Corrección quirúrgica del estrabismo en 2 pacientes con el síndrome de Moebius

ResumenSe presentan las características oftalmológicas y clínicas de 2 pacientes (una mujer y un hombre) con diagnóstico de síndrome de Moebius. Esta entidad por lo general bilateral, de causa multifactorial, se caracteriza por marcada esotropía, con gran limitación de la abducción, y otras alteraciones faciales. Se presentan 2 casos clínicos a los que se les realizó corrección quirúrgica.AbstractIt's presented the ophthalmic and clinical characteristic of 2 patients (female and male), with diagnosis of Moebius syndrome. This is a disorder generally bilateral, of multifactorial cause which is characterized by marked esotropia, with large limitation of abduction, with other facial alterations. We presented 2 clinic cases which already underwent surgical correctio

Síndrome de adherencia del músculo oblicuo inferior izquierdo

ResumenSe presenta el caso de una paciente de 15 años de edad con antecedentes de haber sido operada de estrabismo en 2 ocasiones. Acude a nuestro instituto pues presenta limitación de la elevación en aducción del ojo izquierdo, hipotropía de ese ojo e hipertropía derecha de 25DP. Se plantea un síndrome de adherencia del oblicuo inferior izquierdo y se realiza liberación de adherencias en la zona inferotemporal izquierda y retroinserción del recto superior derecho 4mm (músculo yunta) en un segundo tiempo, encontrándose alineada en posición primaria de mirada, mejorando levemente la elevación.AbstractA case of a 15 years old patient with a history of strabismus is presented here. She had been operated twice and she attends to our institute because of limited elevation in adduction and left hypotropia, as well as 25PD hypertropia in her right eye. Left inferior oblique adherence syndrome is diagnosed. Lysis of adherences in the left infero-temporal area is performed. In a second moment, a right superior rectus recession about 4mm(yoke muscle) is performed, aligning in primary gaze position, and slightly improving elevation

Sistema de Posicionamiento para Vehículos Autónomos

Uno de los objetivos más importantes de los Sistemas Inteligentes de Transporte (ITS) es evitar la pérdida de precisión en el posicionamiento y guiado del vehículo, debido a la disminución en la calidad de la señal del Sistema de Posicionamiento Global (GPS). En este artículo, se presenta un sistema de posicionamiento formado por la combinación de un GPS con una unidad de medida inercial ayudada por los sensores embarcados en el coche para realizar el guiado. En función de la precisión proporcionada por el GPS, el sistema discrimina entre tres posibles comportamientos: 1) Si la precisión es centimétrica, el GPS se encarga en solitario del guiado. 2) Si no se recibe la señal GPS, el control lo toma la unidad inercial. 3) Si la precisión de la señal del GPS no es centimétrica, la posición del vehículo se calcula mediante una combinación de ambas medidas. El sistema se ha instalado en un Citroën C3 Pluriel. Los resultados muestran un correcto comportamiento del vehículo en diferentes situaciones y prueban la necesidad de integrar la información sensorial para realizar un control de navegación óptimo

Towards a dynamic checklist of lichen-forming, lichenicolous and allied fungi of Ecuador – using the <i>Consortium of Lichen Herbaria</i> to manage fungal biodiversity in a megadiverse country

peer reviewedA checklist of Lichen-forming, Lichenicolous and Allied Fungi of Ecuador is presented with a total of 2599 species, of which 39 are reported for the first time from the country. The names of three species, Hypotrachyna montufariensis, H. subpartita and Sticta hypoglabra, previously not validly published, are validated. Pertusaria oahuensis, originally introduced by Magnusson as ‘ad interim’, is validated as Lepra oahuensis. The form Leucodermia leucomelos f. albociliata is validated. Two new combinations, Fissurina tectigera and F. timida, are made, and Physcia mobergii is introduced as a replacement name for the illegitimate P. lobulata Moberg non (Flörke) Arnold. In an initial step, the checklist was compiled by reviewing literature records of Ecuadorian lichen biota spanning from the late 19th century to the present day. Subsequently, records were added based on vouchers from 56 collections participating in the Consortium of Lichen Herbaria, a Symbiota-based biodiversity platform with particular focus on, but not exclusive to, North and South America. Symbiota provides sophisticated tools to manage biodiversity data, such as occurrence records, a taxonomic thesaurus, and checklists. The thesaurus keeps track of frequently changing names, distinguishing taxa currently accepted from ones considered synonyms. The software also provides tools to create and manage checklists, with an emphasis on selecting vouchers based on occurrence records that can be verified for identification accuracy. Advantages and limitations of creating checklists in Symbiota versus traditional ways of compiling these lists are discussed. Traditional checklists are well suited to document current knowledge as a ‘snapshot in time’. They are important baselines, frequently used by ecologists and conservation scientists as an established naming convention for citing species reported from a country. Compiling these lists, however, requires an immense effort, only to inadequately address the dynamic nature of scientific discovery. Traditional checklists are thus quickly out of date, particularly in groups with rapidly changing taxonomy, such as lichenized fungi. Especially in megadiverse countries, where new species and new occurrences continue to be discovered, traditional checklists are not easily updated; these lists necessarily fall short of efficiently managing immense data sets, and they rely primarily on secondary evidence (i.e. literature records rather than specimens). Ideally, best practices make use of dynamic database platforms such as Symbiota to assess occurrence records based both on literature citations and voucher specimens. Using modern data management tools comes with a learning curve. Systems like Symbiota are not necessarily intuitive and their functionality can still be improved, especially when handling literature records. However, online biodiversity data platforms have much potential in more efficiently managing and assessing large biodiversity data sets, particularly when investigating the lichen biota of megadiverse countries such as Ecuador

Ecos de la academia: Revista de la Facultad de Educación, Ciencia y Tecnología - FECYT Nro 3

Ecos de la academia, Revista de la Facultad de Educación Ciencia y Tecnología es una publicación científica de la Universidad Técnica del Norte, con revisión por pares a doble ciego que publica artículos en idioma español, quichua, portugués e inglés. Se edita con una frecuencia semestral con dos números por año.En ella se divulgan trabajos originales e inéditos generados por los investigadores, docentes y estudiantes de la FECYT, y contribuciones de profesionales de instituciones docentes e investigativas dentro y fuera del país, con calidad, originalidad y relevancia en las áreas de ciencias sociales y tecnología aplicada.Ideología, valores y medios. Un reto de niños, padres y maestros. Características de la violencia intrafamiliar en Imbabura. El mercado del arte contemporáneo: La presencia femenina. Recursos educativos abiertos (REA) con metodología PACIE. Educación y Pedagogía. Diversas aproximaciones. Organizadores gráficos interactivos (OGIS): una alternativa didáctica para el aprendizaje. El pseudoperiodismo de investigación en las cadenas generalistas de televisión en España. Educomunicación y bailoterapia como estrategias para fortalecer la Relación Universidad-Sociedad. Catalanes en Ecuador (siglos XVI-XX). La Arqueología y el Arte: los artistas como arqueólogos. Las nuevas tecnologías: su influencia en la comunicación y en la práctica docente. Validación de un instrumento para evaluar competencias genéricas en la formación del maestro de Educación Infantil Análisis de los factores que motivan a los trabajadores en relación de dependencia de Imbabura. El libro La marca-país en América Latina. Bases teóricas y técnicas para el diseño de la marca-país. El libro Historia del Diseño en América Latina y el Caribe: industrialización y comunicación visual. El diseño de la marca “Editorial UTN”. El cartelismo social y la Ecuador Poster Bienal Aprendiendo Ciencia en el Aula didáctica: retos y potencialidades Normas de presentación de artículos en la revista Ecos de la Academia

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Conocimientos tradicionales relativos a la biodiversidad agrícola

La biodiversidad agrícola, a diferencia de la silvestre, requiere la acción continuada de los agricultores para su conservación, ya que las plantas cultivadas dependen de la intervención humana, con actividades como la selección, la siembra, el abonado, la poda u otras prácticas agrícolas para su supervivencia. Desde la revolución agrícola del Neolítico hasta la actualidad, estas prácticas y conocimientos han ido generando y conservando una gran diversidad, amenazada a partir de la segunda mitad del siglo XX por las causas que se han indicado anteriormente.Peer reviewe

Gestión del conocimiento: perspectiva multidisciplinaria. Volumen 12

El libro “Gestión del Conocimiento. Perspectiva Multidisciplinaria”, Volumen 12, de la Colección Unión Global, es resultado de investigaciones. Los capítulos del libro, son resultados de investigaciones desarrolladas por sus autores. El libro cuenta con el apoyo de los grupos de investigación: Universidad Sur del Lago “Jesús María Semprúm” (UNESUR), Zulia – Venezuela; Universidad Politécnica Territorial de Falcón Alonso Gamero (UPTAG), Falcón – Venezuela; Universidad Politécnica Territorial de Mérida Kleber Ramírez (UPTM), Mérida – Venezuela; Universidad Guanajuato (UG) - Campus Celaya - Salvatierra - Cuerpo Académico de Biodesarrollo y Bioeconomía en las Organizaciones y Políticas Públicas (C.A.B.B.O.P.P), Guanajuato – México; Centro de Altos Estudios de Venezuela (CEALEVE), Zulia – Venezuela, Centro Integral de Formación Educativa Especializada del Sur (CIFE - SUR) - Zulia - Venezuela, Centro de Investigaciones Internacionales SAS (CIN), Antioquia - Colombia.y diferentes grupos de investigación del ámbito nacional e internacional que hoy se unen para estrechar vínculos investigativos, para que sus aportes científicos formen parte de los libros que se publiquen en formatos digital e impreso

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

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