron 23 panelistas, quienes respondieron 31 preguntas sobre el tratamiento de EAP. Los panelistas fueron seleccionados con base en la participación en dos encuestas realizadas para determinar la capacidad resolutiva de hospitales en el país y la región. Se utilizó la metodología Delphi modificada, incorporando dos rondas sucesivas de discusión. Para emitir las recomendaciones el grupo tomó en cuenta la opinión de los participantes, que lograron un consenso mayor al 80 %, así como las barreras y los facilitadores para su implementación. Resultados: el consenso formuló cinco recomendaciones integrando las respuestas de los panelistas. Recomendación 1. Las instituciones de atención primaria deben realizar búsqueda activa de EAP en pacientes con factores de riesgo: placenta previa e historia de miomectomía o cesárea en embarazo previo. En caso de haber signos sugestivos de EAP por ecografía, las pacientes deben ser remitidas de manera inmediata, sin tener una edad gestacional mínima, a hospitales reconocidos como centros de referencia. Las modalidades virtuales de comunicación y atención en salud pueden facilitar la interacción entre las instituciones de atención primaria y los centros de referencia para EAP. Se debe evaluar el beneficio y riesgo de las modalidades de telemedicina. Recomendación 2. Es necesario que se definan hospitales de referencia para EAP en cada región de Colombia, asegurando el cubrimiento de la totalidad del territorio nacional. Es aconsejable concentrar el flujo de pacientes afectadas por esta condición en unos pocos hospitales, donde haya equipos de cirujanos con entrenamiento específico en EAP, disponibilidad de recursos especializados y un esfuerzo institucional por mejorar la calidad de atención, en busca de tener mejores resultados en la salud de las gestantes con esta condición. Para lograr ese objetivo los participantes recomiendan que los entes reguladores de la prestación de servicios de salud a nivel nacional, regional o local vigilen el proceso de remisión de estas pacientes, facilitando rutas administrativas en caso de que no exista contrato previo entre el asegurador y el hospital o la clínica seleccionada (IPS). Recomendación 3. En los centros de referencia para pacientes con EAP se invita a la creación de equipos que incorporen un grupo fijo de especialistas (obstetras, urólogos, cirujanos generales, radiólogos intervencionistas) encargados de atender todos los casos de EAP. Es recomendable que esos grupos interdisciplinarios utilicen el modelo de “paquete de intervención” como guía para la preparación de los centros de referencia para EAP. Este modelo consta de las siguientes actividades: preparación de los servicios, prevención e identificación de la enfermedad, respuesta ante la presentación de la enfermedad, aprendizaje luego de cada evento. La telemedicina facilita el tratamiento de EAP y debe ser tenida en cuenta por los grupos interdisciplinarios que atienden esta enfermedad. Recomendación 4. Los residentes de Obstetricia deben recibir instrucción en maniobras útiles para la prevención y el tratamiento del sangrado intraoperatorio masivo por placenta previa y EAP, tales como: la compresión manual de la aorta, el torniquete uterino, el empaquetamiento pélvico, el bypass retrovesical y la maniobra de Ward. Los conceptos básicos de diagnóstico y tratamiento de EAP deben incluirse en los programas de especialización en Ginecología y Obstetricia en Colombia. En los centros de referencia del EAP se deben ofrecer programas de entrenamiento a los profesionales interesados en mejorar sus competencias en EAP de manera presencial y virtual. Además, deben ofrecer soporte asistencial remoto (telemedicina) permanente a los demás hospitales en su región, en relación con pacientes con esa enfermedad. Recomendación 5. La finalización de la gestación en pacientes con sospecha de EAP y placenta previa, por imágenes diagnósticas, sin evidencia de sangrado vaginal activo, debe llevarse a cabo entre las semanas 34 y 36 6/7. El tratamiento quirúrgico debe incluir intervenciones secuenciales que pueden variar según las características de la lesión, la situación clínica de la paciente y los recursos disponibles. Las opciones quirúrgicas (histerectomía total y subtotal, manejo quirúrgico conservador en un paso y manejo expectante) deben incluirse en un protocolo conocido por todo el equipo interdisciplinario. En escenarios sin diagnóstico anteparto, es decir, ante un hallazgo intraoperatorio de EAP (evidencia de abultamiento violáceo o neovascularización de la cara anterior del útero), y con participación de personal no entrenado, se plantean tres situaciones: Primera opción: en ausencia de indicación de nacimiento inmediato o sangrado vaginal, se recomienda diferir la cesárea (cerrar la laparotomía antes de incidir el útero) hasta asegurar la disponibilidad de los recursos recomendados para llevar a cabo una cirugía segura. Segunda opción: ante indicación de nacimiento inmediato (por ejemplo, estado fetal no tranquilizador), pero sin sangrado vaginal o indicación de manejo inmediato de EAP, se sugiere realizar manejo en dos tiempos: se realiza la cesárea evitando incidir la placenta, seguida de histerorrafia y cierre de abdomen, hasta asegurar la disponibilidad de los recursos recomendados para llevar a cabo una cirugía segura. Tercera opción: en presencia de sangrado vaginal que hace imposible diferir el manejo definitivo de EAP, es necesario extraer el feto por el fondo del útero, realizar la histerorrafia y reevaluar. En ocasiones, el nacimiento del feto disminuye el flujo placentario y el sangrado vaginal se reduce o desaparece, lo que hace posible diferir el manejo definitivo de EAP. Si el sangrado significativo persiste, es necesario continuar con la histerectomía haciendo uso de los recursos disponibles: compresión manual de la aorta, llamado inmediato a los cirujanos con mejor entrenamiento disponible, soporte de grupos expertos de otros hospitales a través de telemedicina. Si una paciente con factores de riesgo para EAP (por ejemplo, miomectomía o cesárea previa) presenta retención de placenta posterior al parto vaginal, es recomendable confirmar la posibilidad de dicho diagnóstico (por ejemplo, realizando una ecografía) antes de intentar la extracción manual de la placenta. Conclusiones: esperamos que este primer consenso colombiano de EAP sirva como base para discusiones adicionales y trabajos colaborativos que mejoren los resultados clínicos de las mujeres afectadas por esta enfermedad. Evaluar la aplicabilidad y efectividad de las recomendaciones emitidas requerirá investigaciones adicionales.Q4Pacientes con Espectro de Acretismo Placentario (EAP)Introduction: Placenta accreta spectrum (PAS) is a condition associated with massive postpartum bleeding and maternal mortality. Management guidelines published in high income countries recommend the participation of interdisciplinary teams in hospitals with sufficient resources for performing complex procedures. However, some of the recommendations contained in those guidelines are difficult to implement in low and medium income countries. Objectives: The aim of this consensus is to draft general recommendations for the treatment of PAS in Colombia. Materials and Methods: Twenty-three panelists took part in the consensus with their answers to 31 questions related to the treatment of PAS. The panelists were selected based on participation in two surveys designed to determine the resolution capabilities of national and regional hospitals. The modified Delphi methodology was used, introducing two successive discussion rounds. The opinions of the participants, with a consensus of more than 80 %, as well as implementation barriers and facilitators, were taken into consideration in order to issue the recommendations. Results: The consensus drafted five recommendations, integrating the answers of the panelists. Recommendation 1. Primary care institutions must undertake active search of PAS in patients with risk factors: placenta praevia and history of myomectomy or previous cesarean section. In case of ultrasound signs suggesting PAS, patients must be immediately referred, without a minimum gestational age, to hospitals recognized as referral centers. Online communication and care modalities may facilitate the interaction between primary care institutions and referral centers for PAS. The risks and benefits of telemedicine modalities must be weighed. Recommendation 2. Referral hospitals for PAS need to be defined in each region of Colombia, ensuring coverage throughout the national territory. It is advisable to concentrate the flow of patients affected by this condition in a few hospitals with surgical teams specifically trained in PAS, availability of specialized resources, and institutional efforts at improving quality of care with the aim of achieving better health outcomes in pregnant women with this condition. To achieve this goal, participants recommend that healthcare regulatory agencies at a national and regional level should oversee the process of referral for these patients, expediting administrative pathways in those cases in which there is no prior agreement between the insurer and the selected hospital or clinic.Recommendation 3. Referral centers for patients with PAS are urged to build teams consisting of a fixed group of specialists (obstetricians, urologists, general surgeons, interventional radiologists) entrusted with the care of all PAS cases. It is advisable for these interdisciplinary teams to use the “intervention bundle” model as a guidance for building PAS referral centers. This model comprises the following activities: service preparedness, disease prevention and identification, response to the occurrence of the disease, and debriefing after every event. Telemedicine facilitates PAS treatment and should be taken into consideration by interdisciplinary teams caring for this disease. Recommendation 4. Obstetrics residents must be instructed in the performance of maneuvers that are useful for the prevention and treatment of massive intraoperative bleeding due to placenta praevia and PAS, including manual aortic compression, uterine tourniquet, pelvic packing, retrovesical bypass, and Ward maneuver. Specialization Obstetrics and Gynecology programs in Colombia must include the basic concepts of the diagnosis and treatment of PAS. Referral centers for PAS must offer online and in-person training programs for professionals interested in improving their competencies in PAS. Moreover, they must offer permanent remote support (telemedicine) to other hospitals in their region for patients with this condition. Recommendation 5. Patients suspected of having PAS and placenta praevia based on imaging, with no evidence of active vaginal bleeding, must be delivered between weeks 34 and 36 6/7. Surgical treatment must include sequential interventions that may vary depending on the characteristics of the lesion, the clinical condition of the patient and the availability of resources. The surgical options (total and subtotal hysterectomy, one-stage conservative surgical management and watchful waiting) must be included in a protocol known by the entire interdisciplinary team. In situations in which an antepartum diagnosis is lacking, that is to say, in the face of intraoperative finding of PAS (evidence of purple bulging or neovascularization of the anterior aspect of the uterus), and the participation of untrained personnel, three options are considered: Option 1: In the absence of indication of immediate delivery or of vaginal delivery, the recommendation is to postpone the cesarean section (close the laparotomy before incising the uterus) until the recommended resources for safe surgery are secured. Option 2: If there is an indication for immediate delivery (e.g., non-reassuring fetal status) but there is absence of vaginal bleeding or indication for immediate PAS management, a two-stage management is suggested: cesarean section avoiding placental incision, followed by uterine repair and abdominal closure, until the availability of the recommended resources for safe surgery is ascertained. Option 3: In the event of vaginal bleeding that prevents definitive PAS management, the fetus must be delivered through the uterine fundus, followed by uterine repair and reassessment of the situation. Sometimes, fetal delivery diminishes placental flow and vaginal bleeding is reduced or disappears, enabling the possibility to postpone definitive management of PAS. In case of persistent significant bleeding, hysterectomy should be performed, using all available resources: manual aortic compression, immediate call to the surgeons with the best available training, telemedicine support from expert teams in other hospitals.If a patient with risk factors for PAS (e.g., myomectomy or previous cesarean section) has a retained placenta after vaginal delivery, it is advisable to confirm the possibility of such diagnosis (by means of ultrasound, for example) before proceeding to manual extraction of the placenta.Conclusions: It is our hope that this first Colombian consensus on PAS will serve as a basis for additional discussions and collaborations that can result in improved clinical outcomes for women affected by this condition. Additional research will be required in order to evaluate the applicability and effectiveness of these recommendations.https://orcid.org/0000-0001-6822-0374Revista Nacional - IndexadaCN

Management of acute diverticulitis with pericolic free gas (ADIFAS). an international multicenter observational study

Background: There are no specific recommendations regarding the optimal management of this group of patients. The World Society of Emergency Surgery suggested a nonoperative strategy with antibiotic therapy, but this was a weak recommendation. This study aims to identify the optimal management of patients with acute diverticulitis (AD) presenting with pericolic free air with or without pericolic fluid. Methods: A multicenter, prospective, international study of patients diagnosed with AD and pericolic-free air with or without pericolic free fluid at a computed tomography (CT) scan between May 2020 and June 2021 was included. Patients were excluded if they had intra-abdominal distant free air, an abscess, generalized peritonitis, or less than a 1-year follow-up. The primary outcome was the rate of failure of nonoperative management within the index admission. Secondary outcomes included the rate of failure of nonoperative management within the first year and risk factors for failure. Results: A total of 810 patients were recruited across 69 European and South American centers; 744 patients (92%) were treated nonoperatively, and 66 (8%) underwent immediate surgery. Baseline characteristics were similar between groups. Hinchey II-IV on diagnostic imaging was the only independent risk factor for surgical intervention during index admission (odds ratios: 12.5, 95% CI: 2.4-64, P =0.003). Among patients treated nonoperatively, at index admission, 697 (94%) patients were discharged without any complications, 35 (4.7%) required emergency surgery, and 12 (1.6%) percutaneous drainage. Free pericolic fluid on CT scan was associated with a higher risk of failure of nonoperative management (odds ratios: 4.9, 95% CI: 1.2-19.9, P =0.023), with 88% of success compared to 96% without free fluid ( P &lt;0.001). The rate of treatment failure with nonoperative management during the first year of follow-up was 16.5%. Conclusion: Patients with AD presenting with pericolic free gas can be successfully managed nonoperatively in the vast majority of cases. Patients with both free pericolic gas and free pericolic fluid on a CT scan are at a higher risk of failing nonoperative management and require closer observation