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INTRODUCTION: Outcomes of human immunodeficiency virus (HIV) infected patients admitted to intensive care units (ICU) have improved with antiretroviral therapy (ART). However, whether the outcomes have improved in low- and middle-income countries, paralleling those of high-income countries is unknown. The objective of this study was to describe a cohort of HIV-infected patients admitted to ICU in a middle-income country and identify the risk factors associated with mortality. METHODOLOGY: A cohort study of HIV-infected patients admitted to five ICUs in Medellín, Colombia, between 2009 and 2014 was done. The association of demographic, clinical and laboratory variables with mortality was analyzed using a Poisson regression model with random effects. RESULTS: During this time period, 472 admissions of 453 HIV-infected patients were included. Indications for ICU admission were: respiratory failure (57%), sepsis/septic shock (30%) and central nervous system (CNS) compromise (27%). Opportunistic infections (OI) explained 80% of ICU admissions. Mortality rate was 49%. Factors associated with mortality included hematological malignancies, CNS compromise, respiratory failure, and APACHE II score ≥ 20. CONCLUSIONS: Despite advances in HIV care in the ART era, half of HIV-infected patients admitted to the ICU died. This elevated mortality was associated to underlying disease severity (respiratory failure and APACHE II score ≥ 20), and host conditions (hematological malignancies, admission for CNS compromise). Despite the high prevalence of OIs in this cohort, mortality was not directly associated to OIs.

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Purpose: Determination and development of an effective set of models leveraging Artificial Intelligence techniques to generate a system able to support clinical practitioners working with COVID-19 patients. It involves a pipeline including classification, lung and lesion segmentation, as well as lesion quantification of axial lung CT studies. Approach: A deep neural network architecture based on DenseNet is introduced for the classification of weakly-labeled, variable-sized (and possibly sparse) axial lung CT scans. The models are trained and tested on aggregated, publicly available data sets with over 10 categories. To further assess the models, a data set was collected from multiple medical institutions in Colombia, which includes healthy, COVID-19 and patients with other diseases. It is composed of 1,322 CT studies from a diverse set of CT machines and institutions that make over 550,000 slices. Each CT study was labeled based on a clinical test, and no per-slice annotation took place. This enabled a classification into Normal vs. Abnormal patients, and for those that were considered abnormal, an extra classification step into Abnormal (other diseases) vs. COVID-19. Additionally, the pipeline features a methodology to segment and quantify lesions of COVID-19 patients on the complete CT study, enabling easier localization and progress tracking. Moreover, multiple ablation studies were performed to appropriately assess the elements composing the classification pipeline. Results: The best performing lung CT study classification models achieved 0.83 accuracy, 0.79 sensitivity, 0.87 specificity, 0.82 F1 score and 0.85 precision for the Normal vs. Abnormal task. For the Abnormal vs COVID-19 task, the model obtained 0.86 accuracy, 0.81 sensitivity, 0.91 specificity, 0.84 F1 score and 0.88 precision. The ablation studies showed that using the complete CT study in the pipeline resulted in greater classification performance, restating that relevant COVID-19 patterns cannot be ignored towards the top and bottom of the lung volume. Discussion: The lung CT classification architecture introduced has shown that it can handle weakly-labeled, variable-sized and possibly sparse axial lung studies, reducing the need for expert annotations at a per-slice level. Conclusions: This work presents a working methodology that can guide the development of decision support systems for clinical reasoning in future interventionist or prospective studies.

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The American tropics are hotspots of wild and domesticated plant biodiversity, which is still underutilized by breeding programs despite being conserved at regional gene banks. The improvement of those programs depends on long-term public funds and the maintenance of specialized staff. Unfortunately, financial ups and downs complicate staff connectivity and their research impact. Between 2000 and 2010, Agrosavia (Corporación Colombiana de Investigación Agropecuaria) dramatically decreased its public financial support. In 2017, we surveyed all 52 researchers from Agrosavia involved in plant breeding and plant genetic resource programs to examine the effect of decimating funds in the last ten years. We hypothesized that the staff dedicated to plant breeding still suffer a strong fragmentation and low connectivity. As we expected, the social network among researchers is weak. The top ten central leaders are predominantly males with an M.Sc. degree but have significant experience in the area. The staff has experience in 31 tropical crops, and 17 are on the list of underutilized species. Moreover, although 26 of these crops are in the national germplasm bank, this has not been the primary source for their breeding programs. We proposed five principles to improve connectivity among teams and research impact: (1) The promotion of internal discussion about gender gaps and generation shifts to design indicators to monitor and decrease this disparity over time. (2) The construction of long-term initiatives and synergies with the Colombian government to support the local production of food security crops independent of market trends. (3) Better collaboration between the National Plant Germplasm Bank and plant breeding researchers. (4) A concerted priority list of species (especially those neglected or underutilized) and external institutions to better focus the collaborative efforts in research using public funds. (5) Better spaces for the design of projects among researchers and training programs in new technologies. These principles could also apply in other tropical countries with public plant breeding research programs facing similar challenges.

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RESUMEN Introducción: La mejoría en la funcionalidad de los pacientes con trastorno afectivo bipolar y esquizofrenia es una de las principales metas en el tratamiento. Sin embargo, no hay evidencia del efecto de la intervención socio-ocupacional dentro de una intervención multimodal (IM). Objetivo: Describir el perfil socio-ocupacional y evaluar el efecto de un programa de IM en sujetos con trastorno afectivo bipolar tipo I y esquizofrenia. Métodos: Se realizó un estudio longitudinal, prospectivo y terapéutico-comparativo con 302 pacientes (104 con esquizofrenia y 198 con trastorno afectivo bipolar), asignados aleatoriamente a un grupo de IM (psiquiatría, psicología, medicina, terapia ocupacional, neuropsicología y terapia de familia) o intervención tradicional (IT) (sólo medicina y psiquiatría). Se aplicaron instrumentos que midieron: asertividad, manejo del tiempo libre, habilidades sociales, ansiedad general, autocuidado y desempeño en tareas del hogar, trabajo y comunidad. Resultados: Se identificó que la IM fue más efectiva que la IT en las puntuaciones de ansiedad general (p = 0,026) y participación en las tareas del hogar (p = 0,03) para los pacientes con esquizofrenia. En los pacientes con trastorno afectivo bipolar no se encontraron diferencias estadísticamente significativas. En las otras variables hubo mejoría durante el seguimiento, pero el efecto se observó en ambos grupos de tratamiento. Conclusiones: El presente estudio identificó mejoría en la funcionalidad dentro del hogar en los pacientes con esquizofrenia después de recibir una IM; también se encontró mejora en otras variables, independientemente del tipo de tratamiento. Se deberá realizar futuros estudios con programas de mayor duración y otras estrategias más ecológicas con el fin de aclarar las dudas sobre la efectividad de las intervenciones.

ABSTRACT Background: Functional improvement in bipolar and schizophrenic patients is one of the main aims of treatment. Nevertheless, there is no evidence about the effect of socio-occupational intervention within a multimodal intervention (MI) programme. Objective: To describe the socio-occupational profile and to evaluate the functional effect of a MI in bipolar I and schizophrenic patients. Methods: A prospective, longitudinal, therapeutic-comparative study was performed including 302 subjects (104 schizophrenic and 198 Bipolar Disorder I [BDI] patients), who were randomised into two groups, multimodal (psychiatry, psychology, medicine, occupational therapy, neuropsychology, and family therapy), or traditional intervention (psychiatry and medicine only). Several scales were applied to assess assertiveness, free time management, social abilities, general anxiety, self-care and performance in home, work and community tasks. Results: After performing the longitudinal analysis, it was shown that the multimodal intervention was more effective than traditional intervention in general anxiety scores (P=.026) and development in home tasks (P=.03) in schizophrenic patients. No statistical differences were found in bipolar patients. The other variables showed improvement, however, their effect was similar in both intervention groups. Conclusions: Our study identified functional improvement in home tasks in schizophrenic patients after receiving multimodal intervention. Other variables also showed improvement for both interventions groups. Future studies, applying longer rehabilitation programs and other ecological strategies should be performed to identify the most effective interventions.

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BACKGROUND: Functional improvement in bipolar and schizophrenic patients is one of the main aims of treatment. Nevertheless, there is no evidence about the effect of socio-occupational intervention within a multimodal intervention (MI) programme. OBJECTIVE: To describe the socio-occupational profile and to evaluate the functional effect of a MI in bipolar I and schizophrenic patients. METHODS: A prospective, longitudinal, therapeutic-comparative study was performed including 302 subjects (104 schizophrenic and 198 Bipolar Disorder I [BDI] patients), who were randomised into two groups, multimodal (psychiatry, psychology, medicine, occupational therapy, neuropsychology, and family therapy), or traditional intervention (psychiatry and medicine only). Several scales were applied to assess assertiveness, free time management, social abilities, general anxiety, self-care and performance in home, work and community tasks. RESULTS: After performing the longitudinal analysis, it was shown that the multimodal intervention was more effective than traditional intervention in general anxiety scores (P=.026) and development in home tasks (P=.03) in schizophrenic patients. No statistical differences were found in bipolar patients. The other variables showed improvement, however, their effect was similar in both intervention groups. CONCLUSIONS: Our study identified functional improvement in home tasks in schizophrenic patients after receiving multimodal intervention. Other variables also showed improvement for both interventions groups. Future studies, applying longer rehabilitation programs and other ecological strategies should be performed to identify the most effective interventions.

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Water stress in potato (Solanum tuberosum L.) causes considerable losses in yield, and therefore, potato is often considered to be a drought sensitive crop. Identification of water deficit tolerant potato genotypes is an adaptation strategy to mitigate the climatic changes that are occurring in the Cundiboyacense region in Colombia. Previous studies have evaluated potato plants under water stress conditions using physiological analyses. However, these methodologies require considerable amounts of time and plant material to perform these measurements. This study evaluated and compared the physiological and spectral traits between two genotypes, Diacol Capiro and Perla Negra under two drought levels (10 and 15 days without irrigation from flowering). Reflectance information was used to calculate indexes which were associated with the physiological behavior in plants. The results showed that spectral information was correlated (ρ < 0.0001) with physiological variables such as foliar area (FA), total water content (H2Ot), relative growth rate of potato tubers (RGTtub), leaf area ratio (LAR), and foliar area index (AFI). In general, there was a higher concentration of chlorophyll under drought treatments. In addition, Perla Negra under water deficit treatments did not show significant differences in its physiological variables. Therefore, it could be considered a drought tolerant genotype because its physiological performance was not affected under water stress conditions. However, yield was affected in both genotypes after being subject to 15 days of drought. The results suggested that reflectance indexes are a useful and affordable approach for potato phenotyping to select parent and segregant populations in breeding programs.

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Reportamos el caso de un paciente masculino, 80 años, con historia de dispepsia y sin antecedente familiar de neoplasias. En la endoscopia digestiva alta, en tercio distal, se observó una lesión deprimida plana con aspecto de carcinoma precoz IIC que fue diagnosticada por biopsia como carcinoma escamoso in situ e infiltrante, no queratinizante moderadamente diferenciado grado II. Fue sometido a disección endoscópica submucosa, sin complicaciones. La histopatología concluyo: carcinoma de células escamosas, predominantemente in situ de esófago distal, midiendo 0,6 cm, con foco de 0,1 cm de infiltración en la lámina propia; ausencia de invasión neoplásica angiolinfática o perineural con márgenes de resección quirúrgica libre de neoplasia. Estadio pT1a. Tres meses después, en la endoscopia de control con toma de biopsias de la zona, no hubo evidencia de carcinoma. Presentamos el caso debido a que sigue siendo todo un reto establecer el diagnóstico de cáncer de esófago en etapa temprana, sobre todo en pacientes poco sintomáticos, resaltando la importancia de la cromoendoscopia y de una buena exploración endoscópica para llegar al diagnóstico. La disección endoscopia submucosa podría considerarse como un tratamiento alternativo seguro y eficaz a la cirugía radical.

We report the case of a male patient, 80 years old, with a history of dyspepsia and no family history of neoplasias. In the upper digestive endoscopy in the distal esophagus, a flat depressed lesion with the appearance of early carcinoma, type IIC of Paris classification, was diagnosed by biopsy as a squamous carcinoma in situ, infiltrating, moderately differentiated non-keratinizing grade II carcinoma. He underwent submucosal endoscopic dissection without complications. Histopathology concluded: carcinoma of squamous cells, predominantly in situ of distal esophagus, measuring 0.6 cm, with focus of 0.1 cm of infiltration in the own lamina; absence of angiolymphatic or perineural invasion. The histopathology specimen had margins of surgical resection free of neoplasia. Stage pT1a. Three months later, in the endoscopy control with biopsy of the area, there was no evidence of carcinoma. We present the case because it is still a challenge to establish the diagnosis of esophageal cancer at an early stage, especially in patients without symptoms, highlighting the importance of chromoendoscopy and a good endoscopic examination to reach the diagnosis. Submucosal endoscopy dissection could be considered as a safe and effective alternative treatment to radical surgery.

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We report the case of a male patient, 80 years old, with a history of dyspepsia and no family history of neoplasias. In the upper digestive endoscopy in the distal esophagus, a flat depressed lesion with the appearance of early carcinoma, type IIC of Paris classification, was diagnosed by biopsy as a squamous carcinoma in situ, infiltrating, moderately differentiated non-keratinizing grade II carcinoma. He underwent submucosal endoscopic dissection without complications. Histopathology concluded: carcinoma of squamous cells, predominantly in situ of distal esophagus, measuring 0.6 cm, with focus of 0.1 cm of infiltration in the own lamina; absence of angiolymphatic or perineural invasion. The histopathology specimen had margins of surgical resection free of neoplasia. Stage pT1a. Three months later, in the endoscopy control with biopsy of the area, there was no evidence of carcinoma. We present the case because it is still a challenge to establish the diagnosis of esophageal cancer at an early stage, especially in patients without symptoms, highlighting the importance of chromoendoscopy and a good endoscopic examination to reach the diagnosis. Submucosal endoscopy dissection could be considered as a safe and effective alternative treatment to radical surgery.

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Presentamos un caso de perforación esofágica por cuerpo extraño. Las causas de perforación esofágica pueden clasificarse en: instrumentales, espontáneas, quirúrgicas, traumáticas y cuerpos extraños. La perforación esofágica es una situación grave con alto índice de morbimortalidad debido a su difícil diagnóstico y falta de consenso pleno en su tratamiento. La clínica es polimorfa e inespecífica y el diagnóstico requiere alto grado de sospecha. La mortalidad oscila entre 10 y 40%.

We report a case of esophageal foreign body perforation. The causes of esophageal perforation can be classified into: instrumental, spontaneous, surgical, trauma and foreign bodies. Esophageal perforation is a serious condition with high morbidity and mortality rates due to its difficult diagnosis and lack of full consensus on treatment. The clinic is polymorphous and unspecific and diagnosis requires a high index of suspicion. Mortality ranges from 10 to 40%.

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La realización de un trabajo de investigación geográfico evidenció un uso ineficientede los datos sobre casos de hidatidosis en Chubut.ObjetivosEstudiar el Programa de Control de la Hidatidosis, sus dificultades en el manejode datos y la factibilidad de incorporar nuevas herramientas informáticas y Sistemasde Información Geográfica.MétodosSe realizó un estudio cualitativo, con un propósito de tipo explicativo. La informaciónprimaria y secundaria se obtuvo mediante el trabajo de campo, juntocon realización de entrevistas (semiestructuradas), observación directa y procesamientode la información en gabinete.ResultadosSe comprobó una escasa capacitación del recurso humano que efectúa el registroy carga de datos sobre hidatidosis. Su consecuencia directa es la pocautilidad de los datos para los equipos médicos, decisores políticos, investigadoresy público en general a la hora de llevar a cabo el seguimiento de los casosy determinar las áreas geográficas de mayor riesgo en la provincia.ConclusionesEs fundamental implementar capacitaciones en recursos humanos. De acuerdocon las necesidades, se recomienda utilizar un programa informático que permitaelaborar, tratar y procesar bases de datos confiables.

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BACKGROUND: Expressed sequence tags (ESTs) are an important source of gene-based markers such as those based on insertion-deletions (Indels) or single-nucleotide polymorphisms (SNPs). Several gel based methods have been reported for the detection of sequence variants, however they have not been widely exploited in common bean, an important legume crop of the developing world. The objectives of this project were to develop and map EST based markers using analysis of single strand conformation polymorphisms (SSCPs), to create a transcript map for common bean and to compare synteny of the common bean map with sequenced chromosomes of other legumes. RESULTS: A set of 418 EST based amplicons were evaluated for parental polymorphisms using the SSCP technique and 26% of these presented a clear conformational or size polymorphism between Andean and Mesoamerican genotypes. The amplicon based markers were then used for genetic mapping with segregation analysis performed in the DOR364 x G19833 recombinant inbred line (RIL) population. A total of 118 new marker loci were placed into an integrated molecular map for common bean consisting of 288 markers. Of these, 218 were used for synteny analysis and 186 presented homology with segments of the soybean genome with an e-value lower than 7 x 10-12. The synteny analysis with soybean showed a mosaic pattern of syntenic blocks with most segments of any one common bean linkage group associated with two soybean chromosomes. The analysis with Medicago truncatula and Lotus japonicus presented fewer syntenic regions consistent with the more distant phylogenetic relationship between the galegoid and phaseoloid legumes. CONCLUSION: The SSCP technique is a useful and inexpensive alternative to other SNP or Indel detection techniques for saturating the common bean genetic map with functional markers that may be useful in marker assisted selection. In addition, the genetic markers based on ESTs allowed the construction of a transcript map and given their high conservation between species allowed synteny comparisons to be made to sequenced genomes. This synteny analysis may support positional cloning of target genes in common bean through the use of genomic information from these other legumes.

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