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Background: Traumatic brain injuries (TBI) are a leading cause of death and disability worldwide. Violence is the leading cause of mortality in Honduras. However, the incidence and impact of TBI in this low-middle income country (LMIC) is unknown. The aim of this study is to describe the epidemiology of TBI in Honduras, as captured by an injury surveillance tool in the country's major referral center. Methods: A cross sectional review of all TBI-related emergency department visits at the main referral hospital in Honduras from January to December 2013 was conducted. The calculation of descriptive statistics from Injury Surveillance System (InSS) data was performed. Results: Of 17,971 total injuries seen in 2013, 20% were traumatic brain injuries (n=3,588). The main mechanisms of injury were falls (41.11%), road traffic accidents (23.91%), blunt trauma (20.82%), penetrating knife injuries (5.85%), and firearm injuries (2.26%). Most TBI were classified as mild; 99.69% (Glasgow Coma Scale=15). Emergency room mortality was low (1.11%). The modified Kampala Trauma Score median was 8 (interquartile range 7-8). Conclusion: Mild TBI accounts for a significant percentage of all injuries presenting to a high-volume referral center in Honduras in 2013. Despite the high incidence of violence in this country, most TBI were accidental, secondary to road traffic accidents and falls. Further research is required with more recent data as well as with prospective data collection methods.

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Objectives Latin America is among several regions of the world that lacks robust data on injuries due to neurotrauma. This research project sought to investigate a multi-institution brain injury registry in Colombia, South America, by conducting a qualitative study to identify factors affecting the creation and implementation of a multi-institution TBI registry in Colombia before the establishment of the current registry. Methods Key informant interviews and participant observation identified barriers and facilitators to the creation of a TBI registry at three health care institutions in this upper-middle-income country in South America. Results The study identified barriers to implementation involving incomplete clinical data, limited resources, lack of information and technology (IT) support, time constraints, and difficulties with ethical approval. These barriers mirrored similar results from other studies of registry implementation in low- and middle-income countries (LMICs). Ease of use and integration of data collection into the clinical workflow, local support for the registry, personal motivation, and the potential future uses of the registry to improve care and guide research were identified as facilitators to implementation. Stakeholders identified local champions and support from the administration at each institution as essential to the success of the project. Conclusion Barriers for implementation of a neurotrauma registry in Colombia include incomplete clinical data, limited resources and lack of IT support. Some factors for improving the implementation process include local support, personal motivation and potential uses of the registry data to improve care locally. Information from this study may help to guide future efforts to establish neurotrauma registries in Latin America and in LMICs.

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Decompressive craniectomy (DC) is a neurosurgical procedure useful to prevent and manage the impact of high intracranial pressure (ICP) that leads to brain herniation and brain's tissue ischemia. In well-resourced environment this procedure has been proposed as a last tier therapy when ICP is not controlled by medical therapies in the management of different neurosurgical emergencies like traumatic brain injury (TBI), stroke, infectious diseases, hydrocephalus, tumors, etc. The purpose of this narrative review is to discuss the role of DC in areas of low neurosurgical and neurocritical care resources. We performed a literature review with a specific search strategy in web repositories and some local and regional journals from Low and Middle-Income Countries (LMICs). The most common publications include case reports, case series and observational studies describing the benefits of the procedure on different pathologies but with several types of biases due to the absence of robust studies or clinical registries analysis in these kinds of environments.

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Abstract Montane forests are one of the most decimated of Neotropical biomes even though they provide a suite of valuable ecosystem services such as provision of water to lowland settlements and prevention of erosion and mudslides. In some instances, to restore these and other ecosystem services, degraded montane forests are replaced by exotic tree plantations, which cover sizeable areas in several countries. Despite their importance for assessment of ecological services and for intrinsic ecological value, comparative studies of paired native montane forest and conifer plantation are scarce along the Northern Andean Cordillera. Additionally, extrapolations are challenging because each pair of communities is highly site specific due to environmental setting, age and density of plantation, and reforestation species. Here, we assess and compare structure, biogeochemistry and ecosystem services provided by closely positioned native forest and pine plantation from a protected montane area in Venezuela. Soil nutrients and soil carbon content were 60 and 54 % respectively higher in the forest. As consequence of pine' growth form and leaf biochemistry, aboveground biomass and litter mass, as well as nutrient content and carbon stocks, were higher in the plantation. This results in the plantation storing 30 % more MgC ha-1 than the nearby forest. Canopy structure and litter properties influence the hydrology of both ecosystems through differences in rain throughfall. Most of the ecosystem services itemized are superior in the native forest, with exception that the younger plantation sequesters more carbon. An additional service provided by plantations might be that of ecological corridors that connect fragmented native forests. Our study, a specific case of nutrient and carbon cycling dynamics in paired montane forests and pine plantations, provides another set of data for the design of policy and management of considerable areas in the Neotropics with established conservation plantations.(AU)

Resumen Los bosques montanos son uno de los biomas más devastados del Neotrópico aunque proporcionan valiosos servicios ecológicos al suministrar agua a los asentamientos humanos y proteger contra la erosión y los deslaves. En algunas instancias, para mantener esos servicios ecológicos, los bosques destruidos son reemplazados por plantaciones forestales en áreas considerables de varios países. Aunque existen unos pocos estudios comparativos en a lo largo del norte de la Cordillera Andina, las extrapolaciones son difíciles debido a que estos son altamente específicos debido al entorno ambiental, edad de las plantaciones, y a la especie de conífera dominante. Nosotros analizamos y comparamos la diversidad y estructura de la vegetación, la biogeoquímica y los servicios ecológicos proporcionados por un bosque montano y una plantación de pino adyacente en un área protegida de Venezuela. Los suelos del bosque nativo contienen 60 % más de nitrógeno y 54 % más de carbono que los de la plantación. Como consecuencia de la forma de vida de los pinos y de su composición foliar, la biomasa aérea y el contenido de nutrientes en la hojarasca seca son mayores en la plantación dando como resultado que la plantación contiene 30 % MgC ha-1 más que el bosque. La estructura del dosel influencia la hidrología de ambos ecosistemas mediante diferencias en la penetración del agua de lluvia. La mayoría de los servicios son de menor valor ecológico en la plantación de pino. Sin embargo, esta ofrece servicios que no existirían en su ausencia. En regiones montañosas, las plantaciones de coníferas fueron establecidas para mejorar la provisión de agua y estabilizar los suelos. Sin embargo, nuestros resultados sugieren que las plantaciones pueden proporcionar corredores ecológicos que conecten bosques nativos fragmentados. Nuestro estudio, al proveer un ejemplo adicional de dinámica ecológica comparada, expone las diferencias en servicios ecológicos proporcionados por un bosque montano y una plantación de pino y proporciona información para establecer políticas de conservación y manejo de recursos naturales en extensas áreas neotropicales.(AU)

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AbstractPine plantations in the tropics are often employed to recondition eroded slopes from mudslides, as the Pinus caribaea plantation that shields the Universidad Simón Bolívar campus in Caracas (Venezuela). However, mismanagement of this plantation has led to its rapid degradation. The best option to maintain the protective service is to restore the plantation and direct its successional trajectory towards the neighbouring montane forest. Through experimental manipulation, we aimed to determine which factors block secondary succession and to investigate their effects. Within the experimental constraints imposed by the plantation small area, we analysed the effects of light and fertility limitation, litter accumulation and access to seed on plantation restoration. Light availability was manipulated by clearing and thinning three 800 m2 main plots. Fertilization and litter removal was applied to sub-plots within the light plots. Soils were analysed, microclimate was monitored and, for four years, stem density, species richness and basal area were tallied. Our results showed that light accessibility was the main factor deterring the successional trajectory of the plots, with varying grades of interaction with the sub-treatments. By the end of the fourth year, the cleared plot showed the largest responses in all traits (triplicating stem density and basal area and >20 times higher species richness). The main colonizers were Croton megalodendron, Ocoteafendleri, and Clusia spp. all dominant trees in the nearby native forest. We concluded that the results of this pioneer study, showed that small clearings, repeated in 3-4 year cycles are appropriate for similar restoration schemes. This procedure would create a mosaic of vegetation patches at different successional stages while protecting the slopes from erosion and increasing local biodiversity. Rev. Biol. Trop. 64 (2): 461-471. Epub 2016 June 01.

ResumenEn los trópicos, las plantaciones de pino se emplean comúnmente para proteger laderas erosionadas. Este es el caso de la plantación de Pinus caribaea que resguarda el campus de la Universidad Simón Bolívar en Caracas (Venezuela) de los deslaves de lodo. Sin embargo, el inadecuado manejo de la plantación está conduciendo a su rápido deterioro. La opción más adecuada para mantener el papel protector de la plantación es la restauración dirigida hacia una sucesión similar a la del bosque montano vecino. Mediante manipulaciones experimentales nos proponemos determinar cuáles son los factores que bloquean la sucesión secundaria e investigar sus efectos específicos. Dentro de las limitaciones impuestas por el reducido tamaño de la plantación y su rol protector, aquí analizamos los efectos de la reducida radiación solar y fertilidad del suelo, la acumulación de acículas de pino y el acceso a la fuente de semillas para la restauración. La disponibilidad de radiación solar se varió cortando y entresacando los pinos de parcelas de 800 m2. Los tratamientos de fertilidad y la remoción de acículas (por fuego y manualmente) se realizaron en subparcelas replicadas dentro de las parcelas principales. Los suelos se analizaron fisicoquímicamente, se monitoreo el microclima y, durante 4 años, se censó la densidad, el área basal y la riqueza de especies de los elementos leñosos en las parcelas. Los resultados muestran que el acceso a la radiación solar fue el factor principal que influyó sobre la colonización y crecimiento de nuevos individuos en las parcelas con diversos grados de interacción con los sub-tratamientos. Al finalizar el cuarto año, la parcela totalmente deforestada mostró las respuestas más elevadas (tres veces superior en cuanto a densidad y área basal y hasta veinte veces mayor en cuanto a riqueza de especies) comparada con las parcelas control y parcialmente deforestada. Las principales especies leñosas colonizadoras fueron: Croton megalodendron, Ocotea fendleri y Clusia spp., todas ellas dominantes en el bosque montano vecino. Concluimos que este estudio pionero muestra que el aclareo total de parcelas pequeñas, repetido en ciclos de 3-4 años es apropiado para proyectos de restauración similares. Así se obtendría un mosaico de vegetación en diferentes estadios sucesionales que mantienen el papel protector de la cubierta vegetal e incrementando la biodiversidad local.

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Pine plantations in the tropics are often employed to recondition eroded slopes from mudslides, as the Pinus caribaea plantation that shields the Universidad Simón Bolívar campus in Caracas (Venezuela). However, mismanagement of this plantation has led to its rapid degradation. The best option to maintain the protective service is to restore the plantation and direct its successional trajectory towards the neighbouring montane forest. Through experimental manipulation, we aimed to determine which factors block secondary succession and to investigate their effects. Within the experimental constraints imposed by the plantation small area, we analysed the effects of light and fertility limitation, litter accumulation and access to seed on plantation restoration. Light availability was manipulated by clearing and thinning three 800 m2 main plots. Fertilization and litter removal was applied to sub-plots within the light plots. Soils were analysed, microclimate was monitored and, for four years, stem density, species richness and basal area were tallied. Our results showed that light accessibility was the main factor deterring the successional trajectory of the plots, with varying grades of interaction with the sub-treatments. By the end of the fourth year, the cleared plot showed the largest responses in all traits (triplicating stem density and basal area and >20 times higher species richness). The main colonizers were Croton megalodendron, Ocotea fendleri, and Clusia spp. all dominant trees in the nearby native forest. We concluded that the results of this pioneer study, showed that small clearings, repeated in 3-4 year cycles are appropriate for similar restoration schemes. This procedure would create a mosaic of vegetation patches at different successional stages while protecting the slopes from erosion and increasing local biodiversity.

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Trachypogon spicatus, formerly known as Trachypogon plumosus, is a dominant grass in some savannas of Northern South America. Its dispersal unit, like many other species of the Andropogoneae tribe, bears a hygroscopic awn which facilitates its establishment in favorable microsites. Some authors have previously proposed that there is a positive correlation between awn length and dispersal unit burial, and that this relationship increases the probability of seed survival in the event of a fire, since soil acts as insulator. In this study we experimentally tested this relationship for T. spicatus. A total of 192 diaspores were placed in randomized blocks, in aluminum trays filled with soil under greenhouse conditions. Diaspores were sprayed with water daily for a month to guarantee awn movement; on the last day of the experiment, they were sprayed with red aerosol paint to determine burial depth. The effects of awn length, presence of caryopses, and presence of a pivot for the passive segment of the awn on diaspore burial were evaluated. Germination viability was tested using a tetrazolium salt test for 35 caryopses. No significant differences in diaspore burial were observed between diaspores with and without caryopses (F(2,126) = 0.034, p=0.853). A positive correlation between awn length and diaspore burial was observed only if the passive awn lacked a pivot (r(66)=0.394, p<0.05). Diaspores whose awns had a pivot point achieved significantly deeper burial distances than their counterparts (F(2,126)=7.063, p=0.005). Viability test found that 0% of caryopses tested were able to germinate; this is possibly due to the time difference between sampling and testing. We considered the presence or absence of caryopsis as an important factor, since previous studies have not yet considered it and the high production of sterile diaspores in grasses. These results suggest that the physical mechanism behind T. spicatus diaspore burial is awn torque. This would explain why our results partially support the hypothesis previously proposed by other authors regarding the effect of awn length upon dispersal unit burial, but would also account for the differences observed in burial depth between diaspores with an available pivot point for the passive awn and diaspores lacking thereof.

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Trachypogon spicatus, formerly known as Trachypogon plumosus, is a dominant grass in some savannas of Northern South America. Its dispersal unit, like many other species of the Andropogoneae tribe, bears a hygroscopic awn which facilitates its establishment in favorable microsites. Some authors have previously proposed that there is a positive correlation between awn length and dispersal unit burial, and that this relationship increases the probability of seed survival in the event of a fire, since soil acts as insulator. In this study we experimentally tested this relationship for T. spicatus. A total of 192 diaspores were placed in randomized blocks, in aluminum trays filled with soil under greenhouse conditions. Diaspores were sprayed with water daily for a month to guarantee awn movement; on the last day of the experiment, they were sprayed with red aerosol paint to determine burial depth. The effects of awn length, presence of caryopses, and presence of a pivot for the passive segment of the awn on diaspore burial were evaluated. Germination viability was tested using a tetrazolium salt test for 35 caryopses. No significant differences in diaspore burial were observed between diaspores with and without caryopses (F(2,126)= 0.034, p=0.853). A positive correlation between awn length and diaspore burial was observed only if the passive awn lacked a pivot (r(66)=0.394, p<0.05). Diaspores whose awns had a pivot point achieved significantly deeper burial distances than their counterparts (F(2,126)=7.063, p=0.005). Viability test found that 0% of caryopses tested were able to germinate; this is possibly due to the time difference between sampling and testing. We considered the presence or absence of caryopsis as an important factor, since previous studies have not yet considered it and the high production of sterile diaspores in grasses. These results suggest that the physical mechanism behind T. spicatus diaspore burial is awn torque. This would explain why our results partially support the hypothesis previously proposed by other authors regarding the effect of awn length upon dispersal unit burial, but would also account for the differences observed in burial depth between diaspores with an available pivot point for the passive awn and diaspores lacking thereof. Rev. Biol. Trop. 62 (1): 321-326. Epub 2014 March 01.

Trachypogon spicatus es una gramínea dominante de algunas sabanas del norte de Suramérica. Su unidad dispersante presenta una arista higroscópica la cual facilita su inserción en irregularidades del suelo, facilitando su ubicación en microhábitats favorables para su establecimiento. Igualmente, se ha sugerido que existe una relación positiva entre la longitud de la arista y la capacidad de entierro de la unidad dispersante. Esta relación incrementa la probabilidad de supervivencia de la semilla ante el fuego al ser el suelo aislante de las altas temperaturas. Se colocaron 192 diásporas de T. spicatus, en bloques aleatorios, en bandejas de sustrato bajo condiciones de invernadero. Luego, se sometieron a cambios de humedad para garantizar el movimiento de la arista y pintaron con aerosol rojo el último día del experimento para determinar la profundidad de entierro. Se evaluó el efecto de la presencia de cariópsis, la longitud de la arista y la presencia de un punto de apoyo para la arista sobre la profundidad de entierro de la diáspora. Se realizó una prueba de sal de Tetrazolio para probar la viabilidad de germinación de 35 cariópsis. No se observaron diferencias significativas en la profundidad de entierro entre diásporas provistas y desprovistas de cariópsis (F(2,126)=0.034, p=0.853). La longitud de la arista parece guardar una relación positiva con la profundidad de entierro únicamente para aquellas unidades dispersantes cuyas aristas no cuentan con un punto de apoyo (r(66)=0.394, p<0.05). Por otro lado, aquellas diásporas cuyas aristas contaban con un punto de apoyo lograron profundidades de entierro significativamente mayores (F(2,126)=7.063, p=0.005). La prueba de viabilidad determinó que 0% de las cariópsis analizadas eran capaces de germinar, esto posiblemente sea debido a la diferencia entre el tiempo de recolección y de prueba. Consideramos que el factor presencia/ausencia de cariópsis era importante ya que había sido ignorado en estudios previos y por la alta producción de diásporas estériles en las gramíneas. Los resultados sugieren que el mecanismo físico que opera sobre la capacidad de entierro de la unidad dispersante de T. spicatus es el torque. Esto explica por qué solo se apoyaron parcialmente las hipótesis propuestas previamente por otros autores, y justifica las diferencias observadas en cuanto a la profundidad de entierro entre unidades dispersantes cuyas aristas contaban o carecían de un punto de apoyo.

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La finalidad del trabajo que aquí se describe fue evaluar el tamizaje comunitario para la detección de casos de infección por VIH vinculado a un programa de lucha antituberculosa en una población en alto riesgo de ambas infecciones. De mayo de 1990 a agosto de 1992, trabajadores de salud comunitarios se comunicaron con adultos en domicilios y dispensarios de Cité Soleil, Haití, para ofrecerles servicios institucionales de asesoramiento individual y de detección de VIH y de tuberculosis. A todas las personas que aceptaron la prueba se les dio asesoramiento posterior sobre VIH. Las que tenían tuberculosis activa recibieron tratamiento y a las que tenían enfermedad latente más infección por VHI se les dio la oportunidad de participar en un ensayo clínico sobre quimioprofilaxis antituberculosa. Las personas sometidas al tamizaje para la deteccíon de VIH, que fueron 10 611, constituyeron 10,0(por cento) de la poblacíon adulta de Cité Soleil. Se encontró infección por VIH en 1629 (15,4 por cento) de ellas y tuberculosis activa en 242 (2,3 por cento). Infección latente por Mycobacterium tuberculosis fue detectada en 4800 (65,7 por cento) de los 7309 habitantes de la comunidad que fueron sometidos al tamizaje completo para la detección de tuberculosis, y de esos 4800,781 (16,3 por cento) también estaban infectados por VIH. La elevada prevalencia de infección por VIH en la población examinada, al comparársela con la de otros grupos sometidos a tamizaje en la misma comunidad, indica que las personas en alto riego de infección por VIH buscaron selectivamente o aceptaron someterse a las pruebas de tamizaje ofrecidas en los dispensarios de tuberculosis. Asimismo, a muchas personas se les diagnosticó tuberculosis activa en una fase más temprana de la enfermidad de lo que hubiera sido posible sin un programa de tamizaje. En general, los resultados indican que cuando el tamizaje comunitario para la detección de VIH es parte de un programa de lucha antituberculosa, el resultado puede ser una mejor focalización de destinatarios para las pruebas de detección de ambas infecciones

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La finalidad del trabajo que aqui se describe fue evaluarel tamizaje comunitario para la deteccion de los casos de infeccion por VIH vinculado a un programa de lucha anticuberculosa en una poblacion de alto riesgo de ambas infecciones. De mayo de 1990 a agosto de 1992, trabajadores de salud comunitarios se comunicaron con adultos en domicilios y dispensarios de Cite Soleil, Haiti, para ofrecerles servicios institucionales de asesoramiento individual y de deteccion de VIH y de tuberculosis. A todas las personas que aceptaron la prueba se les dio asesoramiento posterior sobre VIH. Las que tenian tuberculosis activa recibieron tratamiento y a las que tenian enfermedad latente mas infeccion por VIH se les dio la oportunidad de participar en un ensayo clinico sobre quimioprofilaxis antituberculosa. La elevada prevalencia de infeccion por VIH en la poblacion examinada, al compararsela con otros grupos sometidos a tamizaje en la misma comunidad, indica que las personas en alto riesgo de infeccion por VIH buscaron selectivamente o aceptaron someterse a las pruebas de tamizaje ofrecidas en los dispensarios de tuberculosis. Asimismo, a muchas personas se les diagnostico tuberculosis activa en una fase mas temprana de la enfermedad de lo que hubiera sido posible sin un programa de tamizaje. En general, los resultados indican que cuando el tamizaje comunitario para la deteccion de VIH es parte de un programa de lucha antituberculosa, el resultado puede ser una mejor focalizacion de destinatarios para las pruebas de deteccion de ambas infecciones

Este articulo se publico en ingles en el Bull. PAHO. Vol. 30(1), 1996

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