Roads of the Caribbean: regional analysis from Environmental Impact Assessments in Colombia

The road infrastructure produces several impacts on the environment. In the Colombian Caribbean region, the growing road infrastructure threatens systems equilibrium in diverse and not well-known ways. Despite the several administrative tools available in Colombian legislation to manage every project impact, the big picture of the interconnected regional ecosystems falls out of scope. To study the large-scale problems in landscape, we analyzed eight Environmental Impact Studies of road construction projects in the region. We did a scientific and institutional literature review to shed light on the possible unseen problems and future challenges. Results suggest that Environmental Impact Assessments for each project focus on construction processes, ignore accumulative and residual effects, and use typified measures to cover a broad set of impacts. We offer recommendations from an integrated analysis perspective for future projects to understand landscape and water systems alteration at the regional scale

Socioeconomic Inequalities and Toothbrushing Frequency among Schoolchildren Aged 6 to 12 Years in a Multi-Site Study of Mexican Cities: A Cross-Sectional Study

Periodic toothbrushing is the most common, effective, and reliable way to mechanically remove biofilm from oral tissues. The objective of the present study was to determine the association between toothbrushing frequency and socioeconomic position for schoolchildren between 6 and 12 years of age in four cities in Mexico. A cross-sectional study was conducted on 500 Mexican schoolchildren between 6 and 12 years of age from public schools in four Mexican cities. Questionnaires were administered to the parents/guardians of the schoolchildren to obtain the variables included in the study. The dependent variable was toothbrushing frequency, dichotomized as: 0 = less than twice a day and 1 = at least twice a day. The analysis was performed in Stata. The average age of the schoolchildren was 8.9 1.9 years; 50.4% were female. The prevalence of toothbrushing was 52.8% (at least twice a day) (95% CI = 48.457.1). In the multivariate model, the variables associated (p < 0.05) with toothbrushing frequency were older age of the schoolchild (OR = 1.14); younger age of the mother (OR = 0.93); being a girl (OR = 1.70); being enrolled in Seguro Popular (OR = 0.69); being in a household that was owned (OR = 2.43); and being a schoolchild who lived in a home that owned a car (OR = 1.31). The prevalence of toothbrushing at least twice a day was just over 50% in these Mexican children. We found demographic and socioeconomic variables to be associated with toothbrushing. Based on socioeconomic variables that were associated with toothbrushing frequency—such as health insurance, home ownership and the household owning a car—the results of the present study confirm the existence of health inequalities in toothbrushing frequency

Neuroaxial anesthesia caused paraplegia: a case report

Patients who undergo; anesthesia, neuraxial analgesia, or some type of neuraxial blockage are exposed to multiple complications. 33-year-old male patient, suffers a femur fracture with a long oblique trace causing pain and functional limitation for movements. Surgical resolution is determined using neuraxial block at L2-L3 level, and intravenous sedation. During his postoperative follow-up, a decrease in strength was confirmed in the lower limbs with 0/5 on the Daniels scale, 100% sensitivity without sphincter control, steroids were prescribed along with magnetic resonance imaging and a neurosurgical evaluation was requested. The MRI shows bulging of the fibrous annulus that obliterates the epidural fat and makes contact with the thecal sac in the L5-S1 intervertebral disc level. The neurosurgery service prescribes rehabilitation sessions at home, electrostimulation and neuropathic medications. Patient was discharged with rehabilitation sessions at home and medical treatment. In his last consultation, an evaluation from the psychiatry department was requested for ideas of disability, hopelessness, fantasies of death without a suicide plan related to limitations and loss of functionality. Patient does not return to external follow-up, cannot be located

Guía de práctica clínica para el diagnóstico y tratamiento de hemofilia en el Seguro Social de Salud del Perú (EsSalud)

Introduction. Hemophilia is a rare congenital bleeding disorder; which requires interdisciplinary, complex, and often expensive management. The objective of this clinical practice guideline (CPG) is to provide evidence-based clinical recommendations for the evaluation and management of patients with hemophilia in the Peruvian Social Security (EsSalud). Methods. A local elaboration group (GEG-Local) was established, conformed by specialists in hematology and methodologists. The GEG-Local formulated 8 clinical questions to be answered by this CPG. We searched for and selected hemophilia CPGs that answered the questions posed and obtained a score higher than 60% in domains 1 and 3 of the Appraisal of Guidelines for Research and Evaluation II (AGREE-II). During 2016, bibliographic searches were conducted in Pubmed, EMBASE and the Cochrane library, to update 7 clinical questions of the preselected CPG, and to answer a question de novo. In regular work meetings, the GEG-Local reviewed the evidence and formulated the recommendations and flowcharts using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Finally, the CPG was approved with Resolution No. 32-IETSI-ESSALUD-2016. Results. This CPG addressed 8 clinical questions. Based on these questions, 22 recommendations were formulated (three strong recommendations and 19 weak recommendations) and four flowcharts. Conclusion. This article is the summary of the EsSalud CPG, in which the available scientific evidence on the diagnosis and treatment of hemophilia was assessed.Introducción. La hemofilia es un trastorno hemorrágico congénito poco común que requiere un manejo interdisciplinario, complejo, y frecuentemente costoso. El objetivo de la presente guía de práctica clínica (GPC) es proveer recomendaciones clínicas basadas en evidencia para el diagnóstico y tratamiento de hemofilia en el seguro social del Perú (EsSalud). Métodos. Se conformó un grupo elaborador local (GEG-Local) conformado por especialistas en hematología y metodólogos. El GEG-Local formuló ocho preguntas clínicas a ser respondidas por la presente GPC. Se buscaron y seleccionaron GPC de hemofilia que respondieran a las preguntas planteadas y obtuvieran un puntaje mayor a 60% en los dominios uno y tres del instrumento Appraisal of Guidelines for Research and Evaluation II (AGREE-II). Durante el 2016 se realizaron búsquedas bibliográficas en Pubmed, EMBASE y biblioteca Cochrane, para actualizar siete preguntas clínicas de la GPC preseleccionada, y para responder una pregunta de novo. En reuniones de trabajo periódicas, el GEGLocal revisó la evidencia y formuló las recomendaciones y flujogramas usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Finalmente, la GPC fue aprobada con Resolución N° 32-IETSI-ESSALUD-2016. Resultados. La presente GPC abordó ocho preguntas clínicas. En base a dichas preguntas se formularon 22 recomendaciones (tres recomendaciones fuertes y 19 recomendaciones condicionales) y cuatro flujogramas. Conclusión. Este artículo es el resumen de la GPC de EsSalud, en la cual se valoró la evidencia científica disponible sobre diagnóstico y tratamiento de hemofilia

Chronic venous insufficiency: a review

Chronic venous insufficiency (CVI) comprises a complete spectrum of morphological and functional abnormalities of the venous system1 including any long-term functional and morphological alteration. CVI accounts for several abnormalities of the venous system. It is a highly prevalent disease that causes serious economic consequences, a decrease in the quality of life and can lead to serious complications. An exhaustive review was performed with the available literature, using the PubMed, ScienceDirect, Scopus and Cochrane databases from 2004 to 2021. The search criteria were formulated to identify reports related to chronic venous insufficiency. The pathophysiology of chronic venous insufficiency begins with chronic venous hypertension and the dilation of the vessel, this leads to a series of pathological changes in the venous wall and surrounding tissues, in advanced stages of CVI, skin lesions are associated with an increased proliferation of skin capillaries and microcirculatory abnormalities that may be the result of an altered level of factors responsible for the angiogenic response, such as vascular endothelial growth factor (VEGF), fibroblast growth factor 2 (FGF2) and angiostatin. In this review, updates on pathophysiology, clinic, diagnosis, classification and treatment of this disease are analyzed, with special emphasis on therapeutic options. Chronic venous insufficiency is a disease that affects the patient at several levels, mainly diminishing his/her quality of life. Currently there are various treatments ranging from habit modifications, pharmacological, to endovenous and surgical treatment.

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

Territorios sustentables en contexto de pandemia

La obra ofrece trabajos que brindan un conocimiento científico sobre el impacto de la pandemia en la salud, la economía, el ambiente y los territorios y se plantean desafíos para hacer más sostenible la vida en las ciudades y en el campo para insertarse y poder competir a nivel global

Adaptación a los cambios ambientales y territoriales

En este libro se abordan temáticas que destacan la adaptación de los distintos sectores de población a los cambios ambientales y territoriales, la cual muestra las respuestas a la incidencia de los estímulos del entorno, económico, social y ambiental. Así, se destaca la exposición de la población a los efectos destructivos de las amenazas y peligros naturales, lo que ha despertado interés en conocer sus causas, prevenir y mitigar el daño. A través de la revisión de estudios se induce la aprehensión de un tema que adquiere importancia en el contexto de los impactos globales, regionales y locales que se producen como consecuencia de la vulnerabilidad estructural característica de los países en desarrollo.En este libro se proponen estrategias de prevención ante la ocurrencia periódica de inundación en San Mateo Atenco, Estado de México y se analizan los factores sociales que inciden en el deterioro del bosque templado en San Lorenzo Huitzitzilapan. También se exponen soluciones para que se mejoren la condición del bosque y la calidad de vida de la población.Proyecto realizado con financiamiento de la Secretaría de Educación Pública-Subsecretaría de Educación Superior-Dirección General de Educación Superior Universitaria. Número del convenio con la SEP: 2017-15-001-017

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

Jardins per a la salut

Facultat de Farmàcia, Universitat de Barcelona. Ensenyament: Grau de Farmàcia. Assignatura: Botànica farmacèutica. Curs: 2014-2015. Coordinadors: Joan Simon, Cèsar Blanché i Maria Bosch.Els materials que aquí es presenten són el recull de les fitxes botàniques de 128 espècies presents en el Jardí Ferran Soldevila de l’Edifici Històric de la UB. Els treballs han estat realitzats manera individual per part dels estudiants dels grups M-3 i T-1 de l’assignatura Botànica Farmacèutica durant els mesos de febrer a maig del curs 2014-15 com a resultat final del Projecte d’Innovació Docent «Jardins per a la salut: aprenentatge servei a Botànica farmacèutica» (codi 2014PID-UB/054). Tots els treballs s’han dut a terme a través de la plataforma de GoogleDocs i han estat tutoritzats pels professors de l’assignatura. L’objectiu principal de l’activitat ha estat fomentar l’aprenentatge autònom i col·laboratiu en Botànica farmacèutica. També s’ha pretès motivar els estudiants a través del retorn de part del seu esforç a la societat a través d’una experiència d’Aprenentatge-Servei, deixant disponible finalment el treball dels estudiants per a poder ser consultable a través d’una Web pública amb la possibilitat de poder-ho fer in-situ en el propi jardí mitjançant codis QR amb un smartphone