RESUMEN
BACKGROUND: Although tumors of the central nervous system (CNS) are rare, they can cause significant morbidity and mortality. The clinical presentation of patients with non-functional pituitary adenomas (NFPA) ranges from being completely asymptomatic to causing pituitary, hypothalamic, or visual dysfunction due to their large size. Patients usually arrive with large tumors at the time of diagnosis. Objectives: Try to describe the characteristics of NFPA and explain the causes of delayed diagnosis. Methods: We carried out a retrospective study including 58 patients with NFPA and analyzed the tumor volume at the time of diagnosis and its relationship with sociodemographic and health sector variables. Results: Low socioeconomic status (SES) was associated with high tumor volume (SES 1-2 of 17.4 cm3 vs 3-6 of 11.7 cm3, p=0.018), and the time between first consultation and diagnosis was longer in the public sector than in the private sector (13.5 months vs 5.1 months). The time between the first symptom and the first consultation was shorter when they had visual impairment than when they did not (4.1 vs 18.4 months, p=0.006). CONCLUSIONS: On the one hand, citizens should be made aware that a visual deficit should make them go to a medical check-up, and on the other hand, strengthen the health system so that they have the NFPA as a differential diagnosis in patients with some visual alteration. Socioeconomic inequality in our country undoubtedly puts the underprivileged at greater risk.
RESUMEN
In the wet season, a large portion of the Amazon region constitutes one of the most pristine continental areas, with very low concentrations of atmospheric trace gases and aerosol particles. However, land use change modifies the biosphere-atmosphere interactions in such a way that key processes that maintain the functioning of Amazonia are substantially altered. This study presents a comparison between aerosol properties observed at a preserved forest site in Central Amazonia (TT34 North of Manaus) and at a heavily biomass burning impacted site in south-western Amazonia (PVH, close to Porto Velho). Amazonian aerosols were characterized in detail, including aerosol size distributions, aerosol light absorption and scattering, optical depth and aerosol inorganic and organic composition, among other properties. The central Amazonia site (TT34) showed low aerosol concentrations (PM2.5 of 1.3 +/- 0.7 microg m(-3) and 3.4 +/- 2.0 microg m(-3) in the wet and dry seasons, respectively), with a median particle number concentration of 220 cm(-3) in the wet season and 2200 cm(-3) in the dry season. At the impacted site (PVH), aerosol loadings were one order of magnitude higher (PM2.5 of 10.2 +/- 9.0 microg m(-3) and 33.0 +/- 36.0 microg m(-3) in the wet and dry seasons, respectively). The aerosol number concentration at the impacted site ranged from 680 cm(-3) in the wet season up to 20 000 cm(-3) in the dry season. An aerosol chemical speciation monitor (ACSM) was deployed in 2013 at both sites, and it shows that organic aerosol account to 81% to the non-refractory PM1 aerosol loading at TT34, while biomass burning aerosols at PVH shows a 93% content of organic particles. Three years of filter-based elemental composition measurements shows that sulphate at the impacted site decreases, on average, from 12% of PM2.5 mass during the wet season to 5% in the dry season. This result corroborates the ACSM finding that the biomass burning contributed overwhelmingly to the organic fine mode aerosol during the dry season in this region. Aerosol light scattering and absorption coefficients at the TT34 site were low during the wet season, increasing by a factor of 5, approximately, in the dry season due to long range transport of biomass burning aerosols reaching the forest site in the dry season. Aerosol single scattering albedo (SSA) ranged from 0.84 in the wet season up to 0.91 in the dry. At the PVH site, aerosol scattering coefficients were 3-5 times higher in comparison to the TT34 site, an indication of strong regional background pollution, even in the wet season. Aerosol absorption coefficients at PVH were about 1.4 times higher than at the forest site. Ground-based SSA at PVH was around 0.92 year round, showing the dominance of scattering aerosol particles over absorption, even for biomass burning aerosols. Remote sensing observations from six AERONET sites and from MODIS since 1999, provide a regional and temporal overview. Aerosol Optical Depth (AOD) at 550 nm of less than 0.1 is characteristic of natural conditions over Amazonia. At the perturbed PVH site, AOD550 values greater than 4 were frequently observed in the dry season. Combined analysis of MODIS and CERES showed that the mean direct radiative forcing of aerosols at the top of the atmosphere (TOA) during the biomass burning season was -5.6 +/- 1.7 W m(-2), averaged over whole Amazon Basin. For high AOD (larger than 1) the maximum daily direct aerosol radiative forcing at the TOA was as high as -20 W m(-2) locally. This change in the radiation balance caused increases in the diffuse radiation flux, with an increase of Net Ecosystem Exchange (NEE) of 18-29% for high AOD. From this analysis, it is clear that land use change in Amazonia shows alterations of many atmospheric properties, and these changes are affecting the functioning of the Amazonian ecosystem in significant ways.