Aprovechamiento de aguas residuales y residuos del pacifico colombiano para la generación eléctrica

The Colombian Pacific region has 36 municipalities corresponding to areas not interconnected to the National Interconnected System [1], and a population of 1,332,082 inhabitants [2]. The region's electricity supply is made partially from diesel plants with coverage of 6 to 8 hours a day, [3]. Currently, neither solid waste nor wastewater generated has adequate disposal, which generates great environmental and health impacts. The present study estimated the energy potentials that can be obtained from these wastes produced in the region. The calculated theoretical energy potential was 30 MWh / year and the technical energy potential was 20,589 kWh / year, considering an energy conversion efficiency of 50 % and an effective collection of 70%. These potentials cover 5.2% of the total energy demand in the region for 24 hours a day. To solve a total coverage, we can think about the implementation of hybrid systems of distributed generation using the current diesel plants with the supplement of clean energy sources (other biomass residues, water resources or photovoltaic solar systems).La región pacifica colombiana cuenta con 36 municipios correspondientes a zonas no interconectadas al Sistema Interconectado Nacional [1], y una población de 1.332.082 habitantes [2]. El suministro eléctrico de la región se hace de manera parcial a partir de plantas diésel con cubrimiento de 6 a 8 horas diarias, [3] Actualmente, ni los residuos sólidos ni las aguas residuales generadas tienen disposición adecuada, lo que genera impactos ambientales y de salubridad; el presente estudio estimó los potenciales energéticos que pueden obtenerse a partir de estos residuos producidos en la región. El potencial energético teórico calculado fue de 30 MWh/año y el potencial energético técnico, fue de 20.589 kWh/año, al considera una eficiencia de conversión energética de 50% y una recolección efectiva del 70%. Estos potenciales permiten cubrir el 5,2% de la demanda energética total de la región durante 24 horas al día. Para garantizar un cubrimiento total, se pueden pensar en la implementación de sistemas híbridos de generación distribuida usando las plantas diésel actuales con el suplemento de fuentes de energía limpias (otros residuos de biomasa, recursos hídricos o sistemas solares fotovoltaicos)

Eight-and-a-half syndrome: video evidence and updated literature review

The eight-and-a-half syndrome (EHS)—defined by the combination of a seventh cranial nerve palsy and an ipsilateral one-and-a-half syndrome—is a rare brainstem syndrome, which localises to the caudal tegmental region of the pons. We present a case of the EHS secondary to an inflammatory lesion on a previously healthy 26-year-old woman, with a literature review emphasising the relevance of aetiological assessment

Restless legs syndrome in end-stage renal disease patients undergoing hemodialysis

ABSTRACT Restless legs syndrome (RLS) is a frequent complication of hemodialysis that has been associated with poor quality of life and increased risk for complications. Nevertheless, few studies regarding this entity exist in resource-limited settings. Objectives: To determine the prevalence of RLS among Mexican patients on hemodialysis; and compare these patients with a control group of the same population. Methods: We recruited 105 hemodialysis patients. Restless legs syndrome was diagnosed according to the updated criteria set out by the International RLS Study Group. We selected patients who did not meet the criteria, as controls. Results: We found an RLS prevalence of 18%. The RLS patients had a significantly higher prevalence of iron deficiency anemia and uremic pruritus. None of the patients reported RLS symptoms prior to hemodialysis initiation. Conclusions: Restless legs syndrome is common among Mexican patients on hemodialysis. Larger studies are required to address the impact of RLS in hemodialysis patients. Keywords: Restless legs syndrome; renal dialysis; renal insufficiency. RESUMEN El síndrome de piernas inquietas (SPI) es una complicación de la hemodiálisis que se ha asociado con menor calidad de vida y riesgo aumentado de complicaciones. Sin embargo, existen pocos estudios acerca de esta entidad en escenarios de recursos limitados. Objetivos: Determinar la prevalencia de SPI en pacientes mexicanos en hemodiálisis, y comparar las características con un grupo control de la misma población. Métodos: Reclutamos 105 pacientes en hemodiálisis. El SPI se diagnosticó de acuerdo con los criterios actualizados del grupo de estudio internacional del síndrome de piernas inquietas. Seleccionamos a los pacientes que no cumplieron dichos criterios como controles. Resultados: Encontramos una prevalencia de SPI del 18%. Los pacientes con SPI tenían una prevalencia más alta de anemia ferropénica, y prurito urémico. Ninguno de los pacientes reportó síntomas de SPI previo a iniciar la hemodiálisis. Conclusiones: El SPI es frecuente en pacientes mexicanos en hemodiálisis; se requieren estudios más grandes para evaluar el impacto del síndrome en ésta población. Palabras-clave: Síndrome de piernas inquietas; diálisis renal; insuficiencia renal

Lesión renal aguda en trabajadores rurales: Una nefropatía por estrés ambiental

Introducción: la nefropatía mesoamericana es una nefropatía túbulo-intersticial cuya etiología aún se desconoce. Sin embargo, se han descrito casos clínicos similares a esta en otras regiones geográficamente distantes y étnicamente diversas. Aun así, todos tienen un factor común: la intensidad del calor y el trabajo físico rural. Objetivo: estudiar si esta entidad podría presentarse entre trabajadores rurales de una región no mesoamericana con condiciones climáticas y laborales similares, en el campo del Caribe colombiano y considerar cuánto podría pesar en su patogénesis la deshidratación repetitiva. Materiales y metodología: se realizó un estudio observacional, basado en un trabajo de campo en una finca de Sitio Nuevo (Colombia) en 28 voluntarios trabajadores rurales (arrozales), a quienes se les tomó peso, presión arterial y muestras de sangre y orina para medir electrolitos y osmolaridad, en 2 momentos del día (mañana y tarde). Resultados: de los 28 trabajadores jóvenes evaluados, 5 (18 %) presentaron aumento significativo de la creatinina sérica durante el día (0,8±0,15 vs 1,2±0,17, p<0,001). El volumen de agua ingerido por los trabajadores fue muy variable (2.861 ± 1.591 cc). Hubo un aumento significativo en los valores de sodio sérico (p<0,001) y osmolaridad urinaria (p=0,01) entre los valores de la mañana y la tarde en estos 5 pacientes. Conclusión: el dieciocho por ciento de los trabajadores evaluados desarrolló parámetros compatibles con daño renal agudo y deshidratación durante la jornada laboral en el campo del Caribe colombiano.Introduction: Mesoamerican nephropathy is a tubule-interstitial nephropathy whose etiology is still unknown. However, clinical cases like Mesoamerican nephropathy have been described in other geographically distant and ethnically diverse regions. Still, they all have a common factor: the intensity of heat and rural physical labor. Objective: To study whether this entity could occur among rural workers in a non-Mesoamerican region with similar climatic and working conditions, in the Colombian Caribbean countryside, and to consider how much repetitive dehydration could weigh in its pathogenesis. Methodology: An observational study was carried out, based on field work in a farm in Sitio Nuevo (Colombia) with 28 rural worker volunteers (rice fields), who were measured for weight, blood pressure, and blood and urine samples to measure electrolytes and osmolarity, at 2 times of the day (morning and evening). Results: Of the 28 young men workers evaluated, 5 (18 %) presented a significant increase in serum creatinine during the day (0.8±0.15 vs 1.2±0.17, p<0.001). The volume of water ingested by the workers was highly variable (2,861 ± 1,591 cc). There was a significant increase in serum sodium (p<0.001), and urinary osmolarity (p=0.01) values between morning and afternoon values in these 5 patients. Conclusions: Eighteen percent (18 %) of the workers evaluated developed parameters compatible with acute kidney injury and dehydration during the workday in the Colombian Caribbean countryside.Fil: Musso, Carlos. Hospital Italiano; ArgentinaFil: Aroca Martínez, Gustavo. Universidad Simon Bolivar.; Venezuela. Clínica de la Costa; ColombiaFil: Avendaño Echavez, Lil. Clínica de la Costa; ColombiaFil: Cadena Bonfanti, Andrés. Universidad Simon Bolivar.; Venezuela. Clínica de la Costa; ColombiaFil: Castillo, Luis. Clínica de la Costa; Colombia. Universidad Simon Bolivar.; VenezuelaFil: González Torres, Henry. Clínica de la Costa; Colombia. Universidad Simon Bolivar.; VenezuelaFil: Conde, Juan C.. Clínica de la Costa; Colombia. Universidad Simon Bolivar.; VenezuelaFil: Navarro Quiroz, Elkin. Universidad Simon Bolivar.; Venezuela. Clínica de la Costa; ColombiaFil: Peña Vargas, William. Clínica de la Costa; ColombiaFil: Hernandez, Sandra. Clínica de la Costa; ColombiaFil: Velez Verbel, María de los Ángeles. Clínica de la Costa; ColombiaFil: Perez, Rafael. Clínica de la Costa; ColombiaFil: Sierra, Angélica. Clínica de la Costa; ColombiaFil: Rua, Zenen. Clínica de la Costa; ColombiaFil: Palmera, Jorge. Clínica de la Costa; ColombiaFil: Terrasa, Sergio Adrian. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Hospital Italiano; Argentin

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

The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation

XXV Curso Monográfico de Psiquiatría Infantil y la Adolescencia: Tópicos de Psicofarmacología Infantil - 2023

El XXV Curso Monográfico de Psiquiatría Infantil y de la Adolescencia, titulado "Tópicos de Psicofarmacología Infantil," fue un evento destacado en el campo de la salud mental infantil y adolescente. Durante tres días en septiembre de 2023, expertos líderes en la materia se reunieron para explorar a fondo la psicofarmacología en este grupo de edad. El evento, dedicado a la memoria del Dr. Francisco Javier Valencia Granados, comenzó con una ceremonia de inauguración en la que participaron autoridades institucionales. Luego, se sucedieron conferencias magistrales que abordaron una amplia variedad de temas cruciales. Estos incluyeron aspectos fundamentales como la neurobioquímica farmacológica y una introducción a la psicofarmacología. El programa se adentró en cuestiones específicas, como el uso de antipsicóticos en paidopsiquiatría, el abordaje de trastornos del aprendizaje, el tratamiento del suicidio desde una perspectiva psicofarmacológica, y la gestión farmacológica del insomnio en niños. Se exploraron temas especializados, como el tratamiento de la esquizofrenia en pacientes infantiles. El segundo día se centró en trastornos emocionales en niños y adolescentes, destacando el tratamiento del trastorno depresivo, los trastornos ansiosos y el espectro autista. Se presentaron enfoques vanguardistas, como el uso de psicodélicos en adolescentes y las novedades en psicofarmacología, como el dextrometorfano y el bupropión. También se discutió el manejo de la epilepsia y la adicción a los videojuegos. El tercer día se enfocó en el tratamiento farmacológico de trastornos pediátricos específicos, como el trastorno bipolar, el déficit de atención e hiperactividad, la enuresis y encopresis, parasomnias, y el abordaje neuropsiquiátrico en pacientes pediátricos con VIH. Se exploraron también trastornos de la conducta alimentaria y la disforia de género. El evento culminó con una reflexión sobre la salud mental en niños y un emotivo tributo al Dr. Francisco Javier

Clustering COVID-19 ARDS patients through the first days of ICU admission. An analysis of the CIBERESUCICOVID Cohort

Background Acute respiratory distress syndrome (ARDS) can be classified into sub-phenotypes according to different inflammatory/clinical status. Prognostic enrichment was achieved by grouping patients into hypoinflammatory or hyperinflammatory sub-phenotypes, even though the time of analysis may change the classification according to treatment response or disease evolution. We aimed to evaluate when patients can be clustered in more than 1 group, and how they may change the clustering of patients using data of baseline or day 3, and the prognosis of patients according to their evolution by changing or not the cluster.Methods Multicenter, observational prospective, and retrospective study of patients admitted due to ARDS related to COVID-19 infection in Spain. Patients were grouped according to a clustering mixed-type data algorithm (k-prototypes) using continuous and categorical readily available variables at baseline and day 3.Results Of 6205 patients, 3743 (60%) were included in the study. According to silhouette analysis, patients were grouped in two clusters. At baseline, 1402 (37%) patients were included in cluster 1 and 2341(63%) in cluster 2. On day 3, 1557(42%) patients were included in cluster 1 and 2086 (57%) in cluster 2. The patients included in cluster 2 were older and more frequently hypertensive and had a higher prevalence of shock, organ dysfunction, inflammatory biomarkers, and worst respiratory indexes at both time points. The 90-day mortality was higher in cluster 2 at both clustering processes (43.8% [n = 1025] versus 27.3% [n = 383] at baseline, and 49% [n = 1023] versus 20.6% [n = 321] on day 3). Four hundred and fifty-eight (33%) patients clustered in the first group were clustered in the second group on day 3. In contrast, 638 (27%) patients clustered in the second group were clustered in the first group on day 3.Conclusions During the first days, patients can be clustered into two groups and the process of clustering patients may change as they continue to evolve. This means that despite a vast majority of patients remaining in the same cluster, a minority reaching 33% of patients analyzed may be re-categorized into different clusters based on their progress. Such changes can significantly impact their prognosis

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