Abstract Background: Children with congenital heart disease present a higher frequency of cardiorespiratory arrest (CRA) than the general pediatric population. The epidemiology of CRA is not exactly known in our setting, nor are the mortality risk or the neurological evolution factors. Objective: To describe the epidemiology and outcomes associated with pediatric cardiopulmonary resuscitation in a cardiovascular recovery unit. The primary endpoint was the survival to discharge and the secondary endpoints were the return to spontaneous circulation, the survival at 24 hours and the remote neurological condition. Methods: Descriptive, prospective, longitudinal cohort study in children under 18 years of age who required cardiopulmonary resuscitation between 2016 and 2019. Demographic variables, characteristics of cardiopulmonary arrest, resuscitation and outcome were analyzed. An uni- and multivariate analysis was performed comparing survivors and deceased. Results: Out of 1,842 hospitalized patients, 4.1% presented CRA. Fifty patients with complete records were analyzed. Seventy-eight percent (39) returned to spontaneous circulation with a high survival rate of 46%. Resuscitation > 6 min and the use of vasoactive drugs were predictors of mortality; 16/23 patients were followed up, 10 of them with normal development for age at 6 months, six had pervasive developmental disorder. Conclusions: 4.1% of patients presented CRA, with a rate of 3.4 CRA per 1,000 patient-days. Survival at hospital discharge (n = 50) was 46%. Resuscitation > 6 min and the use of vasoactive drugs were independent predictors of mortality. At six months, 63% had normal neurological development for age.

Resumen Antecedentes: Los niños con cardiopatías congénitas experimentan paro cardiorrespiratorio (PCR) con mayor frecuencia que la población pediátrica general. Se desconoce la epidemiología exacta del PCR en nuestro medio, al igual que el riesgo de mortalidad y los factores que influyen en la evolución neurológica. Objetivo: Describir la epidemiología y los resultados asociados con la reanimación cardiopulmonar pediátrica en una unidad de recuperación cardiovascular. El criterio de valoración primario fue la supervivencia al momento del alta hospitalaria; los secundarios fueron el retorno de la circulación espontánea, la supervivencia a las 24 horas y la condición neurológica en el largo plazo. Método: Estudio de cohorte longitudinal, descriptivo, prospectivo, en menores de 18 años que requirieron reanimación cardiopulmonar entre 2016 y 2019. Se analizaron las variables demográficas y las características del paro cardiorrespiratorio y de la reanimación, así como su resultado. Se realizaron análisis de una y múltiples variables para comparar a los pacientes sobrevivientes con los fallecidos. Resultados: De los 1,842 pacientes internados, el 4.1% experimentó PCR. Se analizaron 50 pacientes con expedientes completos. Se logró el retorno de la circulación espontánea en el 78% (39), con una supervivencia alta del 46%. La reanimación > 6 min y el uso de fármacos vasoactivos fueron factores predictivos de mortalidad; se realizó el seguimiento de 16/23 pacientes, 10 de ellos con desarrollo normal para la edad luego de seis meses, seis tenían trastorno generalizado del desarrollo. Conclusiones: El 4.1% de los pacientes presentó un PCR, con una tasa de 3.4 PCR por 1,000 días-paciente. La supervivencia al egreso hospitalario (n = 50) fue del 46%. La reanimación > 6 min y la utilización de fármacos vasoactivos fueron factores predictivos independientes de mortalidad. Luego de seis meses, el 63% tenía desarrollo neurológico normal para la edad.

ABSTRACT Alkaline soils present large amounts of calcium carbonates, with precipitation of insoluble calcium phosphate. The objective of the research was to determine the effects of the P application on the nutrient levels of the foliar tissue of Pennisetum pastures in calcareous soils in Córdoba-Colombia. Soil samples were collected from two locations in the Department of Córdoba. A completely randomized design with a 2 x 3 x 6 factorial arrangement (Vista Hermosa and Carolina), there Pennisetum species (king grass, Cuba OM-22, and Pennisetum purpureum), and six P doses (0, 80, 150, 250, 400, and 650 kg ha-1), applied as P2O5, was used. The addition of P did not increase the contents of N, K, Ca, and Mg in the king grass, Pennisetum purpureum, and Cuba OM-22 pastures. However, in the calcareous soils of Carolina, king grass, Pennisetum purpureum, and Cuba, OM-22 absorbed higher amounts of P.

RESUMO Solos alcalinos podem apresentar grandes quantidades de carbonatos de cálcio, houve precipitação de fosfato de cálcio insolúvel. O objetivo da pesquisa foi determinar a resposta da aplicação de fósforo no conteúdo nutricional do tecido foliar das pastagens Pennisetum purpureum e dois híbridos com espécies do gênero Pennisetum em solos calcários do Departamento de Córdoba-Colômbia. Este estudo foi realizado em estufas e laboratórios da Faculdade de Ciências Agrárias da Universidade de Córdoba, localizada no município de Montería. O solo calcário foi coletado em dois locais do Departamento de Córdoba fazenda Vista Hermosa, e o segundo local correspondeu à localidade de Carolina, e Planeta Rica. Utilizou-se o delineamento inteiramente casualizado com arranjo fatorial 2x3x6 com quatro repetições: dois tipos de solo (Vista Hermosa e Carolina); três gramíneas King Grass (Híbrido entre Pennisetum purpureum y Pennisetum typhoides), Cuba OM-22 (Hibrido entre Pennisetum purpureum Cuba CT-169 y Pennisetum glaucum Tiffton) e elefante roxo (Pennisetum purpureum); seis doses de fosfato (0, 80, 150, 250, 400 e 650 kg ha-1) aplicado na forma de P2O5. A aplicação de P no solo não aumentou os teores de N, K, Ca e Mg na pastagem King Grass, Pennisetum purpureum e Cuba OM-22 estabelecidos nos solos calcários de Vista Hermosa e Carolina. Nos solos calcários da Carolina, King Grass, Pennisetum purpureum e Cuba, OM-22 absorveram maiores quantidades de fósforo.

Abstract: The Royal Household is probably the highest institution of the State as a monarchical system. In this sense, it is worth questioning how these organizations have managed communication with their public of interest during a crisis such as the temporary period of pandemic and post-pandemic, where the World Economic Forum states that it is a time of restart where a great social and economic restart is necessary. The main objective of this work is to know the institutional behavior of the British and Spanish Royal Houses through their respective Twitter accounts to determine convergences, synergies, and communicative styles in the digital environment. All this looking for the keys to the strategic management of the relations of both institutions with their citizens. A quantitative methodological design was established, based on content analysis (Kripendorff’s alpha coefficient=0.852) on a corpus of 2211 messages issued during 2021 by the official Twitter accounts @RoyalFamily (1025 tweets) and @CasaReal (1186 tweets). The results show a significant difference in the content broadcasted, the regularity of the frequency of tweets per hour of broadcast and the interaction, viralization and engagement rates of each of the accounts analyzed. These results show that Twitter is a powerful communication tool capable of seeking the mutual interest suggested by relationship postulates in periods of transition.

Resumen: La Casa Real es, probablemente, la más alta institución del Estado como sistema monárquico. En este sentido cabe cuestionarse cómo estos organismos han gestionado la comunicación, con sus públicos de interés, durante una situación de crisis como ha sido el periodo temporal de pandemia y postpandemia, donde el Foro Económico Mundial establece que es una época de reinicio donde es necesario un gran reinicio social y económico. El objetivo principal de este trabajo es conocer el comportamiento institucional de las casas reales británica y española a través de sus respectivas cuentas de Twitter para determinar convergencias, sinergias y estilos comunicativos en el entorno digital. Todo ello buscando las claves de la gestión estratégica de las relaciones de ambas instituciones con su ciudadanía. Se estableció un diseño metodológico cuantitativo, sustentado en el análisis de contenido (coeficiente alfa de Kripendorff = 0,852) sobre un corpus de 2211 mensajes emitidos durante 2021 por las cuentas oficiales de Twitter @RoyalFamily (1025 tuits) y @CasaReal (1186 tuits). Los resultados muestran una diferencia significativa en los contenidos emitidos, la regularidad de la frecuencia de los tuits por hora de emisión y las tasas de interacción, viralización y engagement de cada una de las cuentas analizadas. Estos resultados evidencian que Twitter es una poderosa herramienta de comunicación capaz de buscar el interés mutuo que sugieren los postulados relacionistas en periodos de transición.

The development of cost-effective molecular devices that efficiently capture and convert sunlight into other useful forms of energy is a promising approach to meet the world’s increasing energy demands. These devices are designed through a successful combination of materials and molecules that work synergistically to promote light-driven chemical reactions. Light absorption by a surface-bound chromophore triggers a sequence of interfacial electron transfer processes. The efficiencies of the devices are governed by the dynamic balance between the electron transfer reactions that promote energy conversion and undesirable side reactions. Therefore, it is necessary to understand and control these processes to optimize the design of the components of the devices and to achieve higher energy conversion efficiencies. In this context, this review discusses general aspects of interfacial electron transfer reactions in dye-sensitized TiO2 molecular devices for solar energy conversion. A theoretical background on the Marcus-Gerischer theory for interfacial electron transfer and theoretical models for electron transport within TiO2 films are provided. An overview of dye-sensitized solar cells (DSSCs) and dye-sensitized photoelectrosynthesis cells (DSPECs) is presented, and the electron transfer and transport processes that occur in both classes of devices are emphasized and detailed. Finally, the main spectroscopic, electrochemical and photoelectrochemical experimental techniques that are employed to elucidate the kinetics of the electron transfer reactions discussed in this review are presented.

ABSTRACT The present work concerns the COVID-19’s spread over The United States, Brazil and Colombia. Although countries show differences in economic development, but similarities such as continental dimension or native social interaction, the spread of COVID-19 in them has some similarities. At the moment, the countries are living the disease with temporal delay. Thus, we used a database on WHO Coronavirus, Mathematical Modeling and Numerical Simulations to describe the most recent COVID-19 development patterns in these countries, which we saw.

RESUMEN Los neutrófilos juegan un papel muy importante en la defensa inmune contra diferentes patógenos. Estas células participan activamente en la respuesta inmune innata a través de diferentes funciones como quimiotaxis, fagocitosis, estallido oxidativo y degranulación, las cuales han sido estudiadas ampliamente. Sin embargo, en los últimos años se ha descrito una nueva función; los neutrófilos activados son capaces de liberar redes de cromatina llamadas trampas extracelulares de neutrófilos (NETs). Estas estructuras están formadas por ADN, histonas y proteínas capaces de inmovilizar y matar microorganismos. Alteraciones en la formación de estas NETs están asociadas con la fisiopatología de varios trastornos, incluyendo las enfermedades autoinmunes (EAI). Las NETs son consideradas una fuente de autoantígenos que ayudan a la producción de autoanticuerpos y al mantenimiento de un ambiente inflamatorio. Esta revisión resume la contribución de las NETs a la patogénesis de vasculitis asociada a anticuerpos contra el citoplasma de los neutrófilos, lupus eritematoso sistémico y artritis reumatoide. Adicionalmente, se describirán los resultados preliminares de la detección de componentes de las NETs en pacientes con síndrome de Sjögren.

ABSTRACT Neutrophils play an important role in immune defence against several pathogens. These cells actively participate in the innate immune response through different functions, such as chemotaxis, phagocytosis, oxidative burst and degranulation, which have been widely studied. However, in the last few years, a new function has been described; activated neutrophils are able to release web-like chromatin structures known as neutrophil extracellular traps (NETs). These structures formed by DNA, histones, and proteins, immobilize and kill microorganisms. Disruption in NET formation is associated with the pathophysiology of several disorders, including the autoimmune diseases. NETs are an important source of the autoantigens involved in the production of autoantibodies and maintenance of the inflammatory milieu. This review provides a summary of the contribution of NETs to the pathogenesis of anti-neutrophil cytoplasmic antibodies-associated vasculitis, systemic lupus erythematosus, and rheumatoid arthritis. The preliminary findings on NETs components in Sjögren.'s syndrome will also be described.

RESUMO Objetivo: Avaliar a reprodutibilidade das medições da retina e da coroide nas áreas macular e peripapilar utilizando a tomografia de coerência ótica com fonte de varredura pacientes com doença de Parkinson. Métodos: Um total de 63 olhos de 63 pacientes com doença de Parkinson idiopática foram avaliados usando um protocolo 3D de tomografia de coerência ótica de fonte Triton Swept. Foram analisadas as seguintes camadas: espessura retiniana total, camada de fibras nervosas da retina, camada de células ganglionares e coróide. O coeficiente de variação foi calculado para cada medição. Resultados: Na área macular, os coeficientes médios de variação da espessura da retina, da camada de células ganglionares + espessura e da espessura da coróide foram de 0,40%, 0,84% e 2,09%, respectivamente. Em relação à área peripapilar, o coeficiente médio de variação da espessura da camada de fibras nervosas da retina foi de 2,78%. O quadrante inferior apresentou a maior reprodutibilidade (coeficiente de variação= 1,62%), enquanto o setor superonasal apresentou a menor reprodutibilidade (coeficiente de variação= 8,76%). Conclusões: A tomografia de coerência ótica de fonte Triton Swept fornece medições altamente reprodutíveis da espessura da retina e da coroide nas áreas macular e peripapilar. A reprodutibilidade é maior nas medidas da espessura da retina versus a espessura da coróide.

ABSTRACT Purpose: To assess the reproducibility of retinal and choroidal measurements in the macular and peripapillary areas using swept-source optical coherence tomography in patients with Parkinson’s disease. Methods: A total of 63 eyes of 63 patients with idiopathic Parkinson’s disease were evaluated using a three-dimensional protocol of swept-source optical coherence tomography. The following layers were analyzed: full retinal thickness, retinal nerve fiber layer, ganglion cell layer, and choroid. The coefficient of variation was calculated for every measurement. Results: In the macular area, the mean coefficients of variation of retinal thickness, ganglion cell layer + thickness, and choroidal thickness were 0.40%, 0.84%, and 2.09%, respectively. Regarding the peripapillary area, the mean coefficient of variation of the retinal nerve fiber layer thickness was 2.78. The inferior quadrant showed the highest reproducibility (coefficient of variation= 1.62%), whereas the superonasal sector showed the lowest reproducibility (coefficient of variation= 8.76%). Conclusions: Swept-source optical coherence tomography provides highly reproducible measurements of retinal and choroidal thickness in both the macular and peripapillary areas. The reproducibility is higher in measurements of retinal thickness versus choroidal thickness.

Abstract Post-translational modification of proteins by ADP-ribosylation, catalysed by poly (ADP-ribose) polymerases (PARPs) using NAD+ as a substrate, plays central roles in DNA damage signalling and repair, modulates a range of cellular signalling cascades and initiates programmed cell death by parthanatos. Here, we present mechanistic aspects of ADP-ribose modification, PARP activation and the cellular functions of ADP-ribose signalling, and discuss how this knowledge is uncovering therapeutic avenues for the treatment of increasingly prevalent human diseases such as cancer, ischaemic damage and neurodegeneration.

ABSTRACT Introduction: The syndrome of pudendal nerve entrapment (SANP) is a clinical entity, little known in the field of General Surgery, which includes a wide range of urinary, sexual and proctological symptoms. The interest for the general surgeon lies in the whole clinic that these patients can present in the proctological sphere. Complex diagnosis requires a sequential treatment that includes different tools. The aim of the present study is to expose the SANP from the point of view of general surgery by exposing a study carried out in patients with proctalgia to assess the results at follow-up after 6 months. Methods: We present an observational study evaluating 53 proctalgia patients in the context of a SANP who have undergone corticoid-anesthetic puncture-hydrodistension of the pudendal nerve and its terminal branches, observing its immediate response in clinical terms of pain and in follow-up to from six months. Results: From the data obtained from our sample, it is observed that the treatment with these punctures improves to 79.25 % of the patients in the immediate period after the puncture and 39.62 % of the patients maintain this improvement after the six months. Conclusions: We conclude that in the presence of proctalgia the surgeon should rule out the existence of a SANP and that, according to our study, corticoid-anesthetic puncture treatment is an effective treatment option that manages to improve an important percentage of patients.

RESUMEN Introducción: El síndrome de atrapamiento del nervio pudendo (SANP) es una entidad clínica, poco conocida en el ámbito de la Cirugía General, que comprende un amplio abanico de síntomas urinarios, sexuales y proctológicos. El interés para el cirujano general radica en toda la clínica que pueden presentar estos pacientes en la esfera proctológica. De diagnóstico complejo, exige un tratamiento secuencial que incluye distintas herramientas. El objetivo del presente estudio es exponer el SANP desde el punto de vista de la cirugía general, exponiendo un estudio realizado en pacientes afectos de proctalgia para valorar los resultados en el seguimiento a partir de los seis meses. Métodos: Presentamos un estudio observacional que evalúa 53 pacientes afectos de proctalgia en el contexto de un SANP que han sido sometidos a tratamiento con punción-hidrodistensión corticoideo-anestésica del nervio pudendo y sus ramas terminales, observando su respuesta inmediata en términos clínicos de dolor y en seguimiento a partir de los seis meses. Resultados: De los datos obtenidos de nuestra muestra, se observa que el tratamiento con dichas punciones mejora al 79,25 % de los pacientes en el periodo inmediato tras la punción, y el 39,62 % de los pacientes mantienen dicha mejoría a partir de los seis meses. Conclusiones: Concluimos que ante la presencia de proctalgia, el cirujano debe descartar la existencia de un SANP y que, según nuestro estudio, el tratamiento con punción corticoideo-anestésica es una opción eficaz de tratamiento que logra mejorar a un importante porcentaje de pacientes.

Abstract Spontaneous hepatic rupture during labour is a rare condition. Because of the difficulty in diagnosing hepatic rupture in pregnant women, it is often associated with a high mortality rate. Although pregnant women with HELLP syndrome are more prone to hepatic rupture, it can also occur with other liver pathologies and even in healthy women. We should be vigilant in case of suspicious clinical signs even if we have no evidence of preeclampsia. An early diagnosis will be the key to reducing the mortality and morbidity rate.

Resumen La aparición de una ruptura hepática en el transcurso de un embarazo normal es algo excepcional. A veces el diagnóstico de ruptura hepática puede ser difícil, lo que condiciona una elevada tasa de mortalidad. Aunque la ruptura hepática es más frecuente que se asocie en gestantes con síndrome de HELLP, también puede ocurrir en pacientes afectas de otras patologías hepáticas, incluso en pacientes sanas. Se debe mantener el estado de vigilancia ante cuadros clínicos sospechosos aun sin evidencia analítica de alteración hepática ni hemodinámica de hipertensión del embarazo, ya que un diagnóstico temprano facilitará el trabajo multidisciplinar que precisa el manejo de esta patología y disminuirá la morbilidad y mortalidad tanto materna como fetal.

The photochemistry and photophysics of coordination compounds have been extensively investigated not only because their structure, stability, reactivity dependence on the metal center oxidation state and the coordinated ligand; but also for their electronic transitions in a wide range of visible radiation. The knowledge of light absorption, excited state deactivation, sensitization and quenching processes are crucial to their manipulation aiming the development of systems capable of execute useful functions such as photosensors and/or probes, luminescent devices and molecular systems to convert sunlight into other types of energy. In this review, the progresses and challenges of biomolecules photosensors, organic light emitting diodes and CO2 photoreduction catalysts based on ruthenium(II), rhenium(I) or iridium(III) coordination compounds are discussed based on their photochemical and photophysical processes.

El uso actual de estevia, a escala industrial, se ha incrementado a nivel mundial, argumento que conlleva a buscar zonas de mejor adaptación del cultivo, en muchas regiones del país. El objetivo de este trabajo fue analizar la estabilidad de los rendimientos y los contenidos de glucósidos de esteviol de Stevia rebaudiana Bert., en función de la oferta de luz de cinco regiones de Colombia. En cada sitio, se construyeron cinco parcelas experimentales del cultivar Morita II, en las localidades de Montería, Córdoba; Campamento, Antioquia; Palmira , Valle del Cauca; Fonseca, La Guajira y Valledupar, Cesar, bajo un diseño de bloques completos al azar, con dos tratamientos de radiación difusa y directa, con cinco repeticiones. Se cuantificaron los contenidos de esteviósido (Stv), rebaudiósido A (RebA), glucósidos principales (GP) en mg.kg-1 de hoja seca, por cromatografía líquida de alta eficacia; la relación RebA/Stv y el rendimiento de hoja seca, en kg.ha-1. Se realizó análisis de varianza y prueba de comparación de medias de Duncan (α=0,05). Los niveles de radiación no afectaron la síntesis de Stv y RebA, tampoco se presentó interacción entre los niveles de radiación de las localidades. Se registraron diferencias significativas en los contenidos de Stv, RebA y la relación RebA/Stv, entre las localidades. En Palmira, con 132,26mg.kg-1, se obtuvieron los mayores contenidos de RebA, mientras que la mayor relación RebA/Stv de 10:1mg.g-1, que define la calidad de la hoja, se observó en Montería.

The current use at industrial-scale of stevia has increased in the world, context that emphasizes the interest to search best areas for planting the crop in many regions of the country. The objective of this work was to analyze the yield stability and content of steviol glycosides of Stevia rebaudiana Bert. in function of light offer in five regions of Colombia. Five experimental plots of the cultivar Morita II were selected, located in Monteria-Cordoba; Campamento - Antioquia; Palmira - Valle del Cauca; Fonseca - Guajira and Valledupar - Cesar, under a complete random block design with two treatments, diffuse and direct radiation, with five replicates for each locality. The content of stevioside (Stv), rebaudioside A (RebA), main glycosides (GP) in mg.kg-1 of dry leaf, with a liquid chromatography of high-efficacy and the relationship Reba/Stv and yield in kg.ha-1 of dry leaf was quantified. Data were analyzed through analysis of variance and Duncan's mean comparison test (α=0.05). The analysis of variance indicated that radiation levels did not affect the synthesis of Stv and RebA and no interaction between radiation levels by locality was detected. Significant differences in the content of Stv, RebA and relation RebA/Stv between the localities were determined. At Palmira, with 132.26mg.kg-1 the highest content of RebA was recorded, while the major relationship RebA/Stv, which defines the leaf quality, of 10:1mg.g-1 was obtained at Monteria.

Objective: To assess the association between mortality in surgery of congenital heart disease in adults, and factors related to patients and operations. Method: Descriptive study of operations performed by specialized surgeons in congenital heart surgery (238), adult acquired surgery (117), and specialty residents (108). The association of mortality with surgical risk and complexity, specialization of surgeon, cardiopulmonary by-pass and aortic cross clamping was assessed fitting logistic regression models. Results: A total of 463 operations were included (442 with cardiopulmonary by-pass) in the study performed between 1991 and 2012. Median age at surgery: 34; 52.8% were women. First surgery: 295, reoperation: 168. Median score of Aristotle was 6.8, with significantly higher complexity since 2001, after restructuring the Unit. Overall hospital mortality was 3.9%. Mortality was significantly associated to number of previous surgeries (OR: 5.02; 95%CI: 1.44-17.52), operations by acquired heart disease surgeons (OR: 3.53; 95%CI: 1.14-10.98), higher Aristotle (OR: 1,64; 95%CI: 1.18-2.29), and high cardiopulmonary by-pass time (OR: 1.13; 95%CI: 1.07-1.19). Conclusions: Surgery of congenital heart disease in adults has been performed with low mortality. High complexity interventions, prolonged cardiopulmonary by-pass times and multiple reoperations were associated to higher mortality. Participation of cardiac surgeons specialized in congenital heart disease is associated with better outcomes.

Objetivo: Analizar la asociación entre mortalidad en cirugía de cardiopatías congénitas del adulto y los factores relacionados con el paciente y la intervención. Método: Estudio descriptivo de intervenciones por cirujanos con actividad habitual en cardiopatías congénitas (238), cardiopatías adquiridas (117) y residentes (108). Se evaluó la asociación de la mortalidad con el riesgo y complejidad quirúrgica, actividad habitual del cirujano, y tiempo de circulación extracorpórea y de pinzamiento aórtico, mediante modelos de regresión logística. Resultados: Se incluyeron 463 cirugías (442 con circulación extracorpórea) entre 1991 y 2012. Edad mediana de intervención: 34 años (52.8% mujeres); primera cirugía 295, reintervención 168. La puntuación mediana del Aristóteles fue 6.8, con complejidad significativamente mayor tras reestructurarse la Unidad en 2001. La mortalidad hospitalaria total fue del 3.9%. La mortalidad se asoció significativamente al número de intervenciones previas (OR: 5.02; IC 95%: 1.44-17.52), intervenciones por cirujanos de cardiopatía adquirida (OR: 3.53; IC 95%: 1.14-10.98), Aristóteles alto (OR: 1,64; IC 95%: 1.18-2.29), y tiempos prolongados de extracorpórea (OR: 1.13; IC 95%: 1.07-1.19). Conclusiones: La mortalidad en cirugía de cardiopatía congénita en adultos es baja. Las intervenciones de alta complejidad, tiempos elevados de extracorpórea y múltiples reintervenciones se asocian con mayor mortalidad. La participación de cirujanos especialistas en cardiopatías congénitas se asocia con mejores resultados.

A raiva transmitida por morcegos hematófagos da espécie Desmodus rotundus representa uma preocupação de saúde pública e causa de importantes prejuízos para a pecuária brasileira. A evidência atual sugere que a ocorrência de raiva está relacionada às características da paisagem, topografia, hidrografia, sistemas de produção animal e usos da terra. Contudo, existem poucos estudos que analisem as possíveis conexões entre fatores geográficos e a diversidade molecular do vírus da raiva, permitindo a compreensão da dinâmica espacial e temporal dos focos de raiva. Um desses trabalhos estabeleceu que a última epizootia de raiva dos herbívoros registrada no leste do estado de São Paulo (na fronteira com Minas Gerais), aconteceu em duas ondas epidêmicas, sendo a primeira em 1998 e, em 1999, a segunda. Considerando esta evidência, o intuito do presente estudo foi analisar casos de raiva em herbívoros na região sudeste de Minas Gerais (2000-2009) e sua possível relação com a epidemia previamente mencionada, incluindo as características geográficas da região. Foram obtidas sequencias parciais dos genes da glicoproteína (539 nt) e da nucleoproteína (414 nt) a partir de 31 isolados de vírus da raiva procedentes de herbívoros. Foi proposta uma árvore filogenética para cada região genômica usando o método de Neighbor joining, fixando o modelo evolutivo Kimura 2 - parâmetros com um nível de bootstrap de 1000 replicações. As sublinhagens genéticas foram localizadas sobre mapas, considerando as áreas de risco para raiva dos herbívoros em São Paulo, assim como as características topográficas e bacias hidrográficas com o intuito de visualizar qualquer padrão aparente de distribuição segundo essas características. As duas árvores filogenéticas mostraram topologias concordantes, sugerindo uma possível origem comum para os surtos que aconteceram ao longo da fronteira SP/MG, ao redor das porções menos elevadas da Serra da Mantiqueira e acompanhando as bacias hidrográficas dos rios Piracicaba/Jaguarí, Paranaíba do Sul, Grande, Pardo e Mogi-Guaçu. Foi possível observar circulação de varias linhagens virais simultaneamente em alguns municípios, possivelmente por causa de sobreposição de surtos. As sequencias de proteína inferidas a partir dos dois genes mostraram mutações sinônimas, excetuando aquelas encontradas entre os resíduos 20 a 200, correspondentes ao domínio externo da glicoproteína. Esta informação salienta a importância da cooperação entre as autoridades sanitárias de ambos os estados para reforçar o programa de controle da doença nas áreas limítrofes.

Rabies transmitted by the hematophagous bat Desmodus rotundus represents a public health concern and a burden for the Brazilian livestock industry. Current evidence suggests that rabies occurrence is related to landscape characteristics, topography, hydrography, animal production systems and land use. However, a few studies have analyzed the possible connections among geographic factors and the molecular diversity of the rabies virus, furthering the understanding of the spatial and temporal dynamics of outbreaks. A study reported that the latest rabies epizootics in herbivores reported in the eastern region of São Paulo (close to the Minas Gerais border) occurred in two epidemic waves; the first was before 1998, and the other occurred after 1999. Using this evidence, the aim of the present study was to analyze cases of rabies in herbivores in the southern region of Minas Gerais (2000-2009) and their possible relationship with the aforementioned epidemics, considering the geographic characteristics of the region. Partial sequences of glycoprotein (539 nt) and nucleoprotein genes (414 nt) were obtained from 31 rabies virus isolates from herbivores. A phylogenetic tree was proposed for each genomic region using the Neighbor joining method, fixing the Kimura 2-parameter evolution model with a bootstrap level of 1,000 replications. Genetic sublineages were plotted on maps, considering rabies risk areas for herbivores in São Paulo, as well as topographic characteristics and hydrographic basins, to visualize any apparent distribution pattern influenced by those features. The phylogenetic trees had concordant topologies, suggesting a possible common origin for rabies outbreaks in herbivores along the SP/MG border, surrounding the less elevated portions of the Serra da Mantiqueira and along the hydrographic basins of Piracicaba/Jaguarí, Paranaíba do Sul, Grande, Pardo and Mogi-Guaçu rivers.The co-circulation of several viral lineages was observed in some municipalities, possibly due to an overlapping of rabies outbreaks. Inferred protein sequences of both genes showed synonymous mutations, except among residues 20 to 200, corresponding to the external domain of the glycoprotein. This information prompted cooperation among the animal health services of both states to reinforce rabies control in the border area.

Background: Free choice is not easy when there is a lack of information. Methods for evaluating quality of care to provide patients with comprehensive and understandable information on hospital departments are therefore necessary. Objectives: To draft a methodological proposal for evaluating quality of care of hospital departments, the data of which can provide citizens with useful care quality information. The proposal should be based on consensus and on the experience of medical specialists, defining thus complementary paths to improvement. Methods: A Delphi study on the quality of care in Nephrology, comprising three phases: assessment results, necessary means for quality, and importance of medical advice and surveys among specialists. The questionnaire was administered to a panel of 32 nephrologists. Results: The nephrologists accepted the outcome criteria on quality of care 55/62 (89%), as well as the proposed means for quality of care 87/92 (95%). 81% of the nephrologists reported the validity and topicality of providing patients with specialist advice as to the most adequate department to better treat their kidney diseases. 86% of the panellists deemed appropriate to include surveys on medical advice as additional criteria for the evaluation of quality of care. Conclusions: It is possible to obtain a consensus-based methodological proposal for the evaluation and improvement of quality of care which includes results on quality of care, means for quality of care, and medical advice based on surveys carried out among specialists to identify the best Nephrology departments. This method could provide reliable and understandable guidance for citizens.

Antecedentes: La libre elección no es fácil cuando se carece de información adecuada. Para ello son necesarios métodos de evaluación de la calidad asistencial que ofrezcan al paciente una información integral y comprensible de los servicios hospitalarios. Objetivos: Definir una propuesta metodológica para evaluar la calidad asistencial de los servicios hospitalarios, cuyos resultados sirvan para ofrecer una información útil al ciudadano. La propuesta debe fundamentarse en el consenso y en la experiencia de los especialistas médicos y definir complementariamente vías de mejora. Métodos: Estudio Delphi sobre calidad asistencial en Nefrología, estructurado en tres apartados: evaluación de resultados, medios necesarios para la calidad, e importancia del consejo médico y de la encuesta a especialistas. El cuestionario fue cumplimentado por un panel formado por 32 nefrólogos. Resultados: Los nefrólogos aceptaron 55/62 (89 %) de los criterios de resultados en calidad asistencial. También aceptaron 87/92 (95 %) de los medios propuestos para la calidad asistencial. El 81 % de los nefrólogos consideró de actualidad el consejo médico de un especialista a un paciente acerca del servicio donde podrían tratar mejor su enfermedad. Un 86 % creyó oportuno incluir encuestas sobre consejo médico como criterio adicional en la evaluación de la calidad asistencial. Conclusiones: Es posible obtener una propuesta metodológica consensuada para la evaluación y mejora de la calidad asistencial que incluya resultados de calidad asistencial, medios para la calidad asistencial y el consejo médico derivado de encuestas a especialistas para identificar los mejores servicios. Este método podría facilitar una orientación fiable y comprensible para el ciudadano.