Diseño de un sistema alternativo de tratamiento de aguas residuales para el vertimiento de La Casona B (La Ceiba) de Unisangil, sede San Gil

Este artículo presenta los estudios realizados en la parte baja de la Casona B (La Ceiba) de Unisangil, sede San Gil, donde se presenta la caracterización típica de las aguas residuales, el tipo de suelo y un levantamiento topográfico para definir las características naturales o artificiales del terreno y de todos los elementos que en él se encuentran. Para lograrlo, se identificaron los agentes contaminantes por medio de una caracterización de aguas residuales que se realizó en el laboratorio CEIAM – UIS, Universidad Industrial de Santander, con el fin de conocer los contaminantes presentes en dicho vertimiento; de esta manera, se realizó un estudio del suelo para identificar su textura y un levantamiento topográfico. Todo esto se tuvo en cuenta para realizar el diseño y la construcción del sistema de tratamiento adecuado y eficaz en la remoción de carga contaminante, que da gran importancia a innovaciones realizadas por el hombre para mejorar la calidad de vida, asegurando un aporte significativo al desarrollo sostenible

Thalamic neuromodulation and its implications for executive networks

The thalamus is a key structure that controls the routing of information in the brain. Understanding modulation at the thalamic level is critical to understanding the flow of information to brain regions involved in cognitive functions, such as the neocortex, the hippocampus, and the basal ganglia. Modulators contribute the majority of synapses that thalamic cells receive, and the highest fraction of modulator synapses is found in thalamic nuclei interconnected with higher order cortical regions. In addition, disruption of modulators often translates into disabling disorders of executive behavior. However, modulation in thalamic nuclei such as the midline and intralaminar groups, which are interconnected with forebrain executive regions, has received little attention compared to sensory nuclei. Thalamic modulators are heterogeneous in regards to their origin, the neurotransmitter they use, and the effect on thalamic cells. Modulators also share some features, such as having small terminal boutons and activating metabotropic receptors on the cells they contact. I will review anatomical and physiological data on thalamic modulators with these goals: first, determine to what extent the evidence supports similar modulator functions across thalamic nuclei; and second, discuss the current evidence on modulation in the midline and intralaminar nuclei in relation to their role in executive function

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: A systematic analysis for the Global Burden of Disease Study 2015

Background: The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. Methods: We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors—the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). Findings: Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57·8% (95% CI 56·6–58·8) of global deaths and 41·2% (39·8–42·8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211·8 million [192·7 million to 231·1 million] global DALYs), smoking (148·6 million [134·2 million to 163·1 million]), high fasting plasma glucose (143·1 million [125·1 million to 163·5 million]), high BMI (120·1 million [83·8 million to 158·4 million]), childhood undernutrition (113·3 million [103·9 million to 123·4 million]), ambient particulate matter (103·1 million [90·8 million to 115·1 million]), high total cholesterol (88·7 million [74·6 million to 105·7 million]), household air pollution (85·6 million [66·7 million to 106·1 million]), alcohol use (85·0 million [77·2 million to 93·0 million]), and diets high in sodium (83·0 million [49·3 million to 127·5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. Interpretation: Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden. Funding: Bill & Melinda Gates Foundation

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities 1,2 . This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity 3�6 . Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55 of the global rise in mean BMI from 1985 to 2017�and more than 80 in some low- and middle-income regions�was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing�and in some countries reversal�of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories. © 2019, The Author(s)

Complement blockade in the management of antineutrophil cytoplasmic antibodyassociated vasculitis

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) are characterized by the presence of ANCA, particularly those directed against proteinase 3 (PR3) or myeloperoxidase (MPO). At present, the most accepted pathogenic pathway is based on the pathogenic nature of ANCA, which stimulate neutrophils with the consequent activation of the alternative complement pathway, leading to the production of C5a, an anaphylatoxin which plays a key role in amplifying the inflammatory process in AAV. Remission induction in patients with AAV continues to depend on the use of glucocorticoids (GC) in combination with rituximab or cyclophosphamide. Indeed, there are very limited treatment options and a clear need for strategies that reduce the use of GC without compromising efficacy. Avacopan is the first drug specifically developed for patients with AAV as its mechanism of action inhibits C5aR1, thus acting on one of the pathophysiological mechanisms of AAV

Efecto de la lidocaína en la inducción de secuencia rápida en la Sala de Urgencias: revisión sistemática y metaanálisis

Introducción: La inducción de secuencia rápida es una técnica empleada para el manejo seguro de la vía aérea en pacientes que presentan riesgo de aspiración y que requieren ventilación mecánica asistida. Consiste en administrar secuencialmente una serie de medicamentos de acción rápida; cabe mencionar que hay efectos fisiológicos propios de la farmacodinamia de cada medicamento, uno que se presenta frecuentemente es la hipotensión posterior a la inducción. Objetivo: El objetivo fue evaluar el efecto de la lidocaína en la tensión arterial media (TAM) posterior a la inducción de secuencia rápida. Método: Se realizó una revisión sistemática de la literatura con metaanálisis, se seleccionaron artículos con diseño de ensayo clínico controlado aleatorizado, que incluían la inducción de secuencia rápida como tema principal, y comparaban protocolos con aplicación de lidocaína vs. sin lidocaína. Se recopilaron datos individuales de los estudios y se analizaron mediante metaanálisis. Resultados: Se recuperaron 37 artículos, de los cuales se incluyeron 13 en la revisión sistemática, de los cuales se incluyeron cinco subgrupos al metaanálisis, con un total de 262 pacientes. El uso de la lidocaína presentó modificaciones en los valores de TAM, sin embargo, el efecto no es consistente en los estudios. Conclusiones: El resultado del metaanálisis no mostró significancia estadística al adicionar lidocaína durante la inducción de secuencia rápida en la TAM

ASPECTOS HIDROLOGICOS DE LAS LAGUNAS DE ATASTA Y POM, MEXICO

Las lagunas de Pom y Atasta forman parte del área natural protegida de flora y fauna laguna de Términos en la región de Campeche, México. Esta es una  importante área ecológica ya que es el habitad de muchas especies nativas y migratorias. Estas lagunas han sido afectadas por actividades industriales y por descargas de aguas residuales. Monitoreo de nitrógeno, fósforo y coliformes fecales en agua superficial fueron realizados a lo largo de ambas lagunas durante las temporadas de seca, lluvia y nortes durante un año. Las altas temperaturas en verano (31 ºC) y mínimas en nortes (25ºC) fueron asociadas con valores de oxigeno disuelto (5.1 y 6.3 mg l-1, respectivamente) indicando también una probable relación con la actividad fitoplanctonica. El pH (8.0-8.2) y la salinidad (0.32 - 3.48 UPS) no mostraron variación significativa entre las tres temporadas climáticas. El nivel de amonio no fue mayor a los valores sugeridos para el control de eutroficación (0.1 mg l-1), mientras que los niveles de fósforo fueron de mayor concentración (2.0-3.5 mg l-1) que aquellos considerados seguros (0.01-0.125 mg l-1) para el medio ambiente. Las más altas concentraciones de N y P cerca de las áreas habitadas sugiere un importante contribución de nutrientes provenientes de aguas de desecho, asociado con la descomposición de material orgánico. La concentración de coliformes fecales durante la temporada de lluvias y nortes (8.0-26.0 MPN 100 ml-1) fue mayor que durante la temporada de seca (1.3-3.5 MPN 100 ml-1) sugiriendo un importante acceso por escurrimiento pluvial y aguas residuales no tratadas proveniente de las áreas cercanas al lago habitadas. La deforestación de manglares y la descontrolada actividad de agricultura afectaran la calidad del agua en ambos lagos en el futuro