Measurement of the cosmic ray spectrum above 4×10184{\times}10^{18} eV using inclined events detected with the Pierre Auger Observatory

A measurement of the cosmic-ray spectrum for energies exceeding $4{\times}10^{18}$ eV is presented, which is based on the analysis of showers with zenith angles greater than $60^{\circ}$ detected with the Pierre Auger Observatory between 1 January 2004 and 31 December 2013. The measured spectrum confirms a flux suppression at the highest energies. Above $5.3{\times}10^{18}$ eV, the "ankle", the flux can be described by a power law $E^{-\gamma}$ with index $\gamma=2.70 \pm 0.02 \,\text{(stat)} \pm 0.1\,\text{(sys)}$ followed by a smooth suppression region. For the energy ($E_\text{s}$) at which the spectral flux has fallen to one-half of its extrapolated value in the absence of suppression, we find $E_\text{s}=(5.12\pm0.25\,\text{(stat)}^{+1.0}_{-1.2}\,\text{(sys)}){\times}10^{19}$ eV.Comment: Replaced with published version. Added journal reference and DO

Energy Estimation of Cosmic Rays with the Engineering Radio Array of the Pierre Auger Observatory

The Auger Engineering Radio Array (AERA) is part of the Pierre Auger Observatory and is used to detect the radio emission of cosmic-ray air showers. These observations are compared to the data of the surface detector stations of the Observatory, which provide well-calibrated information on the cosmic-ray energies and arrival directions. The response of the radio stations in the 30 to 80 MHz regime has been thoroughly calibrated to enable the reconstruction of the incoming electric field. For the latter, the energy deposit per area is determined from the radio pulses at each observer position and is interpolated using a two-dimensional function that takes into account signal asymmetries due to interference between the geomagnetic and charge-excess emission components. The spatial integral over the signal distribution gives a direct measurement of the energy transferred from the primary cosmic ray into radio emission in the AERA frequency range. We measure 15.8 MeV of radiation energy for a 1 EeV air shower arriving perpendicularly to the geomagnetic field. This radiation energy -- corrected for geometrical effects -- is used as a cosmic-ray energy estimator. Performing an absolute energy calibration against the surface-detector information, we observe that this radio-energy estimator scales quadratically with the cosmic-ray energy as expected for coherent emission. We find an energy resolution of the radio reconstruction of 22% for the data set and 17% for a high-quality subset containing only events with at least five radio stations with signal.Comment: Replaced with published version. Added journal reference and DO

Measurement of the Radiation Energy in the Radio Signal of Extensive Air Showers as a Universal Estimator of Cosmic-Ray Energy

We measure the energy emitted by extensive air showers in the form of radio emission in the frequency range from 30 to 80 MHz. Exploiting the accurate energy scale of the Pierre Auger Observatory, we obtain a radiation energy of 15.8 \pm 0.7 (stat) \pm 6.7 (sys) MeV for cosmic rays with an energy of 1 EeV arriving perpendicularly to a geomagnetic field of 0.24 G, scaling quadratically with the cosmic-ray energy. A comparison with predictions from state-of-the-art first-principle calculations shows agreement with our measurement. The radiation energy provides direct access to the calorimetric energy in the electromagnetic cascade of extensive air showers. Comparison with our result thus allows the direct calibration of any cosmic-ray radio detector against the well-established energy scale of the Pierre Auger Observatory.Comment: Replaced with published version. Added journal reference and DOI. Supplemental material in the ancillary file

Utilidad de los probióticos en pediatría

Se define como probiótico al suplemento oral o a algún producto alimentario que contiene un número suficiente de microorganismos viables capaces de alterar la microbiota intestinal del huésped y tiene el potencial de efectos benéficos a la salud. El sistema de defensa de la mucosa intestinal es una parte integral de una red inmunorreguladora que incluye la microbiota. A continuación revisaremos la evidencia que existe hasta el momento sobre la utilidad de los probióticos en el ámbito de la prevención y tratamiento de enfermedades en pacientes pediátricos. El hecho de que actualmente no se encuentre evidencia sobre la utilidad de un probiótico en determinada condición clínica no significa que futura investigación clínica no pueda establecer beneficios clínicos significativos. Se han estudiado los probióticos en diarrea aguda infecciosa, diarrea asociada a antibióticos, enfermedad atópica, prevención de enterocolitis necrosante en neonatos de bajo peso al nacer, tratamiento de erradicación para Helicobacter pylori, enfermedad inflamatoria intestinal, síndrome de intestino irritable, dolor abdominal funcional, cólico del lactante, síndrome de intestino corto y enfermedades infecciosas extraintestinales

Hepatopatía crónica en enfermedades reumatológicas

Las enfermedades de la colágena son desórdenes mediados inmunológicamente, caracterizados por compromiso de múltiples órganos. Dentro de éstos pacientes, el incremento de las aminotransferasas es un fenómeno común. No están bien descritas las características del daño ni el signifi cado de la movilización de las aminotransferasas, ya sea en forma transitoria o intermitente, debido a que habitualmente éstos pacientes no son monitoreados desde el punto de vista del funcionamiento hepático y en consecuencia no son completamente estudiados. Se han descrito una variedad de alteraciones hepáticas asociadas a las colagenopatías como la arteritis y congestión hepática, así como también cambios asociados al uso de medicamentos hepatotóxicos, como son el hígado graso e infl amación inespecífi ca. En algunos casos se han asociado a enfermedades hepáticas bien defi nidas como la cirrosis biliar primaria, hiperplasia nodular regenerativa del hígado, obliteración de la vena portal, hepatitis autoinmune e infecciosa por virus B y C. También se han descrito desórdenes vasculares como el síndrome de Budd-Chiari. Aunque las enfermedades reumatológicas son raras en la población general pediátrica, se deberá de sospechar compromiso hepático en todo paciente con enfermedades reumatológicas

Latin American Considerations for Infant and Young Child Formulae

Infant formula is the only acceptable substitute for breastmilk from 0 to 6 months old when human milk cannot be provided in sufficient amounts. Manufacturers have developed options that intend to meet the changing needs of the child aged from six to twelve months (follow-on formulae) and after the age of one year (young child formulae). The international code for marketing breast milk substitute stipulates standards for marketing practices of these products. In Latin America there are local variations of marketing practices. Novel marketing strategies such as advertising through social media and influencers pose new threats for breastfeeding success in Latin America. This review aims to examine variations in local regulations for marketing of infant formulae and to analyze the emerging phenomenon of influencer advertising. We reviewed the local norms for Latin American countries and examined differences and possible gaps. Emerging evidence of influencer marketing was explored. The results indicate that national regulations differ among Latin American countries, particularly with respect to product labelling and the requirement to use a local native language, highlighting the cost of the product, and different regulations prohibiting certain messages and illustrations. Regarding new marketing strategies, there is limited evidence on advertising infant formula through social media influencers, where different categories of marketing strategies can be described. More transparent reporting of social marketing by formula providers and more independent research on novel marketing strategies are needed

Laminitis en una yegua Pura Raza Española en Tabasco, México: reporte de caso

Laminitis is a serious, highly prevalent disease, recognized as one of the most important clinical syndromes in equines. The present study describes the case of a five-year-old Pura Raza Española mare diagnosed with bilateral laminitis at approximately three months of age. The animal refused to walk, lying down all the time. The degree of claudication, according to the Obel scale, was graded as 5; she also had an altered palmar digital pulse. He was prescribed 30 days of anti-inflammatory therapy with 1.1mg/kg intravenous (IV) of meglumine flunixin every 24 h, accompanied by omeprazole 2 mg/kg orally (O.V.). Additionally, hoof trimming and corrective shoeing were recommended. After eight months of treatment, the mare showed a remarkable improvement and gain in body condition, and a gestation was achieved. The anti-inflammatory treatment, hoof trimming and corrective shoeing favored the growth and hardness of the hoof, being successful in the treatment of laminitisLa laminitis es una enfermedad grave, de alta prevalencia, reconocida como uno de los síndromes clínicos más importantes en equinos. En el presente estudio se describe el caso de una yegua Pura Raza Española de cinco años de edad, con diagnóstico de laminitis bilateral de aproximadamente tres meses. El animal se reusaba a caminar, manteniéndose echado todo el tiempo. El grado de claudicación, según la escala de Obel, se calificó de 5; asimismo, presentaba pulso palmar digital alterado. Se receto terapia de 30 días con antinflamatorios 1.1mg/kg intra venosa (IV) de flunixin de meglumine cada 24 h, acompañado de omeprazol 2 mg/kg vía oral (VO). Adicionalmente, se recomendó recorte de casco y herrajes correctivos. Después de los ocho meses de tratamiento, la yegua presentó una notable mejoría y ganancia de condición corporal, además, se logró una gestación. El tratamiento antiinflamatorio, recorte de casco y herrajes correctivos, favorecieron el crecimiento y dureza del casco, teniendo éxito en el tratamiento de laminiti

Guidelines for the diagnosis and treatment of extrahepatic portal vein obstruction (EHPVO) in children

Introduction. Extrahepatic portal vein obstruction is an important cause of portal hypertension among children. The etiology is heterogeneous and there are few evidences related to the optimal treatment. Aim and methods. To establish guidelines for the diagnosis and treatment of EHPVO in children, a group of gastroenterologists and pediatric surgery experts reviewed and analyzed data reported in the literature and issued evidence-based recommendations.Results. Pediatric EHPVO is idiopathic in most of the cases. Digestive hemorrhage and/or hypersplenism are the main symptoms. Doppler ultrasound is a non-invasive technique with a high degree of accuracy for the diagnosis. Morbidity is related to variceal bleeding, recurrent thrombosis, portal biliopathy and hypersplenism. Endoscopic therapy is effective in controlling acute variceal hemorrhage and it seems that vasoactive drug therapy can be helpful. For primary prophylaxis of variceal bleeding, there are insufficient data for the use of beta blockers or endoscopic therapy. For secondary prophylaxis, sclerotherapy or variceal band ligation is effective; there is scare evidence to recommend beta-blockers. Surgery shunt is indicated in children with variceal bleeding who fail endoscopic therapy and for symptomatic hypersplenism; spleno-renal or meso-ilio-cava shunting is the alternative when Mesorex bypass is not feasible due to anatomic problems or in centers with no experience.Conclusions. Prospective control studies are required for a better knowledge of the natural history of EHPVO, etiology identification including prothrombotic states, efficacy of beta-blockers and comparison with endoscopic therapy on primary and secondary prophylaxis

Estudio multicéntrico sobre la epidemiologia de la Esofagitis Eosinofílica Pediátrica en América Latina

Objetivo: Evaluar las características epidemiológicas de un grupo depacientes pediátricos con esofagitis eosinofílica (EEo) y lasmodalidades de tratamiento empleadas en Latinoamérica. Pacientesy métodos: Estudio multicéntrico, observacional, transversal. Seaplicó una encuesta a 36 Centros de Gastroenterología y EndoscopiaPediátrica de 10 países latinoamericanos con la finalidad de obtenerinformación socio-demográfica y datos sobre el tratamiento utilizadopara el manejo de los casos evaluados durante el periodo 2014-2016. Resultados: 372 casos de EEo pediátrica fueron evaluadosdurante el periodo 2014-2016 y 108 casos (29%) correspondieron altrimestre Abril-Junio 2016. 46,72% de los casos pertenecían algrupo de edad escolar y 71,8% consultaron por disfagia. 87,2% delos pacientes fueron manejados con dieta, 55,3% esteroidesdeglutidos (12,8% en monoterapia) y 6% recibió montelukast. Nohubo reporte de pacientes en terapia con agentes biológicos.Conclusiones: los resultados sugieren un predominio del sexomasculino con una mayor incidencia de la enfermedad en la edadescolar y la adolescencia. Las manifestaciones clínicas másfrecuentes son disfagia, vómitos y síntomas de reflujogastroesofágico. El tratamiento más indicado por los especialistas enAmérica Latina es la dieta seguido del uso de esteroides deglutidos.Los IBP también son ampliamente utilizados como terapiacoadyuvante. Un estudio de prevalencia a nivel continental esnecesario para evaluar el comportamiento de la enfermedad endiferentes regiones de América Latina.&nbsp