Los Derechos Humanos y el reclutamiento de niños, niñas y adolescentes en Colombia: las voces de sus protagonistas

Este estudio aborda las violaciones de derechos humanos de niños, niñas y adolescentes (NNA) reclutados por grupos ilegales en el conflicto armado colombiano, utilizando un enfoque cualitativo y estudios de caso de la última década. A través de entrevistas en profundidad y un análisis temático riguroso, se exploraron las percepciones y vivencias personales de los jóvenes afectados, identificando patrones y temas relacionados con las tácticas de reclutamiento y las violaciones de derechos. Los hallazgos indican que las tácticas de reclutamiento varían desde la coerción hasta la explotación de vulnerabilidades económicas y sociales, con experiencias que abarcan desde roles logísticos hasta la participación directa en combates. Las principales violaciones de derechos incluyen la afectación a la vida, la libertad y la seguridad personal, así como la protección contra la tortura y otros tratos degradantes. Estos resultados resaltan la necesidad de abordar las causas subyacentes del reclutamiento y de implementar programas de rehabilitación para los afectados. Este estudio aporta evidencia crucial para el diseño de políticas y programas de protección a NNA en situaciones de conflicto, y sienta bases para futuras investigaciones y acciones correctivas.Universidad libre-facultad de derecho-Maestría de Derechos Humanos Derecho Internacional Humanitario y Transformación de Sociedades para la PazThis study examines human rights violations against boys, girls and adolescents (BGA) recruited by illegal groups in the Colombian armed conflict, using a qualitative approach and case studies from the last decade. Through in-depth interviews and thorough thematic analysis, the perceptions and personal experiences of affected youth were explored, identifying patterns and themes related to recruitment tactics and rights violations. Findings reveal that recruitment tactics range from coercion to exploiting economic and social vulnerabilities, with roles ranging from logistical support to direct participation in combat. The main rights violations identified include impacts on life, liberty, and personal security, as well as protection from torture and other degrading treatment. These results underscore the need to address the underlying causes of recruitment and implement rehabilitation programs for those affected. This study provides essential evidence for designing policies and programs to protect children and adolescents in conflict situations and lays the groundwork for future research and corrective actions

Crecimiento, desarrollo, maduración y momento óptimo de cosecha del fruto de mango (mangifera indica l.) variedad azocar

El estudio de campo se realizó entre agosto de 1990 y mayo de 1991 con frutos procedentes de la Finca "Frutales el Prado", ubicada en la vereda Costa Verde, municipio de Ciénaga, departamento del Magdalena; bajo condiciones climáticas de temperatura promedia de 28,3 °C, humedad relativa del 787., precipitación anual de 711,7 mm y 2.782,6 horas anuales de brillo solar. Los análisis en los laboratorios del Centro de Investigación Caribia del ICA en Sevilla-Magdalena y de la Universidad del Magdalena (Santa Marta), con el propósito de precisar el momento óptimo de cosecha del mango (Mangifera indica L.) variedad Azúcar, a través de la identificación de las diferentes etapas del crecimiento y desarrollo de los frutos, del análisis de los cambios fisicoquímicos y organolépticos que presentan los productos cosechados en diferentes estados de madurez y almacenados bajo condiciones ambientales. Para su evaluación se tomó al azar una muestra de cinco árboles, en los cuales se marcaron todas las panículas del tercio inferior de la copa del árbol que se encontraban con el 50% de los frutos en estado de "alfiler" (fruto cuyo 142 óvulo ha sido fecundado y ha alcanzado un tamaño aproximado de 2 mm, semejante a la cabeza de un alfiler), en la cosecha de "mitaca" (Agosto 8 - Noviembre 28 1990) y en la "principal" (Enero 3 - Abril 26 1991), recolectando semanalmente frutos a fin de analizar los cambios físicos en longitud, diámetros, peso fresco y seco; químicos en cuanto a sólidos solubles totales, ácido málico, almidón y pH. A los datos obtenidos se le realizaron pruebas estadísticas de regresión con respecto al tiempo. Entre marzo 19 y Abril 11 de 1991 se efectuaron cosechas de frutos con edades de siete a dieciséis semanas de edad, los cuales se almacenaron bajo condiciones ambientales (29°C), para posteriores análisis físicos (tamaño y peso fresco), químicos (sólidos solubles y ácido málico) y organolépticos (color de la epidermis, color, sabor y textura del mesocarpio). Estos parámetros se analizaron a partir de un diseño de bloques al azar, cuyos tratamientos fueron las edades de cosecha, con tres replicaciones para los análisis físicosquímicos y seis para el organoléptico, representado por las personas que colaboraron como catadores. Al comparar las dos cosechas evaluadas se encontró que la cosecha de "mitaca", presenta menor número de ciclos de emisión de panículas, de panículas por ciclo y de panículas por árbol con respecto a la "principal". Igualmente se observó que los ciclos de emisión de panículas más importantes son los intermedios, donde apareció hasta el 60% de todas las inflorescencias. El crecimiento de los frutos de mango variedad Azúcar, en las primeras. semanas de desarrollo, es más rápido en longitud que en cuanto al peso, ya que, en la séptima semana de edad, ha logrado el 90% del largo total promedio, mientras que en la novena, entre el 70% y el 72% de su peso fresco final, donde la contribución relativa de la epidermis y semilla, se estabilizan aportando entre el 11% y el 12% y el mesocarpio entre el 75% y BO% del total. Se encontró que la madurez fisiológica ocurre en la decimoprimera semana de desarrollo, después del estado de "alfiler". En esta época el fruto ha alcanzado su forma típica oblonga-oval, y la relación entre la longitud y el peso fresco se han estabilizado en 0,05. El color de la epidermis cambió de verde claro a verde oliva brillante y en el mesocarpio se advirtió una coloración amarilla más acentuada alrededor de la semilla. Respecto a los sólidos solubles, estos resultaron ser los más bajos (6,97 °Brix y 8,69 °Brix, para las cosechas de "mitaca" y "principal", respectivamente) en tanto que el contenido de almidón fue el más alto (9,32 Y.). La acidez titulable y el pH presentaron un comportamiento uniforme, disminuyendo el primero y aumentando el segundo, en la medida que el fruto se desarrollaba. Para los frutos cosechados y almacenados a temperatura ambiente, las diferencias fueron altamente significativas entre las edades de los mismos. En los de menos de once semanas de edad, el comportamiento no fue adecuado; por el contrario, los cosechados a partir de esta fecha presentaron características físicas, químicas Y organolépticas aceptables, entre los cuales, los mangos con catorce semanas de edad, presentaron las mejores cualidades. Del análisis conjunto de todos los resultados obtenidos, se concluye que el mango (Mangifera indica L) variedad azúcar, se debe cosechar con catorce semanas de edad, los cuales soportan siete días adicionales de almacenamiento en condiciones ambientales de temperatura

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Cabbage and fermented vegetables : From death rate heterogeneity in countries to candidates for mitigation strategies of severe COVID-19

Large differences in COVID-19 death rates exist between countries and between regions of the same country. Some very low death rate countries such as Eastern Asia, Central Europe, or the Balkans have a common feature of eating large quantities of fermented foods. Although biases exist when examining ecological studies, fermented vegetables or cabbage have been associated with low death rates in European countries. SARS-CoV-2 binds to its receptor, the angiotensin-converting enzyme 2 (ACE2). As a result of SARS-CoV-2 binding, ACE2 downregulation enhances the angiotensin II receptor type 1 (AT(1)R) axis associated with oxidative stress. This leads to insulin resistance as well as lung and endothelial damage, two severe outcomes of COVID-19. The nuclear factor (erythroid-derived 2)-like 2 (Nrf2) is the most potent antioxidant in humans and can block in particular the AT(1)R axis. Cabbage contains precursors of sulforaphane, the most active natural activator of Nrf2. Fermented vegetables contain many lactobacilli, which are also potent Nrf2 activators. Three examples are: kimchi in Korea, westernized foods, and the slum paradox. It is proposed that fermented cabbage is a proof-of-concept of dietary manipulations that may enhance Nrf2-associated antioxidant effects, helpful in mitigating COVID-19 severity.Peer reviewe

Nrf2-interacting nutrients and COVID-19 : time for research to develop adaptation strategies

There are large between- and within-country variations in COVID-19 death rates. Some very low death rate settings such as Eastern Asia, Central Europe, the Balkans and Africa have a common feature of eating large quantities of fermented foods whose intake is associated with the activation of the Nrf2 (Nuclear factor (erythroid-derived 2)-like 2) anti-oxidant transcription factor. There are many Nrf2-interacting nutrients (berberine, curcumin, epigallocatechin gallate, genistein, quercetin, resveratrol, sulforaphane) that all act similarly to reduce insulin resistance, endothelial damage, lung injury and cytokine storm. They also act on the same mechanisms (mTOR: Mammalian target of rapamycin, PPAR gamma:Peroxisome proliferator-activated receptor, NF kappa B: Nuclear factor kappa B, ERK: Extracellular signal-regulated kinases and eIF2 alpha:Elongation initiation factor 2 alpha). They may as a result be important in mitigating the severity of COVID-19, acting through the endoplasmic reticulum stress or ACE-Angiotensin-II-AT(1)R axis (AT(1)R) pathway. Many Nrf2-interacting nutrients are also interacting with TRPA1 and/or TRPV1. Interestingly, geographical areas with very low COVID-19 mortality are those with the lowest prevalence of obesity (Sub-Saharan Africa and Asia). It is tempting to propose that Nrf2-interacting foods and nutrients can re-balance insulin resistance and have a significant effect on COVID-19 severity. It is therefore possible that the intake of these foods may restore an optimal natural balance for the Nrf2 pathway and may be of interest in the mitigation of COVID-19 severity

Effect of SGLT2 Inhibitors on Stroke and Atrial Fibrillation in Diabetic Kidney Disease: Results From the CREDENCE Trial and Meta-Analysis

BACKGROUND AND PURPOSE: Chronic kidney disease with reduced estimated glomerular filtration rate or elevated albuminuria increases risk for ischemic and hemorrhagic stroke. This study assessed the effects of sodium glucose cotransporter 2 inhibitors (SGLT2i) on stroke and atrial fibrillation/flutter (AF/AFL) from CREDENCE (Canagliflozin and Renal Events in Diabetes With Established Nephropathy Clinical Evaluation) and a meta-analysis of large cardiovascular outcome trials (CVOTs) of SGLT2i in type 2 diabetes mellitus.METHODS: CREDENCE randomized 4401 participants with type 2 diabetes mellitus and chronic kidney disease to canagliflozin or placebo. Post hoc, we estimated effects on fatal or nonfatal stroke, stroke subtypes, and intermediate markers of stroke risk including AF/AFL. Stroke and AF/AFL data from 3 other completed large CVOTs and CREDENCE were pooled using random-effects meta-analysis.RESULTS: In CREDENCE, 142 participants experienced a stroke during follow-up (10.9/1000 patient-years with canagliflozin, 14.2/1000 patient-years with placebo; hazard ratio [HR], 0.77 [95% CI, 0.55-1.08]). Effects by stroke subtypes were: ischemic (HR, 0.88 [95% CI, 0.61-1.28]; n=111), hemorrhagic (HR, 0.50 [95% CI, 0.19-1.32]; n=18), and undetermined (HR, 0.54 [95% CI, 0.20-1.46]; n=17). There was no clear effect on AF/AFL (HR, 0.76 [95% CI, 0.53-1.10]; n=115). The overall effects in the 4 CVOTs combined were: total stroke (HRpooled, 0.96 [95% CI, 0.82-1.12]), ischemic stroke (HRpooled, 1.01 [95% CI, 0.89-1.14]), hemorrhagic stroke (HRpooled, 0.50 [95% CI, 0.30-0.83]), undetermined stroke (HRpooled, 0.86 [95% CI, 0.49-1.51]), and AF/AFL (HRpooled, 0.81 [95% CI, 0.71-0.93]). There was evidence that SGLT2i effects on total stroke varied by baseline estimated glomerular filtration rate (P=0.01), with protection in the lowest estimated glomerular filtration rate (<45 mL/min/1.73 m2]) subgroup (HRpooled, 0.50 [95% CI, 0.31-0.79]).CONCLUSIONS: Although we found no clear effect of SGLT2i on total stroke in CREDENCE or across trials combined, there was some evidence of benefit in preventing hemorrhagic stroke and AF/AFL, as well as total stroke for those with lowest estimated glomerular filtration rate. Future research should focus on confirming these data and exploring potential mechanisms. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02065791

Kidney and Cardiovascular Effects of Canagliflozin According to Age and Sex: A Post Hoc Analysis of the CREDENCE Randomized Clinical Trial

Rationale & Objective: It is unclear whether the effect of canagliflozin on adverse kidney and cardiovascular events in those with diabetic kid-ney disease varies by age and sex. We assessed the effects of canagliflozin among age group categories and between sexes in the Canagli-flozin and Renal Endpoints in Diabetes with Established Nephropathy Clinical Evaluation (CREDENCE) study.Study Design: Secondary analysis of a random-ized controlled trial. Setting & Participants: Participants in the CREDENCE trial. Intervention: Participants were randomly assigned to receive canagliflozin 100 mg/d or placebo.Outcomes: Primary composite outcome of kid-ney failure, doubling of serum creatinine con-centration, or death due to kidney or cardiovascular disease. Prespecified secondary and safety outcomes were also analyzed. Out-comes were evaluated by age at baseline (<60, 60-69, and >_70 years) and sex in the intention-to-treat population using Cox regression models.Results: The mean age of the cohort was 63.0 & PLUSMN; 9.2 years, and 34% were female. Older age and female sex were independently associ-ated with a lower risk of the composite of adverse kidney outcomes. There was no evidence that the effect of canagliflozin on the primary outcome (acomposite of kidney failure, a doubling of serum creatinine concentration, or death from kidney or cardiovascular causes) differed between age groups (HRs, 0.67 [95% CI, 0.52-0.87], 0.63 [0.4 8-0.82], and 0.89 [0.61-1.29] for ages <60, 60-69, and >_70 years, respectively; P = 0.3 for interaction) or sexes (HRs, 0.71 [95% CI, 0.5 4-0.95] and 0.69 [0.56-0.8 4] in women and men, respectively; P = 0.8 for interaction). No differences in safety outcomes by age group or sex were observed.Limitations: This was a post hoc analysis with multiple comparisons.Conclusions: Canagliflozin consistently reduced the relative risk of kidney events in people with diabetic kidney disease in both sexes and across age subgroups. As a result of greater background risk, the absolute reduction in adverse kidney outcomes was greater in younger participants.Funding: This post hoc analysis of the CREDENCE trial was not funded. The CREDENCE study was sponsored by Janssen Research and Development and was conducted collaboratively by the sponsor, an academic-led steering committee, and an academic research organization, George Clinical.Trial Registration: The original CREDENCE trial was registered at ClinicalTrials.gov with study number NCT02065791

Alirocumab and cardiovascular outcomes after acute coronary syndrome

BACKGROUN

Alirocumab and Cardiovascular Outcomes after Acute Coronary Syndrome

BACKGROUN