Abstract The research presents a compilation of the strategies for the handling and management of mercury (Hg) carried out by Japan as a promoter and manager of the Minamata Convention. This agreement was established to reduce anthropogenic mercury emissions and prevent pollution worldwide. Article 14 of the agreement focuses on cooperation between the governments involved and provides technical assistance. That is why the activities were developed in the training course “Capacity building for the ratification and implementation of the Minamata Convention on Mercury” carried out in Japan, in which representatives from Ecuador, China, Sudan, Brazil, and Armenia. Ecuador is one of the countries that ratified this agreement in 2013, which is why it is necessary to understand the efforts developed by other countries, with a practical perspective, to know their feasibility and implementation in the long term in the national territory. This study describes the activities implemented in Japan, such as processing contaminated waste in the company Nomura Kohsan Co., Ltd. (Hokkaido), to know high-tech centers such as the National Institute for Minamata Disease (NIMD) and the Ministry of the Environment (MEGJ), and a tour of the environmental restoration project in Minamata Bay. The results demonstrate that the actions and policies adopted in Japan have considerably reduced Hg emissions, maintaining them at stable levels, which ratifies compliance with the different articles outlined in the Minamata Convention. Although efforts have been made in Ecuador to combat illegal mining where Hg and assist in mining districts, it is still among the most polluting countries in the region. Private and government entities must put effort into action plans to mitigate pollution and carry out periodic monitoring of emissions of this metal.

Resumen La investigación presenta una recopilación de las estrategias en el manejo y gestión del mercurio (Hg) que realiza Japón como promotor y gestor del Convenio de Minamata. Este acuerdo fue establecido para reducir las emisiones antropogénicas de mercurio y prevenir su polución a nivel mundial. El artículo 14 del convenio establece la cooperación entre los gobiernos involucrados y la prestación de asistencia técnica. Es por ello que las actividades se desarrollaron en el curso de capacitación “Capacity building for ratification and implementation of Minamata Convention on Mercury”, llevado a cabo en Japón, en el cual participaron representantes de Ecuador, China, Sudán, Brasil y Armenia. Ecuador es uno de los países que ratificó en el 2013 este convenio, por lo cual es necesario comprender los esfuerzos desarrollados por otros países, desde una perspectiva práctica, para poder conocer su factibilidad y ser implementadas a largo plazo en el territorio nacional. Se describen las actividades implementadas, en Japón, como la recolección y procesamiento de residuos contaminados en la empresa Nomura Kohsan Co., Ltd. (Hokkaido), visita a centros de alta tecnología como el Instituto Nacional para la Enfermedad de Minamata (NIMD) y el Ministerio del Ambiente (MEGJ), y recorrido por el proyecto de restauración ambiental en la bahía de Minamata. Los resultados demuestran que las acciones y políticas adoptadas en Japón han reducido considerablemente las emanaciones de Hg llegando a mantenerlas en niveles estables, lo que ratifica el cumplimiento de los distintos artículos expuestos en el Convenio de Minamata. A pesar de que en Ecuador se han hecho esfuerzos para mitigar el uso de Hg, aun así, se encuentra entre los principales países contaminantes de la región. Las entidades privadas y gubernamentales deben esforzarse en planes de acción para mitigar la contaminación y llevar a cabo monitoreos periódicos de las emisiones de este metal.

ABSTRACT Introduction: Monkeypox is a zoonotic disease that was first identified in 1958. The virus is a member of Orthopoxvirus genus, of Poxviridae family. It infects wide variety of mammals and its natural reservoir is unknown. Objectives: To describe the important aspects related to pathophysiology, genome, pathogenesis, transmission, replication and immunology of monkeypox. Methods: A search of original articles, case reports, bibliographic and systematic reviews was carried out in VHL Regional Portal, PubMed, Science, Nature and Lancet. Reports from the World Health Organization and the Pan American Health Organization on monkeypox were consulted. Results: Spread of monkeypox virus can occur through close contact with lesions, body fluids, respiratory droplets, and contaminated objects. Once inside the body, the virus infects mucous membranes, epithelial cells and immune cells of adjacent tissues. The virus replicates and spreads rapidly through the blood and lymphatic system. T cells play an important role in regulating the immune response against the virus. However, Orthopoxviruses have developed several mechanisms to evade the immune response. Conclusions: The important aspects described, taken into account about monkeypox transmission, have significantly changed over time. 2022 global monkeypox outbreak presented a chain of transmission primarily among humans associated with sexual contact.

RESUMEN Introducción: La viruela símica es una enfermedad zoonótica identificada por primera vez en 1958. El virus es un miembro del género Orthopoxvirus, de la familia Poxviridae. Infecta a una amplia variedad de mamíferos y se desconoce su reservorio natural. Objetivos: Describir los aspectos importantes relacionados a la fisiopatología, genoma, patogénesis, transmisión, replicación e inmunología de la viruela símica. Métodos: Se realizó una búsqueda de artículos originales, reportes de casos, revisiones bibliográficas y sistemáticas en el Portal Regional de la BVS, PubMed, Science, Nature y Lancet. Se consultaron los informes de la Organización Mundial de la Salud y la Organización Panamericana de la Salud sobre la viruela símica. Resultados: La propagación del virus de la viruela símica puede ocurrir a través del contacto cercano con lesiones, fluidos corporales, gotitas respiratorias y objetos contaminados. Una vez dentro del organismo, el virus infecta mucosas, células epiteliales y células inmunitarias de los tejidos adyacentes. El virus se replica y disemina rápidamente a través del sistema hemático y linfático. Las células T desempeñan un papel importante en la regulación de la respuesta inmunitaria contra el virus. Sin embargo, los Orthopoxvirus han desarrollado varios mecanismos para la evasión de la respuesta inmunitaria. Conclusiones: Los aspectos importantes descritos que se tuvieron en cuenta acerca de la transmisión de la viruela símica han tenido cambio significativo con el tiempo. El brote mundial de viruela símica de 2022 presentó una cadena de transmisión principalmente entre humanos asociada al contacto sexual.

Resumen Objetivo principal: comprender las experiencias de vida de personas con diagnóstico de Covid-19 durante el periodo de cuarentena en Santiago de Chile. Diseño: estudio cualitativo descriptivo de carácter fenomenológico y exploratorio. Metodología: Los participantes fueron personas entre 18 y 65 años, con infección previa por Covid-19 y PCR positivo. Se utilizó un muestreo intencional con 11 informantes. La información se recogió a través de entrevistas en profundidad vía online, grabadas y transcritas manualmente. Para el análisis se siguió la metodología de Colaizzi. Resultados principales: emociones intensas, apoyo de familiares y vecinos, estigma y autocuidado, fueron las cuatro categorías surgidas del análisis. Conclusión principal: las personas con Covid-19 tuvieron en general un alto riesgo de tener problemas emocionales y sociales. Sin embargo, la pandemia también tuvo un efecto positivo sobre las relaciones familiares, el sentido a la vida, el autocontrol y el autocuidado.

Abstract Main objective: to understand the life experiences of people diagnosed with Covid-19 during the quarantine period in Santiago de Chile city. Design: a descriptive phenomenological qualitative study with an exploratory approach. Methodology: Participants aged between 18 and 65 years, with previous Covid-19 infection and positive PCR. Purposive sampling with 11 informants was used. The information was collected through in-depth online interviews, recorded, and manually transcribed. Data were analyzed using Colaizzi's seven-step method. Main results: intense emotions, support from family and neighbors, stigma and self-care were the four categories that emerged from the analysis. Main conclusion: people with Covid-19 had a high risk for emotional and social problems. However, the pandemic also had a positive effect on family relationships, meaning of life, self-control, and self-care.

Abstract Introduction. Currently, rectal trauma continues to be a complex clinical and potentially fatal situation. Its early detection and management is the cornerstone to avoid both mortality and morbidity of patients. Today there is still debate about the ideal surgical approach in rectal trauma, and intraoperative management decisions are greatly affected by the experience and preferences of the surgeon. Methods. A literature search was performed in the PubMed, Clinical Key, Google Scholar and SciELO databases using the keywords described. The most relevant articles published in the last 20 years were selected. Articles written in English and Spanish were considered. Discussion. The rectum is the organ less frequently injured in trauma; however, the clinical implications of overlooking this injury can be devastating for the patient. Options for diagnosis include digital rectal examination, computed tomography and rectosigmoidoscopy. Surgical management will depend on the location, degree of the injury and the associated injuries. Conclusion. Knowledge of the anatomy, the mechanism of trauma and the associated injuries will allow the surgeon to make an adequate clinical-surgical approach that leads to optimal clinical outcomes in patients presenting with rectal trauma.

Resumen Introducción. En la actualidad, el trauma de recto continúa siendo una situación clínica compleja y temida por ser potencialmente mortal. Su detección y manejo temprano es la piedra angular para impactar tanto en la mortalidad como en la morbilidad de los pacientes. Hoy en día, aún existe debate sobre la aproximación quirúrgica ideal en el trauma de recto y las decisiones de manejo intraoperatorias se ven enormemente afectadas por la experiencia y preferencias del cirujano. Métodos. Se realizó una búsqueda de la literatura en las bases de datos de PubMed, Clinical Key, Google Scholar y SciELO utilizando las palabras claves descritas y se seleccionaron los artículos más relevantes publicados en los últimos 20 años; se tuvieron en cuenta los artículos escritos en inglés y español. Discusión. El recto es el órgano menos frecuentemente lesionado en trauma, sin embargo, las implicaciones clínicas que conlleva pasar por alto este tipo de lesiones pueden ser devastadoras para el paciente. Las opciones para el diagnóstico incluyen el tacto rectal, la tomografía computarizada y la rectosigmoidoscopía. El manejo quirúrgico va a depender de la localización, el grado de la lesión y las lesiones asociadas. Conclusión. El conocimiento de la anatomía, el mecanismo de trauma y las lesiones asociadas permitirán al cirujano realizar una aproximación clínico-quirúrgica adecuada que lleve a desenlaces clínicos óptimos de los pacientes que se presentan con trauma de recto.

Abstract The research presents data related to the Strizhkovsky volcanogenic massive sulfide deposit, which is located in the Rudny Altai region, southern Russia. In the present study, samples of polymetallic ores and rocks previously collected were taken as reference. From ten polished sheets of ores, an analysis was carried out with a petrographic microscope and with a scanning electron microscope (SEM) and incorporated with an X- ray electron microprobe. Based on these results, the content (% by weight) of minors associated elements was determined such as Ag, Cd, Bi, Ga, Ge and their theoretical enrichment in basic sulfides (galena, sphalerite, chalcopyrite and pyrite) was calculated. The results show that the theoretical enrichment, considering the sum of the two sulfides with the highest content, for silver (94.83%), bismuth (91.06%), gallium (72.3%) and germanium (75%) is associated with galena and sphalerite, for cadmium (91%) with sphalerite and less galena. The question of attributing Ga and Ge to the mineral components must be adjusted after calculating their reserves in the ore. The data of the theoretical enrichment and the distribution of the content of associated valuable components in the polymetallic ores represent a tool to predict the quality of the different metallurgical concentrates; and in turn to be able to modify the parameters of the metallurgical treatments of lead-zinc ores.

Resumen La investigación presenta datos relacionados al yacimiento de sulfuros masivos volcanogénicos Strizhkovsky, que se localiza en la región de Rudny Altai, sur de Rusia. En el presente estudio se tomaron como referencia muestras de menas polimetálicas y rocas recolectadas de manera previa. A partir de diez láminas pulidas de menas se realizó un análisis con microscopio petrográfico y con microscopio de barrido electrónico (SEM) e incorporado con una microsonda electrónica de rayos X. Con base en estos resultados se determinó el contenido (% en peso) de elementos menores asociados como Ag, Cd, Bi, Ga, Ge y se calculó su enriquecimiento teórico en sulfuros básicos (galena, esfalerita, calcopirita y pirita). Los resultados muestran que el enriquecimiento teórico, considerando la suma de los dos sulfuros con mayor contenido, para plata (94.83%), bismuto (91.06%), galio (72.3%) y germanio (75%) está asociado con galena y esfalerita, para cadmio (91%) con esfalerita y menos galena. La cuestión de atribuir Ga y Ge a los componentes minerales debe ajustarse después de calcular sus reservas en el mineral. Los datos del enriquecimiento teórico y la distribución del contenido de componentes valiosos asociados en las menas polimetálicas suponen una herramienta para pronosticar la calidad de los distintos concentrados metalúrgicos; y a su vez poder modificar los parámetros de los tratamientos metalúrgicos de minerales de plomo-zinc.

Parkinson's disease (PD) is a neurodegenerative multisystemic diseases, which is clinically characterized by the presence of motor symptoms such as bradykinesia, rigidity, resting tremor, and postural instability. However, non-motor symptoms constituting mood disorders, sleep disorders, cognitive dysfunction, or autonomic dysfunction may also be present. Within autonomic dysfunctions, urinary symptoms have been documented in patients with Parkinson's disease. The most common urinary symptoms are nocturia, urinary urgency, increased urinary frequency, and urge incontinence. This article makes a narrative review of the current literature on the pathophysiological mechanisms, clinical manifestations, diagnosis and treatment of urinary dysfunction in patients with Parkinson's disease.

Resumen La enfermedad de Parkinson (EP) es una enfermedad multisistémica de naturaleza neurodegenerativa, que clínicamente se caracteriza por presencia de síntomas motores como bradicinesia, rigidez, temblor en reposo e inestabilidad postural. Sin embargo, también pueden estar presentes síntomas no motores que constituyen trastornos del ánimo, trastornos del sueño, disfunción cognitiva o disfunción autonómica. Dentro de las disfunciones autonómicas, los síntomas urinarios se han documentado en los pacientes con enfermedad de Parkinson. Los síntomas urinarios más comunes son la nicturia, urgencia urinaria, aumento de la frecuencia miccional e incontinencia de urgencia. El presente artículo hace una revisión narrativa de la literatura actual sobre los mecanismos fisiopatológicos, manifestaciones clínicas, diagnóstico y tratamiento de la disfunción urinaria en pacientes con enfermedad de Parkinson.

ABSTRACT Introduction: The offspring of bipolar parents (BO) is a high-risk population for inheriting the bipolar disorder (BD) and other early clinical manifestations, such as sleep disturbances. Objective: To compare the presence of psychiatric disorders and sleep disturbances of BO versus offspring of control parents (OCP). Methods: A cross-sectional analytical study was conducted that compared BO versus OCP. The participants were assessed using valid tools to determine the presence of psychiatric symptoms or disorders. The "Sleep Evaluation Questionnaire" and "School Sleep Habits Survey" were used to determine sleep characteristics and associated factors. Sleep records (7-21 days) were also obtained by using an actigraphy watch. Results: A sample of 42 participants (18 BO and 24 OCP) was recruited. Differences were found in the presentation of the psychiatric disorder. The BO group showed a higher frequency of major depression disorder (MDD; P = .04) and Disruptive Mood Dysregulation Disorder (DMDD; P = .04). The OCP group showed a higher frequency of Attention Deficit and Hyperactivity Disorder (ADHD; P = .65), and Separation Anxiety Disorder (SAD; P = .46). Differences were also found in sleep by using subjective measurements. Compared to the OCP group, BO had a worse perception of quality of sleep (P = .02), a higher frequency of nightmares (P = .01), a shorter total sleep time, and a higher sleep latency. Nevertheless, no differences were found between groups in the actigraphy measurements. Conclusions: The BO group had a higher frequency of Mood Disorders, and at the same time a higher number of sleep disturbances in the subjective measurements. It is possible that there is an association between mood symptoms, sleep disturbances, and coffee intake. No differences were found in the sleep profile by using actigraphy. © 2020 Asociación Colombiana de Psiquiatría. Published by Elsevier España, S.L.U. All rights reserved.

RESUMEN Introducción: los Hijos de Padres con Trastorno Bipolar (HPTB) constituyen una población de riesgo ya que pueden heredar el Trastorno Bipolar (TB) como también manifestaciones clínicas tempranas como seria las alteraciones en el sueño. Objetivo: comparar la presencia de trastornos psiquiátricos y las alteraciones en el sueño de los HPTB con los Hijos de Padres Control (HPC). Métodos: Se realizó un estudio analítico de corte transversal, que comparó HPTB versus HPC. Se entrevistaron con instrumentos validados para determinar la existencia de síntomas y trastornos psiquiátricos. Utilizamos las escalas: "Cuestionario de evaluación de sueño" y "Encuesta sobre hábitos de sueño en escolares" para determinarlas características del sueño y factores asociados con el mismo. Adicionalmente se obtuvo el registro de sueño (7-21 días) por medio de un reloj de actígrafia. Resultados: Se reunió una muestra con 42 sujetos (18 HPTB y 24 HPC). Se encontraron diferencias en la presentación de los trastornos psiquiátricos. El grupo de HPTB presento mayor frecuencia del trastorno depresivo mayor (TDM; p = 0,04) y el trastorno disruptivo de la regulación emocional (TDRE, p = 0,04). En el grupo de HPC por su parte se presentó una mayor frecuencia de Trastorno por Déficit de Atención e Hiperactividad (TDAH; p = 0,65) y de Trastorno de Ansiedad por Separación (TAS; p = 0,46). También se encontraron diferencias a nivel del sueño en las medidas subjetivas. En comparación con el HPC, el grupo de HPTB presento una peor percepción de la calidad de sueño (p = 0,02), una mayor presencia de pesadillas (p = 0,01), un menor tiempo total de sueño y una mayor latencia de sueño. Sin embargo, no se encontraron diferencias entre los dos grupos en las mediciones de actigrafías. Conclusiones: el grupo de HPTB presenta mayor frecuencia de trastornos del estado de ánimo, y a su vez una mayor presencia de alteraciones del sueño en las medidas subjetivas. Es posible que exista una asociación entre los síntomas afectivos, las alteraciones en el sueño y el consumo de café. No se encontraron diferencias en el perfil de sueño por actígrafía. © 2020 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España, S.L.U. Todos los derechos reservados. Children

Abstract Paper aims This study presents several business analytics tools that allow improving the tactical planning of the collection process for a Colombian solid-waste management company. Originality The extant literature of operations research/analytics applied to these systems focuses on facility location or vehicle routing. Tactical decisions are seldom studied in the operations research/analytics literature devoted to waste management systems. By contrast, the focus of this paper is on tactical decisions: fleet sizing, frequency assignment, route scheduling and internal resource allocation in a new waste transfer station. Research method We follow a multimethodology approach that uses mathematical programming, metaheuristics, and discrete event simulation. The models use historical information of the system, and the solution of a model are used as input data for the other models. Main findings Introducing a new waste transfer station allows an important reduction of the compactors fleet. However, to prevent a collapse in its internal operation an even operation is needed. This is achieved by rescheduling the routes to balance their arrival during the day. Additional benefits can be attained if some soft constraints are relaxed. Implications for theory and practice Practitioners looking for tactical planning tools on waste collection systems have here an example of their application and benefits. Improvements can be achieved by tactical planning without heavily disrupting decisions at the operational level.

Abstract The spread of COVID-19 has altered the structure and functioning of spatial systems, giving rise to multiple dynamics. The spatial and temporal concentration of cases requiring medical care has led to the collapse of healthcare systems around the world, particularly in territories with already limited resilience potential and provision of medical services, as was the case of Ecuador. In this South American country, a reform of the healthcare system was launched as part of the 2008 Constitution that involved a strengthened investment in healthcare services; however, when the pandemic started, the implementation of the Comprehensive Healthcare Model (MAIS, in Spanish) had not been consolidated, and a number of constraints limiting its functioning in a scenario of changing public management priorities were expressed. In this context, the present study addressed access to public healthcare from two different perspectives. From a structural perspective, the distribution of hospital infrastructure was studied; from a more contextual perspective, the strategies generated in the context of the pandemic for COVID-19 patients to access healthcare services were analyzed. The structural and contextual perspectives were addressed considering a spatial approach, which led to the configuration of “functional regions”. The hospital infrastructure was analyzed applying gravitational spatial models (Reilly’s and Huff’s models) in the PhilCarto free software to evaluate the hypothetical influence of the existing infrastructure on access to healthcare services in a territory characterized by a duopoly (Quito and Guayaquil) and a great diversity regarding the occupation of space. For the contextual analysis of health care in the COVID-19 pandemic scenario, the Gephi free software was used to perform spatial network analysis from the healthcare database of the Instituto Ecuatoriano de Seguridad Social (Ecuadorian Institute of Social Security; IESS, in Spanish) - one of the main providers of healthcare services in Ecuador. The study of this network was based on the examination of the links between housing areas and healthcare sites for COVID-19 patients, which allowed evaluating both the weight of the territories and the centralities regarding access to healthcare services, leading to the formation of functional regions from spatial links. The application of the modularity algorithm allows the identification of spaces that, beyond a local perspective, form a functional network according to the spatial dynamics of the healthcare provided to COVID-19 patients. The results obtained are discussed from the perspective of spatial inequities in the provision of healthcare services and the analysis of the role of functional regions under crisis scenarios. The first perspective highlights the patterns of inequity in the provision of healthcare services, within the framework of spatial injustice theories. Land-use planning at the national level and the territorial management of public policy are proposed as strategies to achieve higher efficiency and effectiveness levels in the provision of a service that operates in a hierarchical way and where real and potential access to infrastructure are among the driving variables. The functionality of space from this perspective is seen from a multi-scale standpoint, in which the regional scale constructed from functional links is highlighted. Indeed, from the second perspective of the analysis of results, the identification of spatial links and the formation of functional networks reveal spatial structures underlying territorial dynamics. Besides, these results represent strategic and valuable knowledge for the territorial management of the pandemic and, from a broader perspective, of healthcare and the provision of public services. Certainly, functional regions show historically constructed linkages and their use within a crisis scenario. Institutions would benefit by considering these inputs for management more closely linked with historically constructed socio-spatial dynamics that provide clear functionality to space from a regional perspective. The study concludes by highlighting the need for continuous processes to strengthen public services and, even more so, pivotal sectors such as healthcare services, for these efforts to consolidate their effects in the mid- and long term. These efforts have the potential to strengthen contextual management in crisis scenarios such as the pandemic. Both structural and contextual management should incorporate the spatial component as a social construction where citizens and institutions interact. In this sense, pandemic management requires to be founded on the diversity, dynamics, and interaction of spaces.

Resumen La propagación de la COVID-19 ha enfrentado a los sistemas sanitarios del mundo a diversos desafíos. El incremento exponencial de casos que requieren atención hospitalaria ha generado escenarios de sobresaturación de los hospitales. En estos contextos la población y las instituciones han planteado diversas estrategias, entre las que se incluye la movilización de pacientes desde los lugares de vivienda a otros donde podrían ser atendidos. Estos desplazamientos se inscriben en una lógica de regiones funcionales construidas a partir de las prácticas espaciales de la población en un contexto de crisis sanitaria. El objetivo de esta investigación es observar el manejo de la crisis sanitaria desde una perspectiva regional para determinar áreas de influencia de infraestructura hospitalaria, flujos hospitalarios y vínculos entre territorios de vivienda y lugares de atención médica. Como resultado se obtuvo que la atención médica en el contexto de la crisis sanitaria devela una configuración regional subyacente. Esta organización espacial tiene un gran interés para la construcción de eficaces y eficientes sistemas territoriales de atención a pacientes en contextos de crisis y para la construcción de una resiliencia territorial.

Abstract: Lentinula edodes is the most consumed mushroom in the world, being cultivated mainly on waste coming from the forest industry. During shiitake cultivation, incubation is essential and is usually longer than in other edible mushrooms. This stage includes “browning”, which is a process induced by exposure to a photoperiod and although it is believed to bring certain advantages to shiitake cultivation, it has not been widely studied. In this work, we evaluated how the incubation time, the use of different strains and the induction of browning affect the proximate composition, biological efficiency and other yield parameters of L. edodes. In order to do that, three experiments were carried out with three different strains, three different incubation times and the effect of induction or non-induction of browning. As results we found that the proximate composition did not vary with respect to the different incubation times or from the induction of browning, although differences were found according to the strain. On the other hand, the biological efficiency was affected by the incubation time and the strain used, but not by the induction of browning.

Abstract: The Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-associated Organ Dysfunction in Children was released in 2020 and is intended for use in all global settings that care for children with sepsis. However, practitioners managing children with sep sis in resource-limited settings (RLS) face several challenges and disease patterns not experienced by those in resource-rich settings. Based upon our collective experience from RLS, we aimed to reflect on the difficulties of implementing the international guidelines. We believe there is an urgent need for more evidence from RLS on feasible, efficacious approaches to the management of sepsis and septic shock that could be included in future context-specific guidelines.

Resumen: Las Guías Internacionales de la Campaña Sobreviviendo a la Sepsis para el Manejo del Shock Séptico y la Disfunción de Órganos Asociada a la Sepsis en Niños, fueron publicadas en 2020 y están desti nadas a ser utilizadas en todos los lugares que atienden a niños. Sin embargo, los profesionales que atienden a los niños con sepsis en entornos con recursos limitados se enfrentan a una serie de desafíos y perfiles de enfermedad distintos a los que se encuentran en entornos ricos en recursos. Basándonos en nuestra experiencia colectiva en entornos con recursos limitados, nos propusimos reflexionar so bre las dificultades de aplicar las directrices internacionales. Creemos que hay una necesidad urgente de más evidencia de entornos con recursos limitados en enfoques factibles y eficaces para el trata miento de la sepsis y el shock séptico que podrían incluirse en las futuras directrices para situaciones y contextos específicos.

RESUMEN El trastorno bipolar (TB) tiene un gran componente hereditario. Es un trastorno que comienza en la edad adulta temprana, pero acerca del cual se ha descrito un período premórbido que precede al inicio de TB. Durante esta expresión heraldo, pueden aparecer trastornos y síntomas psiquiátricos, como depresivos, maníacos, psicóticos, ansiosos y otros. Objetivo: Determinar el perfil psicopatológico de un grupo de hijos de padres con TB (BO) en comparación con el grupo de hijos de padres control de la misma comunidad (CCO), y su evolución en el tiempo. Los síntomas subumbrales y los trastornos mentales serán incluidos. Métodos: Nosotros llevamos a cabo un estudio observacional mixto de cohorte, con diseño prospectivo. Incluimos sujetos de seis a 30 anos de edad, de la región de Antioquia, Colombia. Un total de 131 sujetos del grupo de riesgo BO y 150 sujetos del grupo CCO fueron evaluados a través de entrevistas de diagnóstico psiquiátricas validadas (K-SADS-PL y DIGS), al inicio yalos4anos de seguimiento. Todas las entrevistas se llevaron a cabo por personal ciego a los diagnósticos de los padres. La evaluación de seguimiento se completó en el 72% de la descendencia. Cuarenta y dos sujetos fueron excluidos ya que superaron la edad de 30 anos, y solo 46 sujetos no fueron seguidos (cambio de dirección o no dieron su consentimiento para participar). Resultados: En comparación con el grupo CCO, el grupo BO tuvo una mayor frecuencia de trastorno afectivo, el trastorno psicótico, los trastornos de externalización y el uso de las sustancias psicoactivas durante ambas evaluaciones en los tiempos 1 y 2. La magnitud de las diferencias entre los grupos aumentó cuando alcanzaron el tiempo 2. El grupo BO tuvo un mayor riesgo de presentar síntomas subumbrales y trastornos psiquiátricos definitivos, tales como trastornos afectivos, trastornos psicóticos y trastornos de externalización. Además, el grupo BO tuvo una edad de comienzo más baja para el consumo de sustancias psicoactivas. Conclusión: Durante el período de seguimiento, el grupo BO tuvo un mayor riesgo de presentar trastornos mentales en comparación con el grupo CCO. Los síntomas y trastornos más importantes que preceden al inicio del TB fueron: depresivo, bipolar no especificado de otra manera, psicóticos y el uso de sustancias.

ABSTRACT Bipolar disorder (BD) has a large hereditary component. It is a disorder that begins in early adulthood, but about which it has been described a premorbid period preceding the onset of BD. During this herald expression psychiatric disorders and symptoms, such as depressive, manic, psychotic, anxious and others, may appear. Objective: To determine the psychopathological profile of a Bipolar Offspring (BO) group compared with the Community Control Offspring (CCO) group, and its evolution over time, including subthreshold symptoms and mental disorders. Methods: We conducted an observational mixed cohort study, with a prospective design. We included subjects from six to 30 years of age, from the region of Antioquia, Colombia. A total of 131 subjects from the risk group BO and 150 subjects from the CCO group were evaluated through validated psychiatric diagnostic interviews (K-SADS-PL and DIGS) at baseline and at 4 years follow up. All interviews were carried out by a staff blind to parent diagnoses. Follow-up assessment were complete in 72% of the offspring. Forty-two subjects were excluded as they surpassed the age of 30 years, and only 46 subjects were not followed (change of address or did not consent to participate). Results: Compared with the CCO group, the BO group had a higher frequency of affective disorder, psychotic disorder, externalizing disorders and use of the psychoactive substances during both assessments at time 1 and 2. The magnitude of the differences between the groups increased when they reach time 2. The BO group had a greater risk for presenting subthreshold symptoms and definitive psychiatric disorders, such as affective disorders, psychotic disorders and externalizing disorders. In addition, the BO group had a younger age of onset for psychoactive substances consumption. Conclusion: During the follow-up period, the BO group had a higher risk of presenting mental disorders compared with the CCO group. The most relevant symptoms and disorders that could precede the onset of BD were depressive, bipolar not otherwise specified, psychotic and substance use.

Abstract: The Northern Andean Cordillera in Colombia hosts unique, megadiverse, and fragile ecosystems, including wet tropical lowland, cloud forest, and paramo that are essential for climate regulation and the subsistence of human settlements. The Serrania de Los Paraguas on the Pacific slope of the western range of the Northern Andes, Colombia, is an ecosystem that needs to be preserved in the face of a major threat due to rapid deforestation. However, there have been very few explorations surveying its plant diversity in the area. Here, we describe two new orchid species to science from the genera Camaridium (C. antonellii: Maxillariinae, Cymbidieae) and Lepanthes (L. valerieae: Pleurothallidinae, Epidendreae) discovered during a floristic survey conducted in the region. Camaridium antonellii is similar to C. inauditum but differs in the fractiflex, ovate-elliptic, acute leaves, the flowers with pink sepals and petals, the lip white, distinctly three-lobed, spotted with purple on the lateral lobes and yellow-cream towards the apex, the mid-lobe ovate to transverse ovate and lanceolate sepals. Lepanthes valerieae, which is similar to L. antennata, differs in the long apical lobes of the petals, surpassing the dorsal sepal, the longer connectives > 18 mm, rounded lobes of the lip, and the oblong, flattened appendix. Illustrations, distribution maps, and photographs are provided.

Resumen: La estructura tributaria hace referencia a la proporción de cada una de las categorías de ingresos tributarios, sobre el total de estos ingresos. Considerando su importancia, este estudio examina el impacto de la estructura tributaria sobre el crecimiento económico en el Ecuador, mediante un análisis econométrico para el período (2010-2019. La información estadística se obtuvo de bases de datos publicadas por las distintas entidades públicas del Estado ecuatoriano. Se utilizó el programa estadístico Stata para el procesamiento de los datos, aplicando un modelo de regresión múltiple; se plantea una investigación descriptiva- correlacional. Los resultados obtenidos determinaron que las variables de la estructura tributaria que mejor explican el crecimiento económico son: el impuesto al valor agregado (11.70%), el impuesto a la salida de divisas (7.20%) y el impuesto a la renta (1.49%); los cuales mantienen una relación directa, es decir, un incremento en estos impuestos produce un aumento del crecimiento económico del país.

Abstract: The tax structure refers to the proportion of each of the categories of tax income, over the total of these income. Considering its importance, this study examines the impact of the tax structure on economic growth in Ecuador, through an econometric analysis for the period (2010-2019. The statistical information was obtained from databases published by the different public entities of the Ecuadorian State The statistical program Stata was used for data processing, applying a multiple regression model, a descriptive-correlational research is proposed. The results obtained determined that the variables of the tax structure that best explain economic growth are: value added tax (11.70%), the foreign currency outflow tax (7.20%) and the income tax (1.49%), which maintain a direct relationship, that is, an increase in these taxes produces an increase in the country's economic growth.