Resumen Antecedentes: Los aneurismas de la arteria carótida interna (ICA) son hallazgos inusuales, representado el 0.4-4% de todos los aneurismas periféricos y el 1% de la patología carotídea. Objetivo: Evaluar el diagnóstico poco común de un aneurisma de carótida, considerando los antecedentes y estilo de vida del paciente. Métodos: Se presenta el caso clínico de una mujer de 54 años practicante de yoga, con tres semanas de evolución de sensación de masa pulsátil en el lado derecho del cuello. No relataba antecedentes de cateterismos, traumatismos o infecciones. Las imágenes de ultrasonido revelaron un aneurisma sacular permeable de 1.6 cm dependiente de la ICA. Durante la cirugía no encontramos signos de daño endotelial. Resultados: Se realizó resección electiva primaria, siendo dada de alta en el segundo día post-operatorio. Los seguimientos mostraron resolución completa de la imagen y síntomas. Las muestras tomadas en el intraoperatorio no demostraron alteraciones. Conclusiones: Es de suma importancia el poder indagar en los antecedentes del paciente para poder filiar una causa etiológica en hallazgos poco comunes.

Abstract Background: Aneurysms of the internal carotid artery (ICA) are a rare finding, only accounting for 0.4-4% of all peripheral aneurysm and 1% of all carotid diseases. Objective: To evaluate the clinical findings of a carotid aneurysm, considering the patient's background. Methods: A 54-year-old woman intense yoga practitioner presented with 3 weeks development of a pulsatile mass on the right side of the neck. No history of intravenous catheters, traumatism, or local infections. Ultrasound images revealed a 1.6 cm patent saccular aneurysm ICA dependent. During surgery, visualization of the aneurysm was seen without sign of endothelial damage. Results: Patient underwent elective resection with primary repair and was discharged 2-day postoperatively. Follow-ups revealed complete resolution of the symptoms with intraoperative tissue samples coming back without abnormalities Conclusions: It is of utmost importance to inquire into the patient's background and perspective in being able to find an etiological case in rare findings.

ABSTRACT Introduction: There is a lack of information about cardiac surgery training and professional practice in Latin American (LATAM) countries. This study is the first comparative analysis of cardiac surgical training and professional practice across LATAM and provides the fundamentals for future academic projects of the Latin American Association of Cardiac and Endovascular Surgery (LACES). Methods: International survey-based comparative analysis of the training and professional practice of cardiac surgeons across LATAM. Trainees (residents/fellows) and staf (graduated) surgeons from LATAM countries were included. Results: A total of 289 respondents (staf surgeons N=221 [76.5%]; residents/fellows N=68 [23.5%]) from 18 different countries participated in the survey. Most surgeons (N=92 [45.3%]) reported being unsatisfied with their salaries. Most respondents (N=181 [62.6%]) stated that it was difficult to obtain a leadership position, and 149 (73.8%) stated that it was difficult to find a job after completing training. Only half of the trainee respondents (N=32 [47.1%]) reported that their program had all resident spots occupied. Only 22.1% (N=15) of residents/fellows were satisfied with their training programs. The majority (N=205 [70.9%]) of respondents would choose cardiac surgery as their specialty again. Most surgeons (N=129 [63.9%]) and residents/fellows (N=52 [76.5%]) indicated that the establishment of a LATAM cardiac surgery board examination would be beneficial. Conclusion: Modernization and standardization of training, as well as greater access to opportunities, may be required in LATAM to increase professional satisfaction of cardiac surgeons and to reduce disparities in the specialty. Such changes may enhance the regional response to the dynamic challenges in the feld.

Resumen OBJETIVO: Evaluar las tasas de cesárea en la finalización de embarazos registrados en el sector privado de la Obra Social de la provincia de Buenos Aires (Instituto de Obra Médico Asistencial) entre los años 2017 a 2021. MATERIALES Y MÉTODOS: Estudio analítico y descriptivo de cesáreas registradas en el Sistema de Modulación Centro Único de Auditoría y Fiscalización IOMA (CUAFI) de las 13 regiones sanitarias de la provincia de Buenos Aires. Se describen los porcentajes de cesárea por año y por región sanitaria. RESULTADOS: Se registraron 75,244 partos únicos. En el año 2017 el porcentaje de cesáreas se incrementó de 69.0% (12,600 cesáreas de 18,258 partos) a 73.6% (8,232 cesáreas de 11,180 partos) en 2021. Los mayores porcentajes de cesárea se registraron en la Región IV (83.6%), la Región XIV (81.7%) y Región X (78.9%). CONCLUSIÓN: El alto porcentaje de cesáreas registrado y el incremento en los últimos años muestra la necesidad de diseñar intervenciones para reducir su tasa. Será importante contar con información de sus indicaciones y explorar intervenciones destinadas al personal de salud y a las mujeres para reducir su práctica.

Abstract OBJECTIVE: To evaluate the rates of caesarean section in the termination of pregnancies registered in the private sector of the Obra Social of the province of Buenos Aires (Instituto de Obra Médico Asistencial) between 2017 and 2021. MATERIALS AND METHODS: Analytical and descriptive study of caesarean sections registered in the Modulation System of the IOMA Single Audit and Control Centre (CUAFI) of the 13 health regions of the province of Buenos Aires. The percentages of caesarean sections per year and per health region are described. RESULTS: 75,244 singleton deliveries were registered in the private sector of the Instituto de Obra Médico Asistencial. In 2017, the percentage of caesarean sections increased from 69.0% (12,600 caesarean sections out of 18,258 deliveries) to 73.6% (8,232 caesarean sections out of 11,180 deliveries) in 2021. The highest caesarean section rates were recorded in Region IV (83.6%), Region XIV (81.7%) and Region X (78.9%). CONCLUSION: The high percentage of caesarean sections recorded and the increase in recent years shows the need to design interventions to decrease the rate. It is important to have information on the indications for caesarean section and to explore interventions aimed at health personnel and women to reduce the rate.

ABSTRACT Introduction: Since the coronavirus disease 2019 (COVID-19) pandemic, cardiac surgeries in patients with previous infection by COVID-19 were suspended or postponed, which led to surgeries performed in patients with an advanced stage of their disease and an increase in the waiting list. There is a heterogeneous attitude in Latin America on the optimal timing to cardiac surgery in patients with previous COVID-19 infection due to scarce data on its outcome. Two Latin American associations joined to establish common suggestions on the optimal timing of surgery in patients with previous COVID-19 infection. Methods: Data collection was performed using a pre-established form, which included year of publication, objective, type of study (prospective/retrospective, descriptive/analytical), number of patients, year of study, waiting time between infection and surgery, type of surgery, morbidity, mortality, and conclusions regarding the association between mortality and morbidity. Final recommendations were approved by the board of directors of Latin American Association of Cardiac and Endovascular Surgery (LACES) and Latin American Confederation of Anesthesia Societies (CLASA). Results: Of the initial 1,016 articles, 11 comprised the final selection. Only six of them included patients who underwent cardiac surgery. According to the analyzed literature, optimal timing for cardiac surgery needs to consider the following aspects: deferable surgery, symptomatic COVID-19 infection, completeness of COVID-19 vaccination. Conclusion: These recommendations derive from the analysis of the scarce literature published at present on outcomes after cardiac surgery in patients with previous COVID-19 infection. These are to be taken as a dynamic recommendation in which Latin American reality was taken into consideration.

RESUMEN Los movimientos en masa detonados por lluvias son una de las causas más frecuentes de desastres en países tropicales y terrenos montañosos. Estudios recientes muestran un aumento en la ocurrencia de movimientos en masa como un impacto esperado del cambio climático inducido por el hombre. Este documento presenta el análisis y la implementación de dos modelos diferentes basados en la física, SHALSTAB y TRIGRS, para evaluar el efecto de las lluvias en la evaluación de peligros de movimientos en masa en los Andes del noroeste colombiano. Las curvas intensidad-duración-frecuencia se utilizaron en escenarios de cambio climático para diferentes períodos de retorno. Según los resultados, aunque aumentan las intensidades de lluvia más altas, la ocurrencia de movimientos en masa no aumenta en una relación directa o proporcional. Teniendo en cuenta un proceso de infiltración constante (SHALSTAB), los resultados muestran áreas inestables mayores, en comparación con un proceso de infiltración transitoria (TRIGRS). Se observó una mayor influencia de la duración de la lluvia en lugar de la intensidad de la lluvia. Los resultados resaltan la necesidad de estudios que incorporen los escenarios de variabilidad y cambio climático en la evaluación de amenaza y la ordenación del territorio a largo plazo.

ABSTRACT Landslides triggered by rainfall are one of the most frequent causes of disasters in tropical countries and mountainous terrains. Recent studies show an upsurge in landslide occurrence as an expected impact of human-induced climate change. This paper presents the analysis and implementation of two different physically-based models, SHALSTAB and TRIGRS, to evaluate the effect of rainfall on landslide hazard assessment in the north-western Colombian Andes. Intensity-Duration-Frequency curves were used in climate change scenarios for different return periods. According to the results, although higher rainfall intensities increase, landslide occurrence does not escalate in a direct or proportional relationship. Considering a steady infiltration process (SHALSTAB), the results show an expansion of d unstable areas, compared with a transient infiltration process (TRIGRS). A greater influence of rainfall duration instead of rainfall intensity was observed. The results highlight the need for studies that incorporate the scenarios of variability and climate change in the hazard assessment and land planning in the long term.

Introduction: work disability is an important outcome in the treatment of spondyloarthritis (SpA) since this disease affects people in the most productive stage of life. Objectives: to investigate working status in patients with axial spondyloarthritis (axSpA) from Argentina, including ankylosing spondylitis (AS) and nonradiographic axial SpA (nr-axSpA), and to evaluate factors associated with work productivity loss (WPL) in this national cohort and factors associated with being employed. Materials and methods: patients with a diagnosis of AS and nr-axSpA according to Assessment of SpondyloArthritis international Society (ASAS 2009) classification criteria and in working age (≤65 years) were included in this multicentric cross-sectional study. Outcomes of interest were employment status, absenteeism and presenteeism, assessed by the Work Productivity and Activity Impairment Spondyloarthritis (WPAI-SpA) questionnaire. Spearman's coefficient was used to assess the correlation between disease measures and WPL. Bivariate and multivariate analysis were performed in order to evaluate factors associated with being employed. Results: 129 patients with axSpA were included, 95 (73.6%) with AS and 34 (26.4%) with nr-axSpA. Median (p25-75) age of 45 (35-55) years. Median (p25-75) disease duration was 62 (24-123) months and diagnosis delay was 24 (6-72) months. 60 (46.5%) of the patients were employed. Median (p25-75) presenteeism of AS patients was 29.6% (0-57) and 30% (20-40) for patients with EspAax-nr (p=0.02). Median (p25-75) WPL was 30% in both groups of patients. A positive correlation was found between WPL and the following variables: ASDAS (Rho:0.60), BASDAI (Rho:0.50), BASFI (Rho:0.60), ASQoL (Rho:0.60) and ASAS health index (Rho:0.54). In the bivariate analysis, the factors associated with unemployment were AS diagnosis, older age, longer disease duration, comorbidities (hypertension and diabetes), fewer years of education, worse quality of life and lower functional capacity. In the multivariate analysis, better physical function (assessed by BASFI) was independently associated with being employed. Conclusions: this study showed that WPL in this national cohort was 30% in axSpA. It was associated with disease activity, health status, quality of life and functional capacity. Better physical function was independently associated with a higher likelihood of keeping patients with axSpA employed.

Introducción: las limitaciones laborales son un punto importante a considerar en el tratamiento de la espondiloartritis axial (EspAax) dado que esta enfermedad afecta a las personas en la etapa más productiva de la vida. Objetivos: describir la situación laboral en pacientes con EspAax de Argentina, incluyendo la espondilitis anquilosante (EA) y la espondiloartritis axial no radiográfica (EspAax-nr), y evaluar los factores asociados a la pérdida de productividad laboral (PPL) en esta cohorte nacional y los factores asociados a estar empleado. Materiales y métodos: en este estudio transversal y multicéntrico se incluyeron pacientes con diagnóstico de EA y EspAax-nr según los criterios de clasificación de la Assessment of SpondyloArthritis international Society (ASAS 2009) y en edad laboral (≤65 años). Los objetivos principales fueron evaluar la situación laboral, el ausentismo y el presentismo, valorados por el cuestionario Work Productivity and Activity Impairment Spondyloarthritis (WPAI-SpA). Se utilizó el coeficiente de Spearman para evaluar la correlación entre las medidas de la enfermedad y la PPL. Se realizó un análisis bivariado y multivariado para evaluar los factores asociados a estar empleado. Resultados: se incluyeron 129 pacientes con EspAax, 95 (73,6 %) con EA y 34 (26,4%) con EspAax-nr. La mediana (p25-75) de edad fue de 45 (35-55) años. La duración mediana de la enfermedad fue de 62 (24-123) meses y el retraso en el diagnóstico fue de 24 (6-72) meses. Sesenta (46,5%) pacientes estaban empleados. La mediana (p25-75) de presentismo de los pacientes con EA fue del 29,6% (0-57) y del 30% (20-40) para los pacientes con EspAax-nr (p=0,02). Asimismo, la mediana (p25-75) de PPL fue del 30% en ambos grupos de pacientes. Se encontró una correlación positiva entre la PPL y las siguientes variables: ASDAS (Rho:0.60), BASDAI (Rho:0.50), BASFI (Rho:0.60), ASQoL (Rho:0.60) y ASAS health index (Rho:0.54). En el análisis bivariado, los factores asociados al desempleo fueron el diagnóstico de EA, la edad avanzada, la mayor duración de la enfermedad, las comorbilidades (hipertensión y diabetes), el menor número de años de educación, la peor calidad de vida y la menor capacidad funcional. En el análisis multivariado, una mejor función física (evaluada por BASFI) se asoció de forma independiente a estar empleado. Conclusiones: este estudio demostró que la PPL en esta cohorte nacional fue del 30% en la EspAax. Se asoció con la actividad de la enfermedad, el estado de salud, la calidad de vida y la capacidad funcional. Una mejor función física se relacionó en forma independiente con una mayor probabilidad de mantener a los pacientes con EspAax empleados.

ABSTRACT The case report of a 58 years patient with personal history of a poor controlled congestive heart failure is described, who went to the emergency service of Luis Bernaza Hospital in Guayaquil, Ecuador, due to a diffuse abdominal pain, constipation and giant inguinoescrotal mass. The pertinent studies were carried out and a giant inguinoescrotal hernia is diagnosed with home loss, without data of intestinal obstruction. The Goñi Moreno technique was used during 12 days to increase the diameter of the abdominal cavity and return the content from the sack to its place. An exploratory laparotomy and hernioplastia were carried out with satisfactory result and follow up in the outpatient department during 2 months, without alterations.

RESUMEN Se describe el caso clínico de un paciente de 58 años de edad con antecedentes personales de insuficiencia cardiaca congestiva mal controlada, quien acudió a emergencias del Hospital Luis Bernaza de Guayaquil, Ecuador, por presentar dolor abdominal difuso, constipación y masa inguinoescrotal gigante. Se realizan los estudios pertinentes y se diagnostica una hernia inguinoescrotal gigante con pérdida de domicilio, sin datos de obstrucción intestinal. Se empleó la técnica de Goñi Moreno durante 12 días para aumentar el diámetro de la cavidad abdominal y regresar el contenido del saco a su lugar. Se efectuó laparotomía exploratoria y hernioplastia con resultado satisfactorio y seguimiento por consulta externa durante 2 meses, sin alteraciones.

Abstract Background: Difficult airway is a clinical situation in which a trained anesthesiologist experiences trouble with facemask ventilation and/or laryngoscopy and/or intubation. Poor identification of at-risk patients has been identified as one of the causes of difficult airway management. Objectives: We aimed to review the literature regarding the use of wristbands to identify adult patients with known or predicted difficult airway in hospitals. Methods: We searched Web of Science (WoS), Scopus, MEDLINE and OVID following the stages described by the PRISMA Extension for Scoping Reviews (PRISMA-ScR). We used a combination of MeSH terms and non-controlled vocabulary regarding the use of difficult airway wristbands in adults. Three researchers independently reviewed the full texts and selected the papers to be included based on the inclusion criteria. Results: Our search generated 334 articles after removing duplicates. After reviewing full text articles, only seven studies were included. Here we found that most were from the United States, in which the authors report the use of in-patients’ wristbands in adults. According to the authors, the use of wristbands is being implemented as a measure of improved quality and safety of in-patients with difficult airway either known or suspected. Conclusions: The identification with wristbands of a difficult airway at an appropriate time is an identification strategy can have a low cost but a high impact on morbidity. It is pertinent to develop a methodology such as the use of wristbands, that allows a good classification and identification of patients with difficult airway in hospitals from Latin America.

Resumen La justicia transicional ofrece mecanismos para garantizar la verdad, la justicia, la reparación y la no repetición a las víctimas de abusos contra los derechos humanos perpetrados durante regímenes dictatoriales y conflictos armados. Se trata de un marco jurídico que ha cobrado auge desde las últimas décadas del siglo veinte y, particularmente en Colombia, se ha constituido en una herramienta para afrontar los períodos posteriores a las negociaciones con grupos armados ilegales en los últimos veinte años. Así lo corrobora, entre otras, la presente revisión de 129 estudios y debates sobre experiencias de Comisiones de la Verdad entre 1997 y 2019.

Abstract Transitional justice provides mechanisms to ensure truth, justice, reparation, and non-repetition to victims of human rights abuses perpetrated during dictatorial re gimes and armed conflict. It is a legal framework, which has boomed since the last decades of the twentieth century and, particularly, in Colombia, has become a tool to deal with post-negotiation periods with illegal armed groups over the past twenty years. This is borne out, among others, by this review of 129 studies and discussions on the experiences of Truth Commissions between 1997 and 2019.

SUMMARY Immunohistochemistry (IH) allows to classify breast cancer in subtypes that are relevant for treatment and prognosis. Compared to genetic markers, IH is cheaper, easier to perform and has good correlation with molecular subtypes. Objective: To describe the immune phenotypic profile of patients with breast cancer attended at a public hospital in Lima, Peru. Methods: Cross-sectional study that included all cases of invasive breast cancer diagnosed from May 1st 2015 to April 30, 2017. Histopathological description was performed and cases were classified based on current protocols into four subtypes. Results: 330 cases were included; 71 were excluded; 259 were left for analysis. Mean age was 54.64 ± 14.07 years. In half of cases the cancer was located in the right breast. The invasive ductal carcinoma accounted for 88.03% of cases; the intermediate histological degree was found in 53.28% of cases. The molecular subtype Luminal A accounted for 40.15% and only 11.97% were non-luminal HER2/neu positive. Conclusions: One in four cases of breast cancer presented with the IH pattern of HER2/neu positive, while the most common IH subtype was Luminal A. Histological degree was associated with the IH subtype.

RESUMEN La inmunohistoquímica permite clasificar al cáncer de mama en subtipos que tienen relevancia para el tratamiento y pronóstico. En comparación con los marcadores genéticos, la inmunohistoquímica es de costos accesibles, más fácil de realizar y tiene buena correlación con los subtipos moleculares. Objetivo: Describir el perfil inmunohistoquímico de cáncer de mama en pacientes atendidos en un hospital general de Lima, Perú. Material y métodos: Estudio descriptivo, transversal y retrospectivo que incluyó todos los casos de carcinoma invasivo de mama diagnosticados entre el 1 de mayo de 2015 y el 30 de abril del 2017. Se realizó la descripción histopatológica de los casos y se los clasificó de acuerdo con los protocolos actuales en cuatro subtipos. Resultados: Se reportaron 330 casos de cáncer de mama, 71 fueron excluidos, quedando 259 para el estudio. La media de edad fue de 54,64 ± 14,07. La neoplasia se localizó de la mama derecha en la mitad de casos. El 88,03% correspondió al tipo histológico carcinoma invasivo ductal no especial, y el grado histológico fue intermedio en el 53,28% de los casos. El subtipo molecular fue Luminal A en el 40,15% del total, y solo un 11,97% de las muestras fueron HER2/neu positivo no luminal. Conclusiones: Uno de cada cuatro casos de cancer de mama presentó una inmunohistoquímica de Her2/neu positivo, mientras que el subtipo inmunohistoquímico más común de carcinoma de mama invasivo fue Luminal A. De igual forma, el grado histológico se asocia al subtipo inmunohistoquímico.

Aim: To determine the associated factors with mortality of adult patients hospitalized with COVID-19. Methods: We conducted a prospective cohort study and included patients older than 18 years hospitalized with the diagnosis of SARS-CoV-2 infection. Those patients with a positive rapid serological test on admission, but no respiratory symptoms nor compatible images were excluded. We collected the data from clinical records. Results: A total of 813 adults were included, 544 (66.9%) with confirmed COVID-19. The mean age was 61.2 years (SD: 15.0) and 575 (70.5%) were male. The most frequent comorbidities were hypertension (34.1%) and obesity (25.9%). The most frequent symptoms on admission were dyspnea (82.2%) and cough (53.9%). A total of 114 (14.0%) patients who received mechanical ventilation, 38 (4.7%) were admitted to the Intensive Care Unit (ICU) and 377 (46.4%) died. The requirement for ventilatory support, greater lung involvement, comorbidities, and inflammatory markers were associated with mortality. It was found that for every 10 - year increase in age, the risk of dying increased by 32% (RR: 1.32 95% CI: 1.25 to 1.38). Those who required admission to the ICU and mechanical ventilation had 1.39 (95% CI: 1.13 to 1.69) and 1.97 (95% CI: 1.69 to 2.29) times the risk of dying compared to those who did not. Conclusion:  We found a high mortality rate in hospitalized patients associated with greater age, more elevated inflammatory markers, and more severe respiratory compromise.

Objetivos. Determinar los factores asociados a mortalidad de los pacientes adultos hospitalizados con COVID-19 en un hospital de referencia de la seguridad social. Materiales y métodos. Se realizó un estudio de cohorte prospectivo. Se incluyó a pacientes mayores de 18 años hospitalizados con el diagnostico de infección por SARS-CoV-2 y se excluyó a quienes ingresaron asintomáticos respiratorios, con prueba rápida serológica positiva al ingreso y sin imágenes compatibles. Los datos se recolectaron a partir de la historia clínica. Resultados. Se incluyó un total de 813 adultos, 544 (66.9%) tuvieron COVID-19 confirmado. La media de la edad fue de 61.2 años (DE: 15.0) y 575 (70.5%) fueron de sexo masculino. Las comorbilidades más frecuentes fueron hipertensión arterial (34.1%) y obesidad (25.9%). Los síntomas más frecuentes al ingreso fueron disnea (82.2%) y tos (53.9%). Un total de 114 (14.0%) pacientes recibieron ventilación mecánica, 38 (4.7%) ingresaron a UCI y 377 (46.4%) fallecieron. El requerimiento de soporte ventilatorio, el mayor compromiso pulmonar, las comorbilidades y los marcadores inflamatorios se asociaron a la mortalidad. Se halló que por cada 10 años que aumenta la edad, el riesgo de morir se incrementa en 32% (RR: 1.32 IC95%: 1.25 a 1.38). Aquellos que requirieron ingreso a UCI y ventilación mecánica tuvieron 1.39 (IC95%: 1.13 a 1.69) y 1.97 (IC95%: 1.69 a 2.29) veces el riesgo de morir, respectivamente. Conclusión. La mortalidad encontrada en nuestro estudio fue alta y estuvo asociada a la edad,  marcadores inflamatorios y compromiso respiratorio. 

ABSTRACT INTRODUCTION: caracterization of patients managed with open abdomen in a 4th level (highest complexity) referral center in neiva, huila, Colombia between 2014-2018. OBJECTIVES: caracterization of patients managed with open abdomen, comorbidities, morbimortality previous to and afterwards primary fascial closure. MATERIAL AND METHODS: retrospective, observational, analitic, descriptive and transversal study in a cohort of patients with open abdomen in a 4 years time lapse RESULTS: 160 patients managed with open abdomen in which the most frequent etiology of OA was traumatic pathology in 36,2%, infectious disease in 26,2%, the most frequent abdominal closure technique used was bogota bag in 79,3%, followed by temporary skin-only closure in 11,2% and negative pressure therapy in 6,8%, first fascial closure was achieved in 51,2%, mortality before first fascial closure was 36,4% and mortality after was 6,0%. CONCLUSION: in a cohort that was similar in regards to causes of open abdomen to those in published literature, we found a high rate of fascial closure in spite of a low rate of negative pressure therapy use, also a similar mortality in the period previous to first fascial closure to that of similar cohorts in literature plus significant additional mortality burden of 6,0% after first fascial closure in those who had to go through additional abdominal surgery in a population with high morbidity burden.

RESUMEN INTRODUCCION: caracterización de los pacientes con abdomen en un centro de referencia de cuarto nivel en la ciudad de neiva, colombia entre los años 2014 al 2018. OBJETIVOS: caracterizar la casuística, comorbilidades y morbimortalidad de los pacientes con abdomen abierto y la morbimortalidad del periodo posterior al cierre primario del mismo. MATERIAL Y METODOS: Estudio retrospectivo, observacional, analítico, descriptivo, transversal, en la población con abdomen abierto en un periodo de 4 años. RESULTADOS: se estudiaron 160 pacientes en los que la etiología mas frecuente del AA fue el trauma en el 36,2%, la patología infecciosa en el 26,2%, la estrategia de cierre abdominal mas utilizada fue la bolsa de bogota en el 79,3%, seguido por el cierre temporal de la piel en el 11,2% y los sistemas de presión negativa en el 6,8%, el cierre definitivo en primera instancia se logro en el 51,2%, la mortalidad antes del primer cierre abdominal fue de 36,4% y la mortalidad posterior a este periodo fue del 6,0%. CONCLUSIONES: en una población homogénea en cuanto a la frecuencia de las causas que llevan al abdomen abierto descritas en la literatura, encontramos una alta frecuencia de cierre definitivo de la fascia a pesar del bajo uso de terapias asistidas por vacio y describimos una mortalidad similar a la referida en la literatura previo al primer cierre abdominal y una mortalidad adicional significativa en el curso posterior al cierre de 6,0% en pacientes con alta carga de morbilidad como causa del fallo del cierre primario

ABSTRACT The culture of dialogue demanded by public policy making contributes to the formation of proactive, transparent and co-leading governance. This article approaches the analysis of public policies, from an emancipatory perspective, from the possibility of building new governance using the culture of debate as a fundamental spring to create links between the actors of civil society. Its objective is to analyze the fundamental features of public policies in constant interaction with the culture of debate, as technologies that, with proper use, guarantee other governance.

RESUMEN La cultura del diálogo que demanda la hechura de políticas públicas contribuye a la formación de una gobernanza proactiva, transparente y coprotagónica. Este artículo se aproxima al análisis de políticas públicas, desde una perspectiva emancipadora, a partir de la posibilidad de construir una nueva gobernanza utilizando la cultura del debate como resorte fundamental para crear nexos entre los actores de la Sociedad civil. Sitúa como objetivo analizar los rasgos fundamentales de las políticas públicas en interacción constante con la cultura del debate, como tecnologías que, con un uso adecuado, garantizan otra gobernanza.

ABSTRACT Bioassays are an excellent tool in environmental risk assessment. The objective of the present work was to carry out ecotoxicological tests with the purpose of deducting the effect that the residuals of the Analytical Chemistry laboratory can have on the ecosystem from the consequences that it produces on a population of organisms that are a fundamental part of the trophic chain. The bioassays of acute toxicity laboratory with larvae of Artemia sp and with lettuce seeds (Lactuca sativa L.). Four concentrations of the study residual were tested: 5, 25, 50 and 100%, with three replicates each and a control group. In the Artemia sp assay, 100% mortality was obtained in all tested concentrations of the residual tested. Regarding the test with lettuce seeds, phytotoxic effects were evidenced, for the evaluated concentrations of the residual, causing inhibition in germination, in the elongation of the root and hypocotyl. In addition anomalies were found in the organs of growth of the plants in the concentrations of 5 and 25%. It is demonstrated that the residuals obtained in the laboratory of Analytical Chemistry of TOXIMED have toxic effects both for aquatic and terrestrial environments

RESUMEN Los bioensayos constituyen una excelente herramienta en la evaluación del riesgo ambiental. El objetivo del presente trabajo fue realizar ensayos ecotoxicológicos con el propósito de estudiar el efecto que los residuales del laboratorio de Química Analítica pueden tener sobre el ecosistema a partir de las consecuencias que produzca sobre una población de organismos que formen parte fundamental de la cadena trófica. Se emplearon los bioensayos de laboratorio de toxicidad aguda con larvas de Artemia sp y con semillas de lechugas (Lactuca sativa L.). Se probaron cuatro concentraciones del residual en estudio: 5, 25, 50 y 100%, con tres réplicas cada uno y un grupo control. En el ensayo de Artemia sp, se obtuvo un 100% de mortalidad en todas las concentraciones probadas del residual ensayado. En cuanto al ensayo con semillas de lechugas, se evidenciaron efectos fitotóxicos, para las concentraciones evaluadas del residual, ocasionando inhibición en la germinación, en la elongación de la raíz y del hipocótilo. Además se encontraron anomalías en los órganos de crecimiento de las plantas en las concentraciones de 5 y 25 %. Quedando demostrado que los residuales obtenidos en el laboratorio de Química Analítica de TOXIMED tienen efectos tóxicos tanto para los medios acuáticos, como para los terrestres.