Reflexiones acerca de la eutanasia en Colombia

ResumenEste artículo de reflexión revisa el desarrollo histórico del término «eutanasia». Se postula que desnaturalizarlo ha dificultado el debate, y que debe diferenciarse de otros aspectos del final de la vida. Se hace un análisis de la problemática de los cuidados paliativos y la eutanasia en Colombia. Al respecto, se presentan algunas opiniones y propuestas.AbstractThis reflective article reviews the historical development of the term “euthanasia”. It is postulated that the distortion of the term “euthanasia” has hindered the debate around it, so it is imperative to differentiate it from other aspects of the end of life. The article ilustrates some difficulties about palliative care and euthanasia that are currently faced in Colombia. Some opinions and proposals are presented

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Mapping density, diversity and species-richness of the Amazon tree flora

Using 2.046 botanically-inventoried tree plots across the largest tropical forest on Earth, we mapped tree species-diversity and tree species-richness at 0.1-degree resolution, and investigated drivers for diversity and richness. Using only location, stratified by forest type, as predictor, our spatial model, to the best of our knowledge, provides the most accurate map of tree diversity in Amazonia to date, explaining approximately 70% of the tree diversity and species-richness. Large soil-forest combinations determine a significant percentage of the variation in tree species-richness and tree alpha-diversity in Amazonian forest-plots. We suggest that the size and fragmentation of these systems drive their large-scale diversity patterns and hence local diversity. A model not using location but cumulative water deficit, tree density, and temperature seasonality explains 47% of the tree species-richness in the terra-firme forest in Amazonia. Over large areas across Amazonia, residuals of this relationship are small and poorly spatially structured, suggesting that much of the residual variation may be local. The Guyana Shield area has consistently negative residuals, showing that this area has lower tree species-richness than expected by our models. We provide extensive plot meta-data, including tree density, tree alpha-diversity and tree species-richness results and gridded maps at 0.1-degree resolution

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Mapping density, diversity and species-richness of the Amazon tree flora

Using 2.046 botanically-inventoried tree plots across the largest tropical forest on Earth, we mapped tree species-diversity and tree species-richness at 0.1-degree resolution, and investigated drivers for diversity and richness. Using only location, stratified by forest type, as predictor, our spatial model, to the best of our knowledge, provides the most accurate map of tree diversity in Amazonia to date, explaining approximately 70% of the tree diversity and species-richness. Large soil-forest combinations determine a significant percentage of the variation in tree species-richness and tree alpha-diversity in Amazonian forest-plots. We suggest that the size and fragmentation of these systems drive their large-scale diversity patterns and hence local diversity. A model not using location but cumulative water deficit, tree density, and temperature seasonality explains 47% of the tree species-richness in the terra-firme forest in Amazonia. Over large areas across Amazonia, residuals of this relationship are small and poorly spatially structured, suggesting that much of the residual variation may be local. The Guyana Shield area has consistently negative residuals, showing that this area has lower tree species-richness than expected by our models. We provide extensive plot meta-data, including tree density, tree alpha-diversity and tree species-richness results and gridded maps at 0.1-degree resolution

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Regurgitación y aspiración de contenido gástrico en pacientes sometidas a cirugía laparoscópica ginecológica con tubo laríngeo con succión

<p style="margin-bottom: 0.0001pt; line-height: normal" class="MsoNormal"><strong><span style="font-size: 10pt; font-family: MyriadPro-BoldCond">OBJETIVO: </span></strong><span style="font-size: 10pt; font-family: BelweBT-Light, serif">determinar la incidencia de regurgitación y aspiración de contenido gástrico en pacientes sometidas a laparoscopia ginecológica (LG) electiva bajo anestesia general, con la utilización del Tubo laríngeo con succión.</span></p> <p style="margin-bottom: 0.0001pt; line-height: normal" class="MsoNormal"><span style="font-size: 10pt; font-family: BelweBT-Light, serif"> </span></p> <p style="margin-bottom: 0.0001pt; line-height: normal" class="MsoNormal"><strong><span style="font-size: 10pt; font-family: MyriadPro-BoldCond">DISEÑO: </span></strong><span style="font-size: 10pt; font-family: BelweBT-Light, serif">estudio clínico prospectivo, observacional y descriptivo.</span></p> <p style="margin-bottom: 0.0001pt; line-height: normal" class="MsoNormal"><span style="font-size: 10pt; font-family: BelweBT-Light, serif"> </span></p> <p style="margin-bottom: 0.0001pt; line-height: normal" class="MsoNormal"><strong><span style="font-size: 10pt; font-family: MyriadPro-BoldCond">SITIO: </span></strong><span style="font-size: 10pt; font-family: BelweBT-Light, serif">Clínica del Prado, Medellín, Antioquia, Colombia.</span></p> <p style="margin-bottom: 0.0001pt; line-height: normal" class="MsoNormal"><span style="font-size: 10pt; font-family: BelweBT-Light, serif"> </span></p> <p style="margin-bottom: 0.0001pt; line-height: normal" class="MsoNormal"><strong><span style="font-size: 10pt; font-family: MyriadPro-BoldCond">INTERVENCIONES: </span></strong><span style="font-size: 10pt; font-family: BelweBT-Light, serif">manejo de la vía aérea con Tubo laríngeo- S™ (TL-S™; VBM Medizintechnik, Sulz, Alemania). </span></p> <p style="margin-bottom: 0.0001pt; line-height: normal" class="MsoNormal"><span style="font-size: 10pt; font-family: BelweBT-Light, serif"> </span></p> <p style="margin-bottom: 0.0001pt; line-height: normal" class="MsoNormal"><strong><span style="font-size: 10pt; font-family: MyriadPro-BoldCond">PACIENTES: </span></strong><span style="font-size: 10pt; font-family: BelweBT-Light, serif">110 mujeres mayores de 18 años, ASA </span><strong><span style="font-size: 10pt; font-family: 'BelweLtBT,Bold', serif">(</span></strong><span style="font-size: 10pt; font-family: BelweBT-Light, serif">Clasificación del riesgo anestésico según la Sociedad Americana de Anestesiología) I y II, sometidas a LG electiva bajo anestesia general, sin contraindicaciones para usar el TL-S</span><span style="font-size: 6pt; font-family: BelweBT-Light, serif">TM</span><span style="font-size: 10pt; font-family: BelweBT-Light, serif">.</span></p> <p style="margin-bottom: 0.0001pt; line-height: normal" class="MsoNormal"><strong><span style="font-size: 10pt; font-family: MyriadPro-BoldCond"> </span></strong></p> <p style="margin-bottom: 0.0001pt; line-height: normal" class="MsoNormal"><strong><span style="font-size: 10pt; font-family: MyriadPro-BoldCond">RESULTADOS: </span></strong><span style="font-size: 10pt; font-family: BelweBT-Light, serif">el 96% de los procedimientos fueron tubectomías o laparoscopias diagnósticas, con una duración promedio de 29 minutos. El éxito de inserción del TLS ™ fue de 94,6%. No se observaron dificultades para la ventilación mecánica ni regurgitación de contenido ácido. </span></p> <p style="margin-bottom: 0.0001pt; line-height: normal" class="MsoNormal"><span style="font-size: 10pt; font-family: BelweBT-Light, serif"> </span></p> <p style="margin-bottom: 0.0001pt; line-height: normal" class="MsoNormal"><span style="font-size: 10pt; font-family: BelweBT-Light, serif">En una paciente se aspiraron secreciones por el tubo de drenaje con pH mayor de 4. No hubo ningún episodio de broncoaspiración.</span></p> <p style="margin-bottom: 0.0001pt; line-height: normal" class="MsoNormal"><strong><span style="font-size: 10pt; font-family: MyriadPro-BoldCond"> </span></strong></p> <p style="margin-bottom: 0.0001pt; line-height: normal" class="MsoNormal"><strong><span style="font-size: 10pt; font-family: MyriadPro-BoldCond">CONCLUSIÓN: </span></strong><span style="font-size: 10pt; font-family: BelweBT-Light, serif">el TL-S™ es una alternativa satisfactoria para el manejo de la vía aérea en LG de corta duración y en pacientes sin otros factores de riesgo para regurgitación de contenido gástrico.</span></p&gt