Resumen El virus SARS-CoV-2 se ha extendido a nivel mundial, rápidamente ha sobrecargado los sistemas de salud. Esta emergencia ha implicado cambios en la atención usual del infarto agudo miocardio con elevación del ST (IAMCEST) puesto que la actividad habitual de las salas de hemodinamia y las vías de traslado de los pacientes se ha visto afectada. La afectación del personal de salud también es una preocupación relevante por lo que presentamos un documento de Consenso de la Asociación Costarricense de Cardiología que pretende generar una guía de trabajo al personal que atiende esta patología y garantizar la atención adecuada del IAMCEST durante la pandemia en Costa Rica.

Abstract The current COVID-19 has spread worldwide, the outbreak is altering the usual activity of the catheterization laboratorios and the usual treatment pathways of patients with chronic diseases or emergencies, such as Acute Coronary Syndrome could be disrupted. The involvement of health personnel is a relevant concern, so we created a consensus document of the Costa Rican Association of Cardiology that aims to generate a decision-making workflow to treat this pathology and guarantee adequate and continuous care for ST elevation myocardial infarction during the COVID-19 outbreak.

Resumen La reoperación en pacientes con cirugía cardiaca previa en bioprótesis disfuncionantes representa una situación de alto riesgo quirúrgico, con elevada morbi-mortalidad perioperatoria. En la actualidad en casos seleccionados, el tratamiento percutáneo transcateter permite reemplazar la válvula mitral con acceso transapical o transeptal. El reemplazo percutáneo de la válvula mitral, tiene menor morbilidad y mortalidad comparado con la cirugía convencional, representando una alternativa terapéutica, la cual representa la única opción en pacientes de alto riesgo quirúrgico. Se presentan dos casos tratados de forma exitosa en nuestro centro con acceso transapical y válvula percutánea balón expandible Sapien XT.

Abstract Transapical mitral Valve in Valve in Hospital México, report of two cases and literatura review Surgical reintervention in patients with previous open heart surgery represents a high risk condition, with high morbidity and mortality in the perioperative period. Nowdays in selected clinical situations of patiens with failing bioprosthesis in mitral position, transcatheter percutaneous treatment allows the replacement of the mitral valve with transapical or transseptal access. The transcatheter percutaneous mitral valve replacement has lower morbidity and mortality in comparison with conventional surgery, representing a therapeutic alternative, wich migth be the only option in high risk patients. We present two cases done at our center with success using apical access and the ballon expandable device Sapien XT.

South Africa is a water-scarce country with increasing pressure on its water resources. Urgent interventions are needed to protect water security within this rapidly developing country. This paper reports on an interdisciplinary Water Security Colloquium, convened by the South African Young Academy of Science in 2014. A selected group of water professionals from academia, civil society and local government was brought together to discuss water security under three focus themes: 'public expectations and municipal obligations', 'water security and governance: challenges and advances', and 'water re-use: health and infrastructural considerations'. Participant perceptions were generated using a focus group methodology, combined with participatory data collection methods. Under each theme, inputs were categorised as 'challenges', 'gaps in knowledge', and 'solutions/recommendations' and these inputs were thereafter ranked in order of importance via a 'voting' process. Major challenges perceived included a lack of both skills and political will in government, a need to restore citizen trust in government intention and capability to deliver water-related services, and a failure to up-scale existing water re-use technology. Participants identified understanding of the process and implications of the Green and Blue Drop Programmes, knowledge transfer to the public, and the role of educators as major knowledge gaps. The top suggestions proposed included creating public awareness around and buy-in to initiatives to improve water security, accessible and user-friendly conversion of research results to implementation, and ensuring an active role for educators in creating awareness around water security. In view of the concerns identified, participants suggested as potential solutions: improving government and public understanding around water issues, incentivising water re-use and conservation, introducing rising block tariffs and improving human capacity development in the water sector. Developing the ecological infrastructure that protects both quantity and quality of water and building strong partnerships among all stakeholders were also recognised as key.

This paper describes a collaborative process of identifying and prioritising current and future water research questions from a wide range of water specialists within South Africa. Over 1 600 questions were collected, reduced in number and prioritised by specialists working in water research and practice. A total of 59 questions were finally proposed as an outcome of the study and are categorised under the themes of change, data, ecosystems, governance, innovation and resources. The questions range in scale, challenge and urgency, and are also aligned with prevailing paradigms in water research. The majority of the questions dealt with relatively short- to medium-term research requirements and most focused on immediate issues such as water supply, service delivery and technical solutions. Formulations of long-term research questions were sparse, partly because some of the principles and methods used in this study were difficult to apply in the South African context, and also because researchers are influenced by addressing what are believed to be the more immediate, short-term water-related challenges in South Africa. This is the first initiative of its kind to produce a comprehensive and inclusive list of research priorities for water in South Africa.

The University of Cape Town's Faculty of Health Sciences, in its hundredth year, carries a strong current of its development in the inscriptions on its pediments, doorways and notice boards. These names describe the Faculty in each of its stages of evolution, and evoke a rich history. The named look down from their portraits with pride at the passing students, the staff, and the flourishing Faculty.

During the past 17 years in South Africa, far-reaching policy, legislation and institutional changes in water-related governance have occurred. Responsible leaders have ensured that a paradigm of integrated water resource management (IWRM) is firmly entrenched in the above policy, legislation and institutional arrangements. IWRM in turn demands a level of interaction between individuals, disciplines and organisations such that multi-sector, multi-level stakeholders can collectively, timeously, wisely and cost-effectively visit the consequences of their proposed, present and past actions. Such social learning processes demand leadership and the ongoing development of leaders at all levels. This paper is structured around the propositions for leadership development in the field outlined by Scharmer (2009a). The principal aim of the paper is to reveal the extent to which the multi-sector catchment management agency (CMA) phenomenon is an ideal crucible for leadership development in the field. It is argued that the complex adaptive system that embodies the water realm needs to be engaged by developing complex adaptive systems of governance and that the CMAs have the potential to meet this requirement. Furthermore, it is argued that processes to achieve this required leadership are also ideal for developing leadership. At a time when worldwide developments in communication and computer technology have spawned an exponential growth in successful endeavours related to self-organising around common challenges, the CMA provides a unique and nourishing context for self-organising that simultaneously connects to South Africa's water governance mainstream of policies, laws, institutions and administrative procedures.

A study was conducted in the Baynespruit, a small, highly-polluted, urban catchment in Pietermaritzburg, South Africa with 2 objectives: firstly, to develop an understanding of the views of stakeholders regarding the pollution problem and the relative importance of components of the problem; secondly, to identify and investigate non-statutory barriers and incentives to participation in multi-stakeholder processes aimed at integrated catchment management to create a healthy Baynespruit. The research methods embraced a number of different qualitative techniques, including a review of print media coverage, semi-structured interviews conducted with a cross-section of stakeholders, as well as participant and direct observation. The study identified the stakeholder groupings along with a number of non-statutory barriers and incentives to their participation in integrated activities to reduce pollution. These barriers and incentives were classed as economic, situational, developmental and socio-cultural in nature. For local residents, building a network of contacts and partnerships could address many of the economic, developmental and socio-cultural barriers they were found to face. Barriers to industry participation in pollution reduction were found to include problems such as a lack of consequences for polluting, and the feeling that it was 'not their problem'. Powerful economic and situational incentives, such as pressure from corporate customers and the public, seem to remain largely unexploited by stakeholders opposing pollution. A lack of resources in the form of time, staff and equipment, as well as unsuccessful past experiences which have created a reluctance to prosecute or release information, were found to be the major impediments preventing staff at government agencies and parastatals from motivating other stakeholders to participate.

Eosinophils have long been thought to be effectors of immunity to helminths but have also been implicated in the pathogenesis of asthma. Patterns of cytokine production in the host may influence the pathogenesis of these diseases by regulating the activities of eosinophils and other components of the immune response. Mice which constitutively over-express IL-5 have profound and life-long eosinophilia in a restricted number of tissues. Although eosinophils from IL-5 transgenics are functionally competent for a number of parameters considered to be important in inflammation, untreated animals are overtly normal and free of disease. In addition, the responses of these animals when exposed to aeroallergens and helminths present a number of apparent paradoxes. Eosinophil accumulation in tissues adjacent to major airways is rapid and extensive in transgenics exposed to the aeroallergen, but even after treatment with antigen over many months these mice show no evidence of respiratory distress or pathology. Helminth-infected IL-5 transgenics and their non-transgenic littermates develop similar inflammatory responses at mucosal sites and are comparable for a number of T cell and antibody responses, but they differ considerably in their ability to clear some parasite species. The life-cycle of Nippostrongylus brasiliensis is significantly inhibited in IL-5 transgenics, but that of Toxocara canis is not. Our results also suggest that eosinophilia and/or over-expression of IL-5 may actually impair host resistance to Schistosoma mansoni and Trichinella spiralis. The pathogenesis of diseases in which eosinophils are involved may therefore be more complex than previously thought.