ABSTRACT Introduction: This article summarizes the clinical practice guideline (CPG) for the management of early-stage cervical cancer (IA1, IA2, IB1, IB2 o IIA1) in the Social Security of Peru (EsSalud). Objective: To provide clinical recommendations based on evidence for the management of early-stage cervical cancer in EsSalud. Materials and methods: A CPG for the management of early-stage cervical cancer in EsSalud was developed. To this end, a guideline development group (local GDG) was established, including medical specialists and methodologists. The local GDG formulated 8 clinical questions to be answered by this CPG. Systematic searches of systematic reviews and -when it was considered pertinent- primary studies were conducted in Pubmed, Embase y CENTRAL during 2017 - 2018. The evidence to answer each of the posed clinical questions was selected. The quality of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work meetings, the local GDG used the GRADE methodology to review the evidence and formulate the recommendations, points of good clinical practice, and the flowchart of management. Finally, the CPG was approved with Resolution No. N 27-IETSI-ESSALUD-2020. Results: This CPG addressed 8 clinical questions on the management of early-stage cervical cancer (IA1, IA2, IB1, IB2 o IIA1). Based on these questions, 10 recommendations (2 strong recommendations and 8 weak recommendations), 7 points of good clinical practice, and 4 flowcharts were formulated. Conclusion: This article summarizes the methodology and evidence-based conclusions from the CPG for the management of early-stage cervical cancer in EsSalud.

RESUMEN Introducción: Este artículo resume la guía de práctica clínica (GPC) para el manejo de cáncer de cuello uterino estadios tempranos (IA1, IA2, IB1, IB2 o IIA1) en el Seguro Social del Perú (EsSalud). Objetivo: Proveer recomendaciones clínicas basadas en evidencia para el manejo de cáncer de cuello uterino estadios tempranos en EsSalud. Materiales y métodos: Se conformó un grupo elaborador de la guía (GEG) que incluyó médicos especialistas y metodólogos. El GEG formuló 8 preguntas clínicas a ser respondidas por la presente GPC. Se realizó búsquedas sistemáticas de revisiones sistemáticas y -cuando fue considerado pertinente- estudios primarios en Pubmed, Embase y CENTRAL durante el 2017 - 2018. Se seleccionó la evidencia para responder cada una de las preguntas clínicas planteadas. La certeza de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). En reuniones de trabajo periódicas, el GEG usó la metodología GRADE para revisar la evidencia y formular las recomendaciones, los puntos de buenas prácticas clínicas y los flujogramas de manejo. Finalmente, la GPC fue aprobada con Resolución N 27-IETSI-ESSALUD-2020. Resultados: La presente GPC abordó 8 preguntas clínicas abordando el manejo del cáncer de cuello uterino en estadios tempranos. En base a dichas preguntas se formularon 10 recomendaciones (2 recomendaciones fuertes y 8 recomendaciones condicionales), 7 puntos de buena práctica clínica, y 4 flujogramas. Conclusión: El presente artículo resume la metodología y las conclusiones basadas en evidencias de la GPC para el manejo del cáncer de cuello uterino en estadios tempranos en EsSalud.

ABSTRACT Introduction: the Maternal and Child Program is a very sensitive program in the health sector since it declares comprehensive care for pregnant women, mothers, children and adolescents. Fetal mortality rates in children under one year of age and low birth weight are indicators that reflect the living conditions of women; the underlying morbidity and quality of life of a society. Objective: to determine the behavior of these two indicators in the municipality of Campechuela during the years 1980 to 2018, a period of 39 years. Methods: a retrospective, descriptive, observational study was carried out. The universe included all the births in Campechuela in the study years, deaths in children under 1 year of age, fetal deaths and low birth weight. The results expressed in absolute frequencies, relative frequencies and rates were represented. Through the use of descriptive statistics techniques, Results: the birth rate has decreased throughout the period under study with variations over time, the infant mortality rate has had a considerable decrease, not being the case, the low weight that has fluctuated, and fetal deaths have behaved in a different way. In an unfavorable way, the results allow us to assess that it is necessary to further intensify the control and monitoring of this prioritized group, and to increase the investigation of the risk factors that lead to these unfavorable indicators. Conclusions: the indicators of the Maternal and Child Program measure the quality of life of a nation, despite all the strategies taken by the Ministry of Public Health there are some results that must be reversed, such as fetal deaths, so more work is required from Primary Health Care, emphasizing promotion and prevention, working with intention the protocols of action in said program.

RESUMO Introdução: o Programa Materno-Infantil é um programa muito sensível no setor saúde, pois declara o atendimento integral a gestantes, mães, crianças e adolescentes. As taxas de mortalidade fetal em menores de um ano e o baixo peso ao nascer são indicadores que refletem as condições de vida das mulheres; a morbidade subjacente e a qualidade de vida de uma sociedade. Objetivo: determinar o comportamento desses dois indicadores no município de Campechuela durante os anos de 1980 a 2018, um período de 39 anos. Métodos: foi realizado um estudo retrospectivo, descritivo e observacional. O universo incluiu todos os partos em Campechuela nos anos de estudo, óbitos em crianças menores de 1 ano, óbitos fetais e baixo peso ao nascer. Os resultados expressos em frequências absolutas, frequências relativas e taxas foram representados. Por meio do uso de técnicas de estatística descritiva, Resultados: a taxa de natalidade diminuiuao longo do período de estudo com variações ao longo do tempo, a taxa de mortalidade infantil diminuiu consideravelmente, não sendo o caso, o baixo peso que tem flutuado, e os óbitos fetais têm se comportado de forma diferente. De forma desfavorável, os resultados permitem avaliar que é necessário intensificar ainda mais o controle e monitoramento desse grupo priorizado, e aumentar a investigação dos fatores de risco que levam a esses indicadores desfavoráveis. Conclusões: os indicadores do Programa Materno Infantil medem a qualidade de vida de uma nação, apesar de todas as estratégias do Ministério da Saúde Pública existem alguns resultados que devem ser revertidos, como os óbitos fetais, por isso é necessário mais trabalho Atenção Primária à Saúde, com ênfase na promoção e prevenção, trabalhando intencionalmente os protocolos de ação desse programa.

RESUMEN Introducción: el Programa Materno Infantil es un programa muy sensible en el sector de la salud ya que declara la atención integral tanto a la embarazada, a la madre, al niño y al adolescente. Las tasas de mortalidad fetal, en menores de un año y el bajo peso al nacer son indicadores que reflejan las condiciones de vida de la mujer; la morbilidad subyacente y la calidad de vida de una sociedad. Objetivo: determinar el comportamiento de estos dos indicadores en el municipio de Campechuela durante los años 1980 a 2018, período de 39 años. Métodos: se realizó un estudio observacional descriptivo, retrospectivo. El universo comprendió todos los nacimientos en Campechuela en los años de estudio, las muertes en menores de 1 año, las muertes fetales y el bajo peso al nacer. Se representaron los resultados expresados en frecuencias absolutas, frecuencias relativas y tasas. Mediante el empleo de las técnicas de la estadística descriptiva, Resultados: la natalidad ha disminuido a lo largo del período en estudio con variaciones en el tiempo, la tasa de mortalidad infantil ha tenido una disminución considerable, no siendo así, el bajo peso que han tenido fluctuaciones, y las defunciones fetales se ha comportado de forma desfavorable, los resultados permiten valorar que hay que intensificar aún más el control y seguimiento a este grupo priorizado, e incrementar las pesquisa de los factores de riesgo que conllevan a estos indicadores no favorables. Conclusiones: los indicadores del Programa Materno Infantil miden la calidad de vida de una nación, a pesar de todas las estrategias tomadas por el Ministerio de Salud Pública existen algunos resultados que hay que revertir como las muertes fetales, por lo que se requiere de más trabajo desde la Atención Primaria de Salud haciendo énfasis en la promoción y la prevención, trabajar con intención los protocolos de actuación en dicho programa.

Resumen Objetivos: analizar, evaluar y describir la utilidad del muestreo de senos petrosos para diagnóstico del síndrome de Cushing de origen central. Material y métodos: se analizaron los aspectos técnicos y resultados del muestreo bilateral venoso de senos petrosos, desde el 1° de enero de 2012 a 31 de diciembre de 2018 en el Hospital Universitario San Vicente de Paúl en Medellín, Colombia. Resultados: el promedio de edad fue 43.3 años con un rango de edad desde los 19 hasta los 69 años. La lateralidad pudo ser demostrada en 68.2% de los casos con una tendencia a la localización en el lado izquierdo en 53.3%. El origen central de producción de ACTH logró ser demostrado en 95.4% de los casos, con una relación central/periferia basal promedio de 21.7 y postestimulación de 70.8. Todas las muestras a los 3, 5 y 10 minutos fueron confirmatorias tras la estimulación. Conclusión: en nuestro estudio retrospectivo el cateterismo de senos petrosos confirmó la fuente central de producción de ACTH por laboratorio en un alto porcentaje de pacientes sin ninguna complicación inmediata.

Abstract Objectives: to analyze, evaluate and describe the usefulness of petrosal sinus sampling for diagnosing central Cushing's syndrome. Materials and methods: the technical aspects and results of bilateral venous sampling of the petrosal sinuses at the Hospital Universitario San Vicente de Paul in Medellín, Colombia, from January 1, 2012 to December 31, 2018, were analyzed. Results: the average age was 43.3 years, with a range from 19 to 69 years. Laterality could be shown in 68.2% of cases, with a tendency to be located on the left in 53.3%. The central source of ACTH production could be shown in 95.4% of cases, with a basal average central/peripheral ratio of 21.7, and 70.8 after stimulation. All samples at 3, 5 and 10 minutes were confirmatory following stimulation. Conclusion: in our retrospective study, petrosal sinus catheterization provided laboratory confirmation of the central source of ACTH production in a high percentage of patients, with no immediate complications.

SUMMARY The clinical care of patients with epilepsy (EP) associated with intellectual disability (ID) represents a challenge for the stomatologist because of its difficult behavioral management. These patients will require alternatives to carry out a successful dental treatment. General anesthesia (AG), is an alternative to the failure of behavioral management techniques, existence of systemic commitment that warrants it, specialized medical access distant from the place of residence or due to particular circumstances of each case. We present the case of a 27-year-old male patient, with a diagnosis of EP associated with ID, of difficult behavioral management treated under general anesthesia in the Special Patients Stomatology service of the Peruvian University Cayetano Heredia. Objective: This article seeks to present a review of the literature and Comprehensive Dental Treatment under general anesthesia of a patient with Epilepsy associated with moderate Intellectual Disability. Conclusions: Patients with these underlying pathologies are prone to present deterioration of the oral organ, so they will require constant stomatological benefits. Due to the low collaboration of this type of patients, the AG should be considered as an alternative to provide the TOI in a single operative act.

RESUMEN La atención clínica del paciente portador de epilepsia (EP) asociada a discapacidad intelectual (DI), representa un reto para el estomatólogo por su difícil manejo conductual. Estos pacientes requerirán de alternativas para poder llevar a cabo un tratamiento odontológico exitoso. La anestesia general (AG), es una alternativa ante la falla de las técnicas de manejo conductual, existencia de compromiso sistémico que lo amerite, acceso médico especializado distante al lugar de residencia o por circunstancias particulares de cada caso. Se presenta el caso de un paciente varón de 27 años, con diagnóstico de EP asociada a DI, de difícil manejo conductual atendido bajo anestesia general en el servicio de Estomatología de Pacientes Especiales de la Universidad Peruana Cayetano Heredia. Objetivo : Este artículo busca presentar una revisión de la literatura y el Tratamiento Odontológico Integral bajo anestesia general de un paciente con de Epilepsia asociada a Discapacidad Intelectual moderada. Conclusiones: Los pacientes con estas patologías de fondo son propensos a presentar deterioro del órgano bucal, por lo que requerirán prestaciones estomatológicas constantes. Por la poca colaboración de este tipo de pacientes, se debe considerar a la AG como alternativa para brindar el TOI en un solo acto operatorio.

ABSTRACT We report the case of a pregnant woman referred to our hospital for suspected partial hydatidiform mole. Ultrasound images showed a normal fetus attached to a small placenta adjacent to a honeycomb-like tumor mass. Amniocentesis revealed a normal karyotype. Due to β-hCG values greater than 800 000 IU and a mass growth of 11% by magnetic resonance imaging, an ultrasound-guided percutaneous tumor biopsy was performed; it ruled out the possibility of choriocarcinoma. The patient had symptoms of hyperthyroidism that required treatment; when the β-HCG levels exceeded one million IU, a course of chemotherapy was prescribed. At 29 weeks, the patient started labor; a cesarean hysterectomy was performed, obtaining a live newborn with Apgar 5 and 7. The pathology report informed the placental mass as an invasive mole. According to our literature search, this is the first case report where an invasive mole coexisted with a healthy fetus. We highlight the importance of using all diagnostic and management tools necessary to achieve fetal viability, without increasing the maternal risk of complications.

RESUMEN Comunicamos el caso de una gestante referida por sospecha de mola parcial. Las imágenes ultrasonográficas mostraban un feto normal unido a placenta pequeña, adyacente a una masa tumoral en ‘panal de abejas’. Se realizó amniocentesis, con resultado de cariotipo normal. Debido a valores de hCG-β superiores a 800 000 UI y crecimiento de la masa de 11% a la resonancia magnética, se realizó biopsia tumoral percutánea guiada por ecografía, la cual alejó la posibilidad de coriocarcinoma. La paciente hizo síntomas de hipertiroidismo que requirieron tratamiento y, al superar la hCG-β el millón de unidades, se decidió dar un curso de quimioterapia. A las 29 semanas inició trabajo de parto; se realizó cesárea-histerectomía, obteniéndose recién nacido vivo, con Apgar 5 y 7. Al examen anatomopatológico, la masa placentaria resultó mola invasiva. De acuerdo con nuestra búsqueda, se comunica el primer caso en la literatura de coexistencia de mola invasiva con feto sano, y resaltamos la importancia de usar las herramientas diagnósticas y de manejo necesarias para lograr la viabilidad del producto de la concepción, sin incrementar el riesgo materno.

ABSTRACT Introduction: dental injuries represent one of the most serious oral health problems in children and adolescents. They are rare in the first year of life and increase when the child begins to walk and run. Patients with Down syndrome have psycho-motor and physical characteristics that make them more susceptible to traumatic injuries in the oral cavity. Case report: 16-year-old male patient with Down syndrome who suffered an uncomplicated crown fracture, he underwent to an esthetic and restorative treatment with a direct layered composite restoration technique. This procedure allowed the achievement of an aesthetic result with a very natural finish, recovering the size of the dental piece without the need to carve it. Conclusions: a successful conventional treatment of an uncomplicated crown fracture was achieved in a patient with Down syndrome having a favorable prognosis, taking into account that, in Dentistry specialty as in any other branch of medical sciences, it is necessary to assess the particularities of each individual and to link other specialties such as Psychology and Medicine in the comprehensive treatment of these patients, in order to reach quality care.

RESUMEN Introducción: los traumatismos dentales representan uno de los más serios problemas de salud bucal en niños y adolescentes. Son poco frecuentes en el primer año de vida y aumentan cuando el niño comienza a caminar y correr. Los pacientes con síndrome de Down presentan características psico-motoras y físicas que le confieren una mayor susceptibilidad para sufrir lesiones traumáticas en la cavidad bucal. Presentación del caso: paciente con síndrome de Down de 16 años de edad, masculino, que sufrió una fractura no complicada de corona, para lo cual recibió tratamiento estético y restaurador con técnica directa de restauración con composite por capas. Este proceder permitió conseguir un resultado estético con un acabado muy natural, recobrando el tamaño de la pieza dental sin que fuera necesario su tallado. Conclusiones: se consiguió realizar un tratamiento convencional exitoso a una fractura no complicada de corona en un paciente con síndrome de Down cuyo pronóstico es favorable, teniendo en cuenta que, en Estomatología como en cualquier otra rama de las ciencias médicas, es preciso valorar las particularidades de cada individuo y vincular otras especialidades como la Psicología y la Medicina en el tratamiento integral, para alcanzar una atención de calidad.

Abstract The advancement of digital technologies in the last decade has motivated analysis regarding a new era in capitalism. Most of these analyzes, however, are narrow in scope, as they only address isolated technologies. In addition, they are short-lived, as they do not recognize the links between these digital technologies and the preceding block of information and communication technologies. We propose a broader scope and longer timeframe to fill these gaps. We conceptualized the Digital Technological System (2010-2020) as the cluster of artificial intelligence, cloud computing and Big Data. This cluster generates three innovation streams: digitization, algorithmization and platformization. The autocatalytic relationships between the technologies of this cluster and between previous ICT systems indicate historical continuity. However, the phenomenon of data commoditization that unfolds from this system is configured as a major historical discontinuity

Resumo O avanço das tecnologias digitais na última década motivou análises a respeito de uma nova era no capitalismo. A maioria delas, contudo, é estreita em escopo, por abordar apenas tecnologias isoladas. Além disso, são curtas em temporalidade, por não reconhecerem os vínculos destas tecnologias digitais com o bloco de tecnologias de informação e comunicação precedentes. Propõe-se no presente trabalho uma visão de escopo mais amplo e temporalidade mais extensa para preencher estas lacunas. Conceituou-se o Sistema Tecnológico Digital (2010-2020) como o cluster de inteligência artificial, computação em nuvem e Big Data. Este cluster gera três fluxos de inovações: digitização, algoritmização e plataformização. As relações autocatalíticas entre as tecnologias deste cluster e entre sistemas prévios de TIC indicam continuidade histórica. No entanto, o fenômeno da comoditização de dados que se desdobra deste sistema configura-se como descontinuidade histórica de monta.

Resumen El dolor de espalda es uno de los síntomas más frecuentes en las instituciones de salud. La neurocirugía desempeña un papel importante en el diagnóstico y tratamiento del dolor de espalda que a menudo resulta en intervenciones quirúrgicas que incluyen la fusión intersomática lumbar entre otras alternativas terapéuticas. Sin embargo, la funcionalidad y los índices de calidad de vida esperados no siempre demuestran una mejora completa, a pesar del tratamiento médico y quirúrgico adecuado. Por lo tanto, los autores realizaron una revisión de la literatura no sistemática para evaluar los elementos más importantes involucrados en las evaluaciones diagnósticas que incluyen: anatomía lumbosacra, procesos patológicos de la columna vertebral que causan dolor de espalda e indicaciones de fusión intersomática lumbar. Finalmente, el papel relevante que tienen los parámetros espinopélvicos en un adecuado planeamiento quirúrgico. Esta revisión de la literatura no sistemática tiene como objetivo establecer la evaluación más contribuyente de los factores espinopélvicos antes de la cirugía para mejorar la selección de pacientes que se someten a tratamiento quirúrgico y, por lo tanto, mejorar su funcionalidad y los índices de calidad de vida.

Abstract Back pain is one of the most frequent presenting symptoms in healthcare institutions. Neurosurgery plays a major role on diagnosis and treatment of back pain that often results in surgical interventions that includes lumbar interbody fusion among other therapeutic alternatives. Nevertheless, functionality and expected quality of life indexes do not always demonstrate full improvement despite adequate medical and surgical treatment. Therefore, the authors made a non-systematic literature review in order to assess the most important elements involved on diagnostic assessments that include: lumbosacral anatomy, spine pathological processes that result in back pain, indications for lumbar interbody fusion and finally, the relevant part that spinopelvic balance parameters plays for adequate planning for surgery treatment. This non-systematic literature review aims to establish the most contributing assessment spinopelvic factors prior surgery in order to improve selection of patients that undergo surgical treatment and therefore, improve their functionality and quality of life indexes.

RESUMEN INTRODUCCIÓN: El manejo endovascular de la estenosis de la arteria vertebral en pacientes con infarto cerebral recurrente continúa siendo un tema con múltiples lagunas de conocimiento debido a la poca evidencia científica con la que se cuenta en la actualidad. CASOS CLÍNICOS: Se informan dos casos típicos de estenosis vertebral y recurrencia de infarto cerebral cerebral manejados con dispositivos endovasculares alternativos a los utilizados en la actualidad (stent balón expandible medicado con zotarolimus), con desenlaces clínicos e imagenológicos satisfactorios. Se describe la técnica usada, la condición clínica y se ilustran los resultados angiográficos. CONCLUSIÓN: A la luz de las nuevas generaciones de dispositivos y técnicas neuroendovasculares, consideramos que debe realizarse una evaluación cuidadosa e individual de los pacientes con recurrencia de enfermedad cerebrovascular y estenosis vertebral, a pesar de un manejo médico optimizado. Aún se requieren estudios conrolados que permitan la uniformidad futura en la selección de pacientes y la toma de decisiones.

SUMMARY INTRODUCTION: Endovascular management of vertebral artery stenosis in patients with recurrent cerebral infarction remains a topic with multiple gaps in knowledge because of poor scientific evidence is available today. REPORT OF CASES: Here are reported two typical cases of cerebral infarction recurrence due to vertebral artery stenosis managed with new endovascular devices (balloon-expandable-stent medicated with zotaroli-mus), with satisfactory clinical and neuroimaging outcomes. Herein it is described the technique used and the angiographic findings are illustrated. CONCLUSION: In light of new devices and neurointerventional techniques, we consider that it should be done a careful and individual evaluation of patients with vertebral stenosis and stroke recurrence despite an optimized medical management. It is still required more studies that allow future consistency in the selection of patients and decision making.

Abstract: Data on the biology of G. longleyi and G. neglecta collected in the Colombian Caribbean is provided. Four research cruises were developed (August and December 2009, and March and May 2010) in a 100-550 m depth range using trawl nets. Two hundred and sixty-nine organisms of G. longleyi showed a 54.41 - 123.77 mm Total Length range, with a mean of 82.54 ± 15.41 mm LT. Cephalotoracic length varied between 11.34 - 32.84 mm and registered a mean of 19.27 ± 5.16 mm. Size range of 493 organisms of G. neglecta was found between 57.84 - 119.09 mm LT with a 71.97 ± 8.00 mm mean and a 12.24 - 30.93 mm LC range (15.70 ± 2.40 mm mean). Sex ratio was 6:3 females/male for G. longleyi whereas in G. neglecta was 15:1. The higher values of biomass for G. longleyi were distributed in the southern area, in front of the Gulf of Morrosquillo and Cartagena, while the higher biomass values for G. neglecta were distributed in the northern zone, toward north of Santa Marta. Both species showed a distinct geographic and depth distribution pattern that suggest a differential use of the environmental conditions.

Resumen: Se aporta información de Glyphocrangon longleyi y Glyphocrangon neglecta recolectadas en el Caribe colombiano. Se realizaron 4 campañas de investigación (agosto y diciembre del 2009 y marzo y mayo 2010) entre 100 y 550 metros de profundidad. Mediante redes de arrastre se recolectaron 269 individuos de G. longleyi entre 54.41 y 123.77 mm de longitud total, (82.54 ± 15.41 mm LT) y 11.34-32.84 mm de longitud del cefalotórax (19.27 ± 5.16 mm LC). Para G. neglecta se registraron 493 individuos con un rango de 57.84 y 119.09 mm LT (71.97 ± 8.00 mm) y de 12.24 y 30.93mm LC (15.70 ± 2.40 mm). La proporción sexual de G. longleyi fue de 6:3 hembras: machos, mientras que para G. neglecta fue 15:1. Los valores altos de biomasa para G. longleyi estuvieron distribuidos en la zona sur, entre el golfo de Morrosquillo y Cartagena, mientras que los valores altos de biomasa para G. neglecta estuvieron distribuidos en la zona norte, hacia el norte de Santa Marta. Las 2 especies muestran un patrón de distribución geográfico y batimétrico distinto indicativo del aprovechamiento diferencial del gradiente de condiciones ambientales.

ABSTRACT This work presents results of objective measurements of vicuña fiber obtained from wild animals and community management in Jujuy Province, Argentina, from 2014 to 2015. The aim of this paper is to provide technical information to improve the method of shearing and fiber classification, and also describe the quality attributes of the vicuña fiber in this geographic region. Mean fiber diameter (MFD) and staple length (SL) were measured on three different sites of fleece. The influence of the animal sex, the method of shearing and the site of fleece were also studied. Results indicate that sex has not significant effect of measured parameters, although the sampling site of fleece has affected these fiber caracteristics. The method of shearing may be a significant contributor to staple length variation

RESUMEN Este trabajo reúne datos objetivos que permiten caracterizar a la fibra de vicuña proveniente de esquilas comunitarias en silvestría, realizadas los años 2014 y 2015 en la provincia de Jujuy, Argentina. El objetivo del trabajo es aportar criterios técnicos para la mejora del método de esquila y clasificación de la fibra, así como también, indagar sobre los atributos de calidad particulares que tiene la fibra en esta región geográfica. Los principales parámetros medidos fueron el diámetro medio de las fibras (DMF) y la longitud de mecha (LM). Sobre estas variables, se estudió la influencia del sexo del animal, del método de esquila (esquila a tijera o a máquina eléxtrica) y de la región del vellón de donde se extrajo la muestra (costilla, lomo o bordel). Se encontraron diferencias estadísticamente significativas entre las diferentes regiones del vellón y no según el sexo del animal. El método de esquila influyó sobre el valor de longitud de mecha

Field surveys were carried out to investigate the surface jet flows and the resulting circulation patterns generated by diffused aeration in a shallow lake. In conrast to previous studies, the experimental conditions included point-source bubble plumes with very high air flow rates (100-400 L/min) relative to the shallow water depth (1.5 m). The results indicate that the surface jet velocity can be described by linear profiles. The decay of this velocity with distance displayed a similar behaviour to that reported in the literature, but the surface jet spread much faster under the present conditions. Combining our results with published data allowed for the generation of dimensionless correlations for the velocity and depth of the surface jet. A good agreement between the total circulation flow rates predicted by using the proposed correlations and integral modelling was also obtained. Lastly, a simple returning flow model was proposed to describe the circulation flow patterns induced by the bubble plumes. The results were also applied to assess the impact of circulation on vertical algae migration, which is important for water quality management.

Resumen Introducción: La enfermedad asociada a Clostridium difficile es la principal causa de diarrea infecciosa adquirida en el hospital; su creciente incidencia, las menores tasas de respuesta al tratamiento inicial y la mayor tasa de recaídas han incrementado la carga de la enfermedad. Objetivo: Determinar las características clínicas de los pacientes hospitalizados con enfermedad asociada a C. difficile. Materiales y métodos: Se hizo un estudio de casos anidado en una cohorte. Se revisaron las historias clínicas de pacientes con diarrea iniciada durante su hospitalización a quienes se les había practicado la prueba de detección de la toxina A-B de C. difficile, entre febrero de 2010 y febrero de 2012. Se definió como caso al paciente hospitalizado con diarrea y prueba de Enzyme Linked Fluorescent Assay (ELFA) positiva para la toxina y, como control, a aquel con resultado negativo para la toxina. Se recolectaron los datos demográficos y clínicos, así como la información sobre los factores asociados, la estancia hospitalaria, el tratamiento y las complicaciones. Resultados: Durante el periodo de seguimiento se recolectaron datos de 123 pacientes, de los cuales 30 fueron positivos para la toxina. La edad media en la población de estudio fue de 49 años y el 60 % correspondía a hombres. Los síntomas predominantes fueron el dolor abdominal (35 %) y la fiebre (34 %). Las principales complicaciones fueron la alteración electrolítica y la sepsis grave asociada con disfunción renal. La mortalidad total fue de 13 % y los factores independientes asociados con la aparición de la infección fueron el uso de inhibidores de la bomba de protones y la cirugía gastrointestinal previa. Conclusiones: El uso de inhibidores de la bomba de protonesy la cirugía gastrointestinal previa fueron factores asociados con la infección por C. difficile.

Abstract Introduction: Clostridium difficile infection is the leading cause of nosocomial infectious diarrhea. The increasing incidence added to a lower rate of response to the initial treatment and higher rates of relapse has generated a higher burden of the disease. Objective: To determine the clinical characteristics of hospitalized patients with C. difficile infection. Materials and methods: We made a nested case-cohort study. We reviewed medical records of the patients with nosocomial diarrhea for whom an assay for toxin A-B of C. difficile had been requested from February, 2010, to February, 2012. We defined case as a patient with diarrhea and a positive assay for the toxin, and control as those patients with a negative assay for the toxin. We collected data on demographic and clinical characteristics, risk factors, hospital length of stay, treatment, and complications. Results: We collected data from 123 patients during the follow-up period, 30 of whom were positive for the toxin. Mean age in the study population was 49 years and 60% were men. The main symptoms were abdominal pain (35%) and fever (34%). The principal complications were electrolytic alteration and severe sepsis with secondary acute kidney injury. Mortality was 13% and independent factors associated to the appearance of the infection were the use of proton pump inhibitors and previous gastrointestinal tract surgery. Conclusions: The use of proton pump inhibitors and previous gastrointestinal tract surgery were factors associated to C. difficile infection.

Prior to 2007, efforts to monitor and conserve hawksbill turtles (Eretmochelys imbricata) in the eastern Pacific Ocean were opportunistic and records were virtually non-existent. The first abundance estimates were published in 2010, but contained limited data on the species. Ongoing research since that time has led to the identification of several rookeries, including sites containing large proportions of the overall hawksbill nesting currently known to occur in the region. Monitoring projects were established at several sites and have since provided substantial nesting data on the species. Here we summarize data collected between 1983 and March 2016 from all sites (n = 9) confirmed to host >10 nests in any given season to provide an update on hawksbill nesting in the eastern Pacific. We documented a total of 3,508 hawksbill nests, 265,024 hatchlings and 528 individual nesting females in the region. The vast majority of these records (99.4%, 99.9% and 99.6%, respectively) were generated subsequent to 2007, coinciding with the discovery of eight of the nine rookeries included in this study and the organization of monitoring efforts at those sites, which led to the increased documentation conferred here. Our findings should not be misconstrued as increases in actual nesting or signs of recovery, which could diminish the ongoing need for conservation actions, but rather as optimism, that there is still an opportunity to restore the species in the eastern Pacific. The top three sites in terms of average annual number of nests were Estero Padre Ramos (Nicaragua; 213.2 ± 47.6 nests), Bahia de Jiquilisco (El Salvador; 168.5 ± 46.7 nests) and Aserradores (Nicaragua; 100.0 ± 24.0 nests), and all three sites are located in mangrove estuaries in Central America, highlighting the importance of these rookeries/habitats for the survival and recovery of hawksbills in the region. The remaining six sites received between 6.9 ± 7.3 nests (Costa Careyes, Mexico) and 59.3 ± 17.7 nests (Los Cobanos, El Salvador) annually. By integrating data collected on nesting hawksbills with local conservation realities at the most important known hawksbill rookeries in the eastern Pacific, we provide a more holistic view of the conservation status and management needs of the species in this ocean region.

Small-scale coastal fisheries can cause detrimental impacts to non-target megafauna through bycatch. This can be particularly true when high-use areas for such species overlap with fishing grounds, as is the case with hawksbill turtle (Eretmochelys imbricata) aggregations at lobster gillnet fishing sites in El Salvador and Nicaragua. We quantified hawksbill bycatch by partnering with local fishers to record data for 690 gillnet sets on rocky reefs at Los Cobanos Reef Marine Protected Area (2008-2009) and Punta Amapala (2012-2014) in El Salvador, and La Salvia (2012-2014) in Nicaragua. Based on 31 observed hawksbill captures, the mean bycatch-per-unit-effort (0.0022; individuals per set = 0.0450) and mortality (0.74) are among the highest reported for the species across fishing gear types and oceanic regions worldwide, and we conservatively estimate that at least 227 juvenile hawksbill captures occurred in lobster gillnet fishing fleets at our sites during the study. Estimated mortality for the 227 hawksbills -which could approach the 74% observed mortality of total captures-from interactions with lobster gillnet fisheries at these sites during the study period may constitute the greatest single source of human-induced in-water mortality for juvenile, sub-adult, and adult hawksbills in the eastern Pacific, and is of grave concern to the population. Based on our findings, we discuss neritic habitat use by hawksbills during their 'lost years' and offer recommendations for bycatch reduction strategies, including community-based efforts to enhance sustainable self-governance via the establishment of locally crafted conservationist norms and marine protected areas at important developmental habitat.