Ampliación del rango de distribución de Rhipidomys leucodactylus (Rodentia: Cricetidae): una nueva localidad para el Ecuador

La distribución del género Rhipidomys (Rodentia: Cricetidae) comprende desde bosques húmedos de tierras bajas hasta bosques montanos altos en el neotrópico. En el Ecuador la presencia de Rhipidomys leucodactylus está reportada para las estibaciones nororiental, noroccidental y sur suroccidental de la cordillera de los Andes. El registro de un espécimen macho adulto de R. leucodactylus en un bosque montano a una altura de 2164 metros de elevación se convierte en una ampliación del rango de distribución altitudinal para la especie a manera general, además de ser una nueva localidad de registro en el suroriente del Ecuador

Aportes sobre la dieta y distribución del Ocelote Leopardus pardalis (Linné 1758) en los altos Andes de Ecuador

The Ocelot, Leopardus pardalis is a carnivore with wide distribution in South America. In Ecuador, most of the records come from lowland tropical forests and foothills of the Andes (<900 m at sea level), where this species has a variety of prey, particularly small mammals. However, in the high Andean regions, neither their occurrence nor their diet is known. On November 8, 2016 an adult male of L. pardalis was collected dead in the Usho locality, province of Cañar; the record is located in the high-Andean region in south of Ecuador at 2818 meters to sea level. During the evaluation of the specimen, several digested barbs were found and these were associated with the species of short-tailed porcupine, Coendou rufescens. This record shows that L. pardalis occurs at least seasonally in the high-Andean region of Ecuador; It also shows predation on the high-Andean species in their eating habits.El Ocelote, Leopardus pardalis es un carnívoro con amplia distribución en América del sur. En Ecuador, los registros se concentran en bosques tropicales de tierras bajas y en estribaciones de los Andes (< 900 m de elevación), en donde disponen de una variedad de preseas, particularmente de pequeños mamíferos. Sin embargo, en las regiones alto-Andinas no se conoce sobre su presencia ni tampoco sobre su dieta. El 8 de noviembre de 2016 un macho adulto de L. pardalis que fue colectado muerto en la localidad de Usho, provincia del Cañar; el registro está localizado en la región alto-Andina al sur del Ecuador a 2818 m de elevación. Durante la evaluación del espécimen se encontraron varias púas digeridas y asociadas a la especie de Puerco espín de cola corta, Coendou rufescens. Este registro demuestra que L. pardalis ocurre al menos estacionalmente en la región alto-Andina del Ecuador; además demuestra la predación de especies alto-Andinas dentro de sus hábitos alimenticios

Compromising between European and US allergen immunotherapy schools: Discussions from GUIMIT, the Mexican immunotherapy guidelines

Background: Allergen immunotherapy (AIT) has a longstanding history and still remains the only disease-changing treatment for allergic rhinitis and asthma. Over the years 2 different schools have developed their strategies: the United States (US) and the European. Allergen extracts available in these regions are adapted to local practice. In other parts of the world, extracts from both regions and local ones are commercialized, as in Mexico. Here, local experts developed a national AIT guideline (GUIMIT 2019) searching for compromises between both schools. Methods: Using ADAPTE methodology for transculturizing guidelines and AGREE-II for evaluating guideline quality, GUIMIT selected 3 high-quality Main Reference Guidelines (MRGs): the European Academy of Allergy, Asthma and Immunology (EAACI) guideines, the S2k guideline of various German-speaking medical societies (2014), and the US Practice Parameters on Allergen Immunotherapy 2011. We formulated clinical questions and based responses on the fused evidence available in the MRGs, combined with local possibilities, patient's preference, and costs. We came across several issues on which the MRGs disagreed. These are presented here along with arguments of GUIMIT members to resolve them. GUIMIT (for a complete English version, see Supplementary data) concluded the following: Results: Related to the diagnosis of IgE-mediated respiratory allergy, apart from skin prick testing complementary tests (challenges, in vitro testing and molecular such as species-specific allergens) might be useful in selected cases to inform AIT composition. AIT is indicated in allergic rhinitis and suggested in allergic asthma (once controlled) and IgE-mediated atopic dermatitis. Concerning the correct subcutaneous AIT dose for compounding vials according to the US school: dosing tables and formula are given; up to 4 non-related allergens can be mixed, refraining from mixing high with low protease extracts. When using European extracts: the manufacturer's indications should be followed; in multi-allergic patients 2 simultaneous injections can be given (100% consensus); mixing is discouraged. In Mexico only allergoid tablets are available; based on doses used in all sublingual immunotherapy (SLIT) publications referenced in MRGs, GUIMIT suggests a probable effective dose related to subcutaneous immunotherapy (SCIT) might be: 50–200% of the monthly SCIT dose given daily, maximum mixing 4 allergens. Also, a table with practical suggestions on non-evidence-existing issues, developed with a simplified Delphi method, is added. Finally, dissemination and implementation of guidelines is briefly discussed, explaining how we used online tools for this in Mexico. Conclusions: Countries where European and American AIT extracts are available should adjust AIT according to which school is followed

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Primer reporte de leucismo para Artibeus fraterculus (Chiroptera: Phyllostomidae) en Ecuador

Se reporta por primera vez un caso de leucismo en el murciélago Artibeus fraterculus. El espécimen se registró en la provincia de Los Ríos, Ecuador, en la localidad de Mangas-Saiba en un pequeño parche de bosque maduro húmedo de tierras bajas. Se capturó, fotografió y recolectó un individuo macho subadulto con pelaje blanco cremoso, los patagios presentan áreas translúcidas y la coloración de los ojos café. Este registro se convierte en el segundo de leucismo en murciélagos para el Ecuador

Sociedad Civil y democracia en América Latina: desafíos de participación y representación

¿Por qué plantearse los problemas de la sociedad civil desde el ángulo de la relación entre participación y representación? La elección del tema de este Lente de Aproximación responde a una visión tanto de los avances desarrollados por la investigación sobre sociedad civil en la región, como a un análisis de los procesos sociales y políticos más importantes que están verificándose en América Latina y el Caribe, de los cuales la sociedad civil forma parte y es a su vez condicionada por ellos

Sociedad Civil y democracia en América Latina: desafíos de participación y representación

¿Por qué plantearse los problemas de la sociedad civil desde el ángulo de la relación entre participación y representación? La elección del tema de este Lente de Aproximación responde a una visión tanto de los avances desarrollados por la investigación sobre sociedad civil en la región, como a un análisis de los procesos sociales y políticos más importantes que están verificándose en América Latina y el Caribe, de los cuales la sociedad civil forma parte y es a su vez condicionada por ellos