Spatial modeling with repopulation potential for three flora species of Huaytapallana Regional Conservation Area, Peru

In the high mountain ecosystems of the Huaytapallana Regional Conservation Area (ACR-H) there are three species of flora (Krapfia macropetala, Gentianella scarlatinostriata and Senecio canescens) of social, economic, cultural and medicinal importance, however their population status and undefined local distribution make these species area more vulnerable to extinction. Therefore, the objective of this work is to determine the population distribution for repopulation purpose in the ACR-H from the potential distribution in Peru using Maxent algorithm and a local model developed with the Saaty pairwise hierarchy matrix, adding a soil sample for a better application of the final model. The results show that the Species Distribution Models (SDMs) have a high confidence because the Area Under the Curve (AUC) surpass 0.90. Otherwise, the local model is consistent by showing a Consistency Ratio (CR) of less than 0.10. As a final result, all species obtained optimal spaces for repopulation near the Huaytapallana Cordillera, where Krapfia macropetala obtained the largest extension (715.334 ha) and Gentianella scarlatinostriata is the smallest (650.096 ha). Further there were no differences in the parameters evaluated in the three soil samples, which facilitates the application of the models for the repopulation of these three species

Integrating top-down and bottom-up approaches to design global change adaptation at the river basin scale

The high uncertainty associated with the effect of global change on water resource systems calls for a better combination of conventional top-down and bottom-up approaches, in order to design robust adaptation plans at the local scale. The methodological framework presented in this article introduces bottom-up meets top-down integrated approach to support the selection of adaptation measures at the river basin level by comprehensively integrating the goals of economic efficiency, social acceptability, environmental sustainability and adaptation robustness. The top-down approach relies on the use of a chain of models to assess the impact of global change on water resources and its adaptive management over a range of climate projections. Future demand scenarios and locally prioritised adaptation measures are identified following a bottom-up approach through a participatory process with the relevant stakeholders and experts. The optimal combinations of adaptation measures are then selected using a hydro-economic model at basin scale for each climate projection. The resulting adaptation portfolios are, finally, climate checked to define a robust least-regret programme of measures based on trade-offs between adaptation costs and the reliability of supply for agricultural demands. This innovative approach has been applied to a Mediterranean basin, the Orb river basin (France). Mid-term climate projections, downscaled from 9 General Climate Models, are used to assess the uncertainty associated with climate projections. Demand evolution scenarios are developed to project agricultural and urban water demands on the 2030 time horizon. The results derived from the integration of the bottom-up and top-down approaches illustrate the sensitivity of the adaptation strategies to the climate projections, and provide an assessment of the trade-offs between the performance of the water resource system and the cost of the adaptation plan to inform local decision-making. The article contributes new methodological elements for the development of an integrated framework for decision-making under climate change uncertainty, advocating an interdisciplinary approach that bridges the gap between bottom-up and top-down approaches.The study has been financially supported by BRGM-ONEMA joint project on Hydro-economic modelling and by the IMPADAPT project (CGL2013-48424-C2-1-R) from the Spanish ministry MINECO (Ministerio de Economia y Competitividad) with European FEDER funds. Corentin Girard is supported by a grant from the University Lecturer Training Program (FPU12/03803) of the Ministry of Education, Culture and Sports of Spain. We also acknowledge the CERFACS for the climate scenarios provided from the SCRATCH 2010 dataset (March 2012 release - http://www.cerfacs.fr/similar to page/work/scratch/). We thank as well the anonymous reviewers and the Editors of Global Environmental Change, for their useful and encouraging comments during the review process.Girard, CDP.; Pulido-Velazquez, M.; Rinaudo, J.; Page Oliva, C.; Caballero, I. (2015). Integrating top-down and bottom-up approaches to design global change adaptation at the river basin scale. Global Environmental Change. 34:132-146. https://doi.org/10.1016/j.gloenvcha.2015.07.002S1321463

Quality of life in patients with epilepsy attending in neurology department of San José Hospital in Bogotá.

Introducción: en el mundo aproximadamente 50 millones de personas presentan epilepsia, La enfermedad genera una gran secuela en el paciente, y en las familias con esta enfermedad. Objetivo: describir condiciones que afecten la calidad de vida, mediante el formulario QOLIE-10, en los pacientes con epilepsia valorados en el Hospital de San José en Bogotá. Materiales y métodos: estudio observacional descriptivo de corte transversal a partir de la encuesta de calidad de vida en epilepsia (QOLIE-10). La información se resumió con frecuencias y medidas de tendencia central y de dispersión. Resultados: se realizaron 157 encuestas. Según la clasificación del QOLIE 10, 43,3% de los pacientes presentaron mala calidad de vida, por lo cual, sumada la calificación regular (19,8%), se interpreta que la mayoría de pacientes no tienen buena calidad de vida. La calidad de vida, al igual que en el resto de la población mundial, se ve afectada por la frecuencia ictal. Conclusión: en la población de pacientes con epilepsia su calidad de vida no es buena a pesar de que 71% son tratados con monoterapia y tienen control de la enfermedad.Introduction: in the world about 50 million people have epilepsy, the disease causes a great sequel to the patient, and families with this disease Objective: to describe conditions that affect the quality of life by QOLIE-10 form in patients with epilepsy, valued at San José Hospital of Bogotá. Materials and methods: cross-sectional descriptive observation from the survey of quality of life in epilepsy (QOLIE-10). The information was summarized using frequencies, measures of central tendency and dispersion. Results: 157 surveys were obtained. According to the classification of QOLIE 10, 43.3% of patients had poor quality of life, which along with the regular grade (19.8%) is interpreted that most patients do not have a good quality of life. Quality of life as in the rest of the world population is affected by the ictal frequency. Conclusion: in patients with epilepsy Population their quality of life is not good although 71% are on monotherapy and have control of the disease

Laparoscopic cholecystectomy and common bile duct exploration using choledochotomy and primary closure following failed endoscopic retrograde cholangiopancreatography: A multicentric comparative study using three-port vs multiport

Background: Laparoscopic surgery has changed many ways in which we as surgeons manage patients, offering better results, quicker recovery, and fewer complications using minimally invasive techniques, especially in common bile duct (CBD) surgery. Not only can laparoscopic techniques be applied to programed surgery but also emergencies and those following failed endoscopic retrograde cholangiopancreatography (ERCP). Objectives and aims: Describe and compare clinical and surgical results of the laparoscopic CBD exploration with primary closure using a 3-port vs multiport approach. Materials and methods: We present a multicentric comparative study of 197 consecutive patients who underwent a laparoscopic gallbladder removal along with CBD exploration with primary closure following failed (ERCP to extract CBD stones; 104 patients were managed by three-port vs 93 multiport laparoscopic surgery in five centers of Bogotá, Colombia, between 2013 and 2017 with follow-up of 1 year. Results: A total of 197 patients were taken to laparoscopic gallbladder removal along with CBD exploration with primary closure, 104 patients via three-port technique and 93 patients via multiport. All (100%) the patients had previously failed ERCP. The average surgical time on the three-port approach was 106 minutes vs 123 minutes on multiport. Only in the multiport technique we had an average conversion of 2%. Mean hospital stay of 2.5 days, less for the three-port approach vs multiport in 5–7 days. There was a need of reintervention in 1% of the patients who underwent three-port exploration. Conclusion: Postoperative pain, use of an additional port, complication rates, operation time, and cost of the three-port technique were similar to those of the conventional approach. Large randomized controlled trials are needed to examine the true benefits of the three-port technique

La apendicectomía laparoscópica de incisión única con puerto de guante quirúrgico es rentable y fiable en la apendicitis aguda complicada: Un estudio multicéntrico de casos y controles en Colombia

Antecedentes: El abordaje laparoscópico de puerto único (SPL) y multipuerto (MPL) son el patrón oro del tratamiento de la apendicitis aguda, debido a sus múltiples ventajas sobre la cirugía abierta, principalmente por sus efectos directos sobre la recuperación, la estética y los costes del procedimiento. Sin embargo, en los países del tercer mundo, el abordaje laparoscópico aún no es totalmente reproducible debido a los costes de la técnica. La apendicectomía laparoscópica de incisión única con puerto de guante quirúrgico (SGP-SILA) se ha propuesto como una opción viable. Sin embargo, nunca ha sido estudiada en Colombia. Objetivo: Evaluar el costo-efectividad y la confiabilidad de la SGP-SILA en el manejo de la apendicitis aguda complicada, comparada con el abordaje tradicional MPL. Materiales y métodos: Se realizó un estudio retrospectivo de casos y controles comparando pacientes sometidos a apendicectomía laparoscópica por SGP-SILA vs. MPL, evaluando costos operatorios asociados a variables intraoperatorias y postoperatorias en dos centros terciarios de Bogotá, Colombia. Los datos fueron analizados y expresados según su naturaleza y distribución. Resultados: Se incluyeron 116 pacientes (SGP-SILA: 62 y MPL: 54). La mediana del tiempo quirúrgico para SGP-SILA fue de 60 min frente a 39 min para MPL. Se demostró que la SGP-SILA causaba una menor frecuencia de infección del sitio quirúrgico (4 frente a 8 pacientes; p = 0,047). Se encontró una correlación significativa entre la infección del sitio quirúrgico de grado III y el tiempo de cirugía (p = 0,047) en el grupo MPL; también, con la estancia hospitalaria (p < 0,001). Asimismo, se encontró un menor riesgo de infección del sitio quirúrgico con la técnica SGP-SILA (22% frente a 31%). La SGP-SILA generó una reducción de los costes operativos directos e indirectos de aproximadamente el 10% (616 USD frente a 683 USD). Conclusiones: La SGP-SILA y la MPL son procedimientos factibles y comparables en la resolución de la apendicitis aguda complicada. La SGP-SILA resulta ser más rentable que la MPL, debido al uso de instrumentos más fácilmente accesibles. Puede ser una técnica reproducible en países de ingresos bajos y medios.Background: The single-port (SPL) and multi-port (MPL) laparoscopic approach are the gold standard of management of acute appendicitis, due to its multiple advantages over open surgery, mainly because of its direct effects on recovery, esthetics and costs of the procedure. However, in third-world countries, the laparoscopic approach is not yet fully reproducible due to the costs of the technique. The surgical-glove port single incision laparoscopic appendectomy (SGP-SILA) has been proposed as a viable option. However, it has never been studied in Colombia. Objective: To evaluate the cost-effectiveness and reliability of SGP-SILA in the management of complicated acute appendicitis, compared to traditional MPL approach. Materials and methods: A retrospective case control study was carried out comparing patients undergoing laparoscopic appendectomy by SGP-SILA vs. MPL, evaluating operating costs asso- ciated with intraoperative and postoperative variables in two tertiary centers in Bogota, Colombia. The data were analyzed and expressed according to their nature and distribution. Results: 116 patients were included (SGP-SILA: 62 and MPL: 54). The median surgical time for SGP-SILA was 60 min vs. 39 min for MPL. SGP-SILA was shown to cause lower frequency of surgical site infection (4 vs. 8 patients; p = 0.047). It was found a significant correlation between Grade III surgical site infection and surgery time (p = 0.047) in the MPL group; also, with hospital stay (p < 0.001). Also, a lower risk of surgical site infection was found with the SGP-SILA technique (22% vs. 31%). SGP-SILA generated a reduction in both direct and indirect oper- ating costs of approximately 10% (616 USD vs. 683 USD). Conclusion: SGP-SILA and MPL are feasible and comparable procedures in the resolution of complicated acute appendicitis. SGP-SILA turns out to be more cost-effective compared to MPL, due to the use of more easily accessible instruments. This may be a reproducible technique in low- and middle-income countries

Laparoscopic choledochal cyst resection with simplified common bile duct reconstruction in an adult population: A case series

Introducción: Los quistes de colédoco (CC) son una patología congénita poco frecuente en la población adulta. Desde 1995, el manejo laparoscópico ha sido descrito para esta entidad. Sin embargo, su manejo se considera un tema controvertido debido al aumento del riesgo de colangiocarcinoma. Materiales y métodos: se realizó un estudio retrospectivo, observacional y descriptivo considerando pacientes diagnosticados de CC que fueron operados en un centro de referencia de cirugía hepatobiliar desde enero de 2013 hasta junio de 2018. Los pacientes fueron llevados a laparoscopia simplificada hepaticoyeyunostomía con reconstrucción en Y de Roux. Se presenta un análisis retrospectivo de los datos obtenidos. Resultados: Diez pacientes adultos con CC fueron sometidos a reconstrucción biliar quirúrgica a una edad media de 34,5 años; 75% tenía CC Todani tipo I y 25% Todani tipo IV-B CC. Aproximadamente el 50% de los pacientes fueron diagnosticados mediante colangiopancreatografía retrógrada endoscópica (CPRE) y el 50% de ellos mediante colangiopancreatografía por resonancia magnética. Ninguno requirió reintervención, no se informó mortalidad; y la estancia media en el hospital fue 5 días, ningún paciente tuvo fuga biliar posoperatoria, ninguno se convirtió a cirugía abierta y todos los pacientes tuvieron una tolerancia adecuada a la alimentación oral 2 días postoperatorios. El seguimiento a largo plazo no mostró incidencia de colangiocarcinoma después de un seguimiento de 2 años. Conclusión: Los quistes de colédoco en adultos son una patología poco frecuente que tiene una alta probabilidad de desarrollar malignidad cuando no se realiza de forma adecuada quirúrgicamente manejado y debido al reflujo biliar secundario. Estos factores hacen que el manejo quirúrgico sea una decisión crítica. El abordaje laparoscópico simplificado presentado en este trabajo parece ser una alternativa eficaz y segura a la cirugía reconstructiva de la vía biliar.Introduction: Choledochal cysts (CC) are rare congenital pathology in adult population. Since 1995, laparoscopic management has been described for this entity. Nevertheless, its management is considered to be a controversial matter due to the augmented risk of associated cholangiocarcinoma. Materials and methods: A retrospective, observational, and descriptive study was conducted considering patients diagnosed with CC who were operated at a hepatobiliary surgery referral center from January 2013 to June 2018. Patients were taken to simplified laparoscopic hepaticojejunostomy with a Roux-en-Y reconstruction. A retrospective analysis of the data obtained is presented. Results: Ten adult patients with CC underwent surgical biliary reconstruction at a mean age of 34.5 years; 75% had Todani type I CC and 25% Todani type IV-B CC. About 50% of the patients were diagnosed via endoscopic retrograde holangiopancreatography (ERCP) and 50% of them via magnetic resonance cholangiopancreatography. None required re-intervention, no mortality was reported; and the mean hospital stay was 5 days, no patient had postoperative biliary leakage, none was converted to open surgery, and all patients had adequate oral feeding tolerance 2 days postoperative. Long-term follow-up showed no incidence of cholangiocarcinoma after 2-year follow-up. Conclusion: Choledochal cysts in adults is a rare pathology that has a high probability of developing malignancy when not adequately surgically managed and because of secondary bile reflux. These factors make surgical management a critical decision. The simplified laparoscopic approach presented in this paper seems to be an effective and safe alternative to biliary duct reconstructive surgery

Staphylococcus aureus seroproteomes discriminate ruminant isolates causing mild or severe mastitis

Staphylococcus aureus is a major cause of mastitis in ruminants. In ewe mastitis, symptoms range from subclinical to gangrenous mastitis. S. aureus factors or host-factors contributing to the different outcomes are not completely elucidated. In this study, experimental mastitis was induced on primiparous ewes using two S. aureus strains, isolated from gangrenous (strain O11) or subclinical (strain O46) mastitis. Strains induced drastically distinct clinical symptoms when tested in ewe and mice experimental mastitis. Notably, they reproduced mild (O46) or severe (O11) mastitis in ewes. Ewe sera were used to identify staphylococcal immunoreactive proteins commonly or differentially produced during infections of variable severity and to define core and accessory seroproteomes. Such SERological Proteome Analysis (SERPA) allowed the identification of 89 immunoreactive proteins, of which only 52 (58.4%) were previously identified as immunogenic proteins in other staphylococcal infections. Among the 89 proteins identified, 74 appear to constitute the core seroproteome. Among the 15 remaining proteins defining the accessory seroproteome, 12 were specific for strain O11, 3 were specific for O46. Distribution of one protein specific for each mastitis severity was investigated in ten other strains isolated from subclinical or clinical mastitis. We report here for the first time the identification of staphylococcal immunogenic proteins common or specific to S. aureus strains responsible for mild or severe mastitis. These findings open avenues in S. aureus mastitis studies as some of these proteins, expressed in vivo, are likely to account for the success of S. aureus as a pathogen of the ruminant mammary gland

Management of ruptured abdominal aortic aneurysm: A challenge for the general surgeon

Introducción. El aneurisma aórtico abdominal roto, tiene una mortalidad del 80 % al 90 %. Para su reparación existe una técnica abierta y otra endovascular, las cuales tienen diferencias entre sus beneficios y complicaciones. El método de elección en la actualidad para la corrección de esta alteración anatómica es endovascular, sin embargo, no es el más usado, porque no se cuenta todo el tiempo con el equipo humano de cirugía vascular para su realización. Caso clínico. Ingresa a urgencias un paciente en estado de shock de origen desconocido, con dolor abdominal de 24 horas de evolución. Se realiza una tomografía con contraste que demuestra un aneurisma aórtico abdominal infrarrenal roto. Debido a que no se contaba con el equipo de cirugía vascular, es llevado de urgencia a una corrección abierta que duró 153 minutos, con un sangrado intraoperatorio de 1754 cc. Fue dado de alta a los 12 días postoperatorios sin ninguna complicación. Discusión. La reparación endovascular del aneurisma aórtico abdominal roto es la mejor elección, ya que muestra mayores beneficios en comparación con la reparación abierta, sin embargo, no es el más utilizado, porque se necesita de un personal bien entrenado en cirugía endovascular, por lo que, dentro de la formación de los cirujanos generales, se tiene que incluir el aprendizaje de las técnicas abiertas.Introduction. The ruptured abdominal aortic aneurysm has a mortality of 80% to 90%. There is an open and an endovascular techniques for its repair, which have differences between their benefits and complications. The method of choice for the correction of this anatomical alteration is endovascular; however, it is not the most frequently used, mainly because the vascular surgical team is not available all the time to perform it. Clinical case. A patient in a state of shock of unknown origin was admitted to the emergency room, with abdominal pain of 24 hours of evolution. A contrast-enhanced CT scan demonstrated a ruptured infrarenal abdominal aortic aneurysm. Due to the lack of a vascular surgery team, the patient was rushed for an open surgery that lasted 153 minutes, with an intraoperative bleeding of 1754 cc. He was discharged 12 days after surgery without any complications. Discussion. Endovascular repair of ruptured abdominal aortic aneurysm is the best choice, since it shows greater benefits compared to open repair. However, it is not the most widely used because it requires well-trained personnel in endovascular surgery. Therefore, learning of open techniques must be included in the training of general surgeons

Biliogastrointestinal reconstruction with duodenectomy and pancreas preservation by laparoscopy after open failed coledocoduodenostomy

Las lesiones de la vía biliar y las reconstrucciones biliodigestivas son un reto quirúrgico para el cirujano, además de una situación que exige su máxima habilidad y conocimiento. Presentamos el caso de un paciente con una reconstrucción biliodigestiva por una lesión de vía biliar abierta la cual fue fallida. Se decide llevar a reconstrucción biliodigestiva por laparoscopia, con preservación del páncreas, en un asa con hepatoyeyunostomía y gastroyeyunostomía. Este caso ilustra la posibilidad del manejo con cirugía mínimamente invasiva incluso en los casos más graves; sin embargo, se requiere alta experticia al momento de abordarlo.Bile duct injury and bile duct reconstruction are a surgical challenge for the surgeon, in addition to a situation that demands maximum skill and knowledge. We present a case of a patient with a biliodigestive reconstruction due to an open bile duct injury which was failed, it was decided to take a biliodigestive reconstruction by laparoscopy, with preservation of the pancreas, with hepaticoyejunostomy and gastroyejunostomy. This case illustrates the possibility of handling with minimally invasive surgery even in the most severe cases, however, they require high expertise when addressing it