In El Salvador, chronic kidney disease had reached epidemic proportions towards the end of this century’s first decade. In 2011–2012, the Ministry of Health reported it was the leading cause of hospital deaths in men, the fifth in women, and the third overall in adult hospital fatalities. Farming was the most common occupation among men in dialysis (50.7%). By 2017, chronic kidney disease admissions had overwhelmed hospital capacity. In 2009, El Salvador’s Ministry of Health, Cuba’s Ministry of Public Health and PAHO launched a cooperative effort to comprehensively tackle the epidemic. The joint investigations revealed a total prevalence of chronic kidney disease in the adult population of farming communities higher than that reported internationally (18% vs.11%–14.8%), higher in men than in women (23.9% vs 13.9%) and higher in men who were farmers/farmworkers than in men who were not (31.3% vs. 14.8%). The disease was also detected in children. An association was found between chronic kidney disease and exposure to agrochemicals (OR 1.4–2.5). In 51.9% of all chronic kidney disease cases, traditional causes (diabetes, hypertension, glomerulopathies, obstructive nephropathies and cystic diseases) were ruled out and the existence of a particular form of chronic kidney disease of nontraditional etiology was confirmed (whose initial cases were reported as early as 2002). In the patients studied, functional alterations and histopathologic diagnosis confirmed a chronic tubulointerstitial nephritis; most presented with neurosensory hearing loss, altered tendon reflexes and tibial artery damage. The main results of this cooperation were the epidemiologic, physiopathologic, clinical and histopathologic characterization of chronic kidney disease of nontraditional etiology. This characterization facilitated case definition for the epidemic and led to the hypothesis of systemic toxicity from agrochemicals (e.g., paraquat, glyphosate), which particularly affect the kidneys and to which farmers/farmworkers (who may also become dehydrated in the fields) are most exposed. The research thus also laid the foundations for design of comprehensive intersectoral government actions to reduce cases and put an end to the epidemic. Chronic kidney disease; chronic renal failure; tubulointerstitial nephritis; epidemiology; histopathology; international cooperation; agrochemicals; environmental pollutants, noxae, and pesticides; occupational health; PAHO; El Salvador; Cuba

Este trabajo presenta una propuesta de regionalización biogeográfica de los bosques tropicales perennifolios de Mesoamérica, resultado de un análisis de parsimonia de endemismos (PAE), utilizando modelos de nicho ecológico (GARP) con mamíferos terrestres, usando 41 527 registros para las 233 especies de mamíferos reconocidas. La regionalización propuesta muestra que los bosques tropicales perennifolios de Mesoamérica se dividen por el istmo de Tehuantepec en Oaxaca en: a) un grupo septentrional que comprende la Sierra Madre de Chiapas-Guatemala y la Península de Yucatán, y b) un grupo austral, que contiene la vertiente pacífica hacia el sur incluyendo Centroamérica. Además se encontró congruencia con trabajos filogenéticos, lo que sugiere una historia biogeográfica común.

Mesoamerica is a biologically complex zone that expands from Southern Mexico to extreme Northern Colombia. The biogeographical patterns and relationships of the mammalian fauna associated to the Mesoamerican Tropical Evergreen Forest (MTEF) are poorly understood, in spite of the wide distribution of this kind of habitat in the region. We compiled a complete georeferenced database of mammalian species distributed in the MTEF of specimens from museum collections and scientific literature. This database was used to create potential distribution maps through the use of environmental niche models (ENMs) by using the Genetic Algorithm for Rule-Set Production (GARP) using 22 climatic and topographic layers. Each map was used as a representation of the geographic distribution of the species and all available maps were summed to obtain general patterns of species richness in the region. Also, the maps were used to construct a presence-absence matrix in a grid of squares of 0.5 degrees of side, that was analyzed in a Parsimony Analysis of Endemicity (PAE), which resulted in a hypothesis of the biogeographic scheme in the region. We compiled a total of 41 527 records of 233 species of mammals associated to the MTEF. The maximum concentration of species richness (104-138 species) is located in the areas around the isthmus of Tehuantepec, Northeastern Chiapas-Western Guatemala, Western Honduras, Central Nicaragua to Northwestern Costa Rica and Western Panama. The proposed regionalization indicates that mammalian faunas associated to these forests are composed of two main groups that are divided by the isthmus of Tehuantepec in Oaxaca in: a) a Northern group that includes Sierra Madre of Chiapas-Guatemala and Yucatan Peninsula; and b) an austral group, that contains the Pacific slope of Chiapas towards the South including Central America. Some individual phylogenetic studies of mammal species in the region support the relationships between the areas of endemism proposed, which suggest a common biogeographical history. in spite that Mesoamerica is considered one of the most important hotspots for biological conservation, the poor knowledge of the biogeographic patterns, the scarcity of protected areas, and the high rate of habitat transformation due to human activities, make prioritary the development of conservation strategies that include patterns of species richness, endemism, and mammalian associations.

OBJETIVO: A associação entre tumores cerebrais e déficits cognitivos é bem estabelecida na literatura. No entanto, estudos sobre a cognição de pacientes com gliomas de baixo e alto grau são escassos, especialmente, em sujeitos com baixa escolaridade. Este estudo investigou o funcionamento cognitivo de uma amostra de pacientes com gliomas de baixo e alto grau antes da intervenção cirúrgica. MÉTODO: Os pacientes com glioma de baixo grau (G1, n=19) e alto grau (G2, n=8) foram avaliados quanto à memória, funções executivas, habilidades visuo-perceptivas e visuo-espaciais, nível intelectual e linguagem. RESULTADOS: Houve prejuízo significativo em G2 na memória episódica verbal e visual, funções executivas incluindo flexibilidade mental, fluência verbal nominal e categórica e velocidade de processamento de informações. G1 demonstrou apenas déficits específicos de evocação verbal e visual, flexibilidade mental e velocidade de processamento. CONCLUSÃO: Estes achados demonstraram níveis diferenciados de comprometimento nos domínios executivos e mnésticos de pacientes com gliomas de baixo e alto grau.

OBJECTIVE: The relationship between brain tumors and cognitive deficits is well established in the literature. However, studies investigating the cognitive status in low and high-grade gliomas patients are scarce, particularly in patients with average or lower educational level. This study aimed at investigating the cognitive functioning in a sample of patients with low and high-grade gliomas before surgical intervention. METHOD: The low-grade (G1, n=19) and high-grade glioma (G2, n=8) patients underwent a detailed neuropsychological assessment of memory, executive functions, visuo-perceptive and visuo-spatial abilities, intellectual level and language. RESULTS: There was a significant impairment on verbal and visual episodic memory, executive functions including mental flexibility, nominal and categorical verbal fluency and speed of information processing in G2. G1 showed only specific deficits on verbal and visual memory recall, mental flexibility and processing speed. CONCLUSION: These findings demonstrated different levels of impairments in the executive and memory domains in patients with low and high grade gliomas.

A importância do topodiagnóstico na paralisia facial periférica é a localização anatômica precisa da lesão neural. Consiste ele na realização de testes clínicos para avaliar as funções de cada um dos ramos do nervo. O Grupo de Paralisia Facial do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, com estatística de 873 pacientes, demonstra que praticamente 50% dos casos, das mais diversas etiologias, apresentavam lesão suprageniculada. A importância desse dado é a indicação da via de acesso, quando necessária a exploração cirúrgica do nervo facial.

The topodiagnosis allows the physician to determine the topographic localization of pathology involving the facial nerve. It is based on clinical tests that evaluate the function of each one of the rami of the facial nerve. With a statistic of 873 patients, the Facial Nerve Group of Hospital das Clínicas, São Paulo University, found that suprageniculate lesions are responsible for 50% of the facial nerve involvement of several etiologies. Based on these results, the physician is able to develop a rationale for therapy and surgical access for facial nerve lesions.