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The deep ocean releases large amounts of old, pre-industrial carbon dioxide (CO2) to the atmosphere through upwelling in the Southern Ocean, which counters the marine carbon uptake occurring elsewhere. This Southern Ocean CO2 release is relevant to the global climate because its changes could alter atmospheric CO2 levels on long time scales, and also affects the present-day potential of the Southern Ocean to take up anthropogenic CO2. Here, year-round profiling float measurements show that this CO2 release arises from a zonal band of upwelling waters between the Subantarctic Front and wintertime sea-ice edge. This band of high CO2 subsurface water coincides with the outcropping of the 27.8 kg m-3 isoneutral density surface that characterizes Indo-Pacific Deep Water (IPDW). It has a potential partial pressure of CO2 exceeding current atmospheric CO2 levels (∆PCO2) by 175 ± 32 µatm. Ship-based measurements reveal that IPDW exhibits a distinct ∆PCO2 maximum in the ocean, which is set by remineralization of organic carbon and originates from the northern Pacific and Indian Ocean basins. Below this IPDW layer, the carbon content increases downwards, whereas ∆PCO2 decreases. Most of this vertical ∆PCO2 decline results from decreasing temperatures and increasing alkalinity due to an increased fraction of calcium carbonate dissolution. These two factors limit the CO2 outgassing from the high-carbon content deep waters on more southerly surface outcrops. Our results imply that the response of Southern Ocean CO2 fluxes to possible future changes in upwelling are sensitive to the subsurface carbon chemistry set by the vertical remineralization and dissolution profiles.

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Viruses have been implicated in cancer development in both humans and animals. The role of viruses in cancer is typically to initiate cellular transformation through cellular DNA damage, although specific mechanisms remain unknown. Silent and long-term viral infections need to be present, in order to initiate cancer disease. In efforts to establish a causative role of viruses, first is needed to demonstrate the strength and consistency of associations in different populations. The aim of this study was to determine the association of bovine leukemia virus (BLV), a causative agent of leukemia in cattle, with breast cancer and its biomarkers used as prognosis of the severity of the disease (Ki67, HER2, hormonal receptors) in Colombian women. An unmatched, observational case-control study was conducted among women undergoing breast surgery between 2016-2018. Malignant samples (n = 75) were considered as cases and benign samples (n = 83) as controls. Nested-liquid PCR, in-situ PCR and immunohistochemistry were used for viral detection in blood and breast tissues. For the risk assessment, only BLV positive samples from breast tissues were included in the analysis. BLV was higher in cases group (61.3%) compared with controls (48.2%), with a statistically significant association between the virus and breast cancer in the unconditional logistic regression (adjusted-OR = 2.450,95%CI:1.088-5.517, p = 0.031). In this study, BLV was found in both blood and breast tissues of participants and an association between breast cancer and the virus was confirmed in Colombia, as an intermediate risk factor.

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Introducción: en la actualidad, la diabetes se considera una emergencia mundial debido al aumento de su prevalencia, posibles complicaciones y elevada mortalidad. Algunos factores culturales, como las creencias fatalistas, pueden representar una barrera para su control. Objetivo: revisar la evidencia científica disponible de la relación entre el fatalismo y el control glucémico en adultos con diabetes tipo 2. Metodología: se realizó una búsqueda en EBSCO Academic Search Complete, Science Direct, Web of Science, Pubmed, Springer, Redalyc, Latindex, Mediclatina y Fuente Académica vía EBSCO, delimitada a 10 años (2008-2018). Se utilizaron los descriptores DeCS y MeHS y la búsqueda de los estudios se efectuó en español e inglés. Los estudios se evaluaron para su validez a través de la guía para estudios analíticos transversales del Joanna Briggs Institute Critical Appraisal. Resultados: de 275 resultados que arrojó la búsqueda, se seleccionaron cinco estudios correlacionales-transversales, publicados en inglés en Estados Unidos, Líbano, Turquía e Israel, que incluyeron entre 130 y 615 pacientes con diagnóstico (5-14.4 años) de diabetes tipo 2. La evidencia disponible sugiere que existe una relación entre el fatalismo y el control glucémico. Conclusión: la relación entre el fatalismo y el control glucé-mico en adultos con diabetes tipo 2 es compleja y represen- ta en pacientes fatalistas una barrera para el control de la enfermedad.

Introduction: Diabetes is currently considered a worldwide emergency due to its increased prevalence, possible complications, and high mortality. Some cultural factors, such as fatalistic beliefs, may represent a barrier to diabetes control. Objective: Review scientific evidence avaible on the relationship between fatalism and glycemic control in adults with Type 2 Diabetes. Methods: A search was carried out in EBSCO Academic Search Complete, Science Direct, Web of Science, Pubmed, Springer, Redalyc, Latindex, Mediclatina y Fuente Académica EBSCO, limited to ten years (2008-2018). DeCS and MeHS descriptors were used, the search for studies was in Spanish and English. The studies were evaluated for validity through the Joanna Briggs Institute Critical Assessment guide for cross-sectional analytical studies. Results: The information query delivered 275 results and 5 from these studies were included. These are correlational-cross-sectional studies, published in English, from countries such as The United States of America, Lebanon, and Israel, which studied between 130 and 615 patients with diagnosis of T2D (between 5 and 14.4 years). Available evidence suggests that there is a relationship between fatalism and glycemic control. Conclusion: The relationship between fatalism and glycemic control in adults with Type 2 Diabetes is complex and represents, in more fatalistic patients, a barrier to disease control.

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Over the last ten years, satellite and geographically constrained in situ observations largely focused on the northern hemisphere have suggested that annual phytoplankton biomass cycles cannot be fully understood from environmental properties controlling phytoplankton division rates (e.g., nutrients and light), as they omit the role of ecological and environmental loss processes (e.g., grazing, viruses, sinking). Here, we use multi-year observations from a very large array of robotic drifting floats in the Southern Ocean to determine key factors governing phytoplankton biomass dynamics over the annual cycle. Our analysis reveals seasonal phytoplankton accumulation ('blooming') events occurring during periods of declining modeled division rates, an observation that highlights the importance of loss processes in dictating the evolution of the seasonal cycle in biomass. In the open Southern Ocean, the spring bloom magnitude is found to be greatest in areas with high dissolved iron concentrations, consistent with iron being a well-established primary limiting nutrient in this region. Under ice observations show that biomass starts increasing in early winter, well before sea ice begins to retreat. The average theoretical sensitivity of the Southern Ocean to potential changes in seasonal nutrient and light availability suggests that a 10% change in phytoplankton division rate may be associated with a 50% reduction in mean bloom magnitude and annual primary productivity, assuming simple changes in the seasonal magnitude of phytoplankton division rates. Overall, our results highlight the importance of quantifying and accounting for both division and loss processes when modeling future changes in phytoplankton biomass cycles.

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Anthropogenically forced changes in ocean biogeochemistry are underway and critical for the ocean carbon sink and marine habitat. Detecting such changes in ocean biogeochemistry will require quantification of the magnitude of the change (anthropogenic signal) and the natural variability inherent to the climate system (noise). Here we use Large Ensemble (LE) experiments from four Earth system models (ESMs) with multiple emissions scenarios to estimate Time of Emergence (ToE) and partition projection uncertainty for anthropogenic signals in five biogeochemically important upper-ocean variables. We find ToEs are robust across ESMs for sea surface temperature and the invasion of anthropogenic carbon; emergence time scales are 20-30 yr. For the biological carbon pump, and sea surface chlorophyll and salinity, emergence time scales are longer (50+ yr), less robust across the ESMs, and more sensitive to the forcing scenario considered. We find internal variability uncertainty, and model differences in the internal variability uncertainty, can be consequential sources of uncertainty for projecting regional changes in ocean biogeochemistry over the coming decades. In combining structural, scenario, and internal variability uncertainty, this study represents the most comprehensive characterization of biogeochemical emergence time scales and uncertainty to date. Our findings delineate critical spatial and duration requirements for marine observing systems to robustly detect anthropogenic change.

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INTRODUCTION: Orthohantaviruses are still a significant public health threat in endemic countries, with high case fatality rates (CFR). In Bolivia, the reporting of small outbreaks occurred until 2012. The findings of 40 laboratory-confirmed cases diagnosed in two departments are reported herein. METHODS: This was an observational, retrospective and cross-sectional study. Data on laboratory-confirmed cases in 2018 were collected from the hospitals and departmental health services (SEDES) of Santa Cruz and Tarija. An ELISA was used for the detection of IgM antibody to hantavirus in the patient blood samples. RESULTS: Forty patients were IgM-positive. The median age of the patients was 24 years (interquartile range 19-41 years) and 72.5% were male. All patients were hospitalized; 57.5% were admitted to the intensive care unit and had cardiopulmonary compromise, with 83% of these presenting acute respiratory distress syndrome and 89.5% of these requiring mechanical ventilation. Six patients died (CFR 15%). Patients <15 or >60 years old were more prone to die (odds ratio 10.33, 95% confidence interval 1.411-75.694), as were those with comorbidities (odds ratio 16.5, 95% confidence interval 1.207-225.540). CONCLUSIONS: Orthohantavirus infections were associated with a high CFR. These cases occurred in areas with eco-epidemiological conditions facilitating viral transmission, including the presence of rodents, as well as the risk of spillover to humans due to social, environmental, and occupational factors.

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Attribution of anthropogenically-forced trends in the climate system requires understanding when and how such signals will emerge from natural variability. We apply time-of-emergence diagnostics to a Large Ensemble of an Earth System Model, providing both a conceptual framework for interpreting the detectability of anthropogenic impacts in the ocean carbon cycle and observational sampling strategies required to achieve detection. We find emergence timescales ranging from under a decade to over a century, a consequence of the time-lag between chemical and radiative impacts of rising atmospheric CO2 on the ocean. Processes sensitive to carbonate-chemical changes emerge rapidly, such as impacts of acidification on the calcium-carbonate pump (10 years for the globally-integrated signal, 9-18 years regionally-integrated), and the invasion flux of anthropogenic CO2 into the ocean (14 globally, 13-26 regionally). Processes sensitive to the ocean's physical state, such as the soft-tissue pump, which depends on nutrients supplied through circulation, emerge decades later (23 globally, 27-85 regionally).

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Substantial interannual variability in marine fish recruitment (i.e., the number of young fish entering a fishery each year) has been hypothesized to be related to whether the timing of fish spawning matches that of seasonal plankton blooms. Environmental processes that control the phenology of blooms, such as stratification, may differ from those that influence fish spawning, such as temperature-linked reproductive maturation. These different controlling mechanisms could cause the timing of these events to diverge under climate change with negative consequences for fisheries. We use an earth system model to examine the impact of a high-emissions, climate-warming scenario (RCP8.5) on the future spawning time of two classes of temperate, epipelagic fishes: "geographic spawners" whose spawning grounds are defined by fixed geographic features (e.g., rivers, estuaries, reefs) and "environmental spawners" whose spawning grounds move responding to variations in environmental properties, such as temperature. By the century's end, our results indicate that projections of increased stratification cause spring and summer phytoplankton blooms to start 16 days earlier on average (±0.05 days SE) at latitudes >40°N. The temperature-linked phenology of geographic spawners changes at a rate twice as fast as phytoplankton, causing these fishes to spawn before the bloom starts across >85% of this region. "Extreme events," defined here as seasonal mismatches >30 days that could lead to fish recruitment failure, increase 10-fold for geographic spawners in many areas under the RCP8.5 scenario. Mismatches between environmental spawners and phytoplankton were smaller and less widespread, although sizable mismatches still emerged in some regions. This indicates that range shifts undertaken by environmental spawners may increase the resiliency of fishes to climate change impacts associated with phenological mismatches, potentially buffering against declines in larval fish survival, recruitment, and fisheries. Our model results are supported by empirical evidence from ecosystems with multidecadal observations of both fish and phytoplankton phenology.

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New estimates of pCO2 from profiling floats deployed by the Southern Ocean Carbon and Climate Observations and Modeling (SOCCOM) project have demonstrated the importance of wintertime outgassing south of the Polar Front, challenging the accepted magnitude of Southern Ocean carbon uptake (Gray et al., 2018, https://doi:10.1029/2018GL078013). Here, we put 3.5 years of SOCCOM observations into broader context with the global surface carbon dioxide database (Surface Ocean CO2 Atlas, SOCAT) by using the two interpolation methods currently used to assess the ocean models in the Global Carbon Budget (Le Quéré et al., 2018, https://doi:10.5194/essd-10-2141-2018) to create a ship-only, a float-weighted, and a combined estimate of Southern Ocean carbon fluxes (<35°S). In our ship-only estimate, we calculate a mean uptake of -1.14 ± 0.19 Pg C/yr for 2015-2017, consistent with prior studies. The float-weighted estimate yields a significantly lower Southern Ocean uptake of -0.35 ± 0.19 Pg C/yr. Subsampling of high-resolution ocean biogeochemical process models indicates that some of the differences between float and ship-only estimates of the Southern Ocean carbon flux can be explained by spatial and temporal sampling differences. The combined ship and float estimate minimizes the root-mean-square pCO2 difference between the mapped product and both data sets, giving a new Southern Ocean uptake of -0.75 ± 0.22 Pg C/yr, though with uncertainties that overlap the ship-only estimate. An atmospheric inversion reveals that a shift of this magnitude in the contemporary Southern Ocean carbon flux must be compensated for by ocean or land sinks within the Southern Hemisphere.

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ABSTRACT Objective: To report the case of a placental site tumour which presented clinically in the form of a nephrotic syndrome secondary to IgA nephropathy. Case presentation: A 24-year-old woman, primigravida, referred to a Level IV complexity institution in Bogotá (Colombia), where she was diagnosed with IgA nephropathy as a paraneoplastic manifestation of a placental site trophoblastic tumour. After total hysterectomy as treatment, the patient evolved well, with oedema resolution and a drop in proteinuria. The patient completed one year of medical follow-up, with no evidence of disease. Discussion: Placental site trophoblastic tumour is rare, is part of the differential diagnosis for gestational trophoblastic disease and may present as a renal paraneoplastic manifestation which usually resolves once the tumour is treated. IgA nephropathy may be secondary to chronic inflammatory diseases and neoplastic diseases, as in this case.

RESUMEN Objetivo: reportar un caso de tumor del lecho placentario, cuya manifestación clínica fue síndrome nefrótico secundario a nefropatía IgA. Presentación del caso: se describe el caso de una paciente de 24 años, primigestante, quien fue remitida a una institución de cuarto nivel de complejidad localizada en Bogotá (Colombia), en donde se le hizo diagnóstico de nefropatía por IgA como manifestación paraneoplásica de un tumor trofoblástico del lecho placentario. Se realizó histerectomía total como tratamiento, con evolución satisfactoria, con resolución de los edemas y descenso de proteinuria; completó un año en seguimiento médico, sin evidencia de enfermedad. Discusión: el tumor trofoblástico del lecho placentario es infrecuente, hace parte del diagnóstico diferencial de la enfermedad trofoblástica gestacional (ETG), y puede manifestarse con fenómenos paraneoplásicos a nivel renal, que generalmente se resuelven con el tratamiento del tumor. La nefropatía por IgA puede ser secundaria a enfermedades inflamatorias crónicas y a patologías neoplásicas, como en este caso.

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The original version of this Article contained errors in Fig. 6. In panel a, the grey highlights obscured the curves for CESM, CM2.6 and SOSE, and the labels indicating SWIR, KP, MR, PAR, and DP were inadvertently omitted. These have now been corrected in both the PDF and HTML versions of the Article.

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Abstract IgA nephropathy is the most common glomerulonephritis, in which less than 10% of patients have a rapid decline of renal function. The histological findings of this group resemble those of vasculitis, with presence of crescents and fibrinoid necrosis. The coexistence of IgA nephropathy and neutrophil anti-cytoplasmic antibodies is infrequent, and the pathogenic role of these antibodies in IgA nephropathy is unclear. Here we describe a case of a patient with IgA nephropathy, rapidly progressive glomerulonephritis and neutrophil positive anti-cytoplasmic antibodies, and literature review is presented.

Resumen La nefropatía por IgA es la glomerulonefritis más frecuente, en la cual menos del 10% de los pacientes cursan con deterioro rápido de la función renal. Los hallazgos histológicos de este grupo semejan los de vasculitis, con presencia de semilunas y necrosis fibrinoide. La coexistencia de nefropatía por IgA y anticuerpos anticitoplasma de neutrófilo es infrecuente y no está claro el rol patogénico de estos anticuerpos en la nefropatía por IgA. A continuación, se describe un caso de un paciente con nefropatía por IgA, glomerulonefritis rápidamente progresiva y anticuerpos anticitoplasma de neutrófilo positivos y se realiza una revisión de la literatura referente al tema.

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Introducción: Diversos factores pueden influir en la preferencia del uso de hemodiálisis crónica (HDC) sobre diálisis peritoneal crónica (DPC) como terapia de enfermedad renal crónica en pacientes estado 5 en programas de diálisis crónica (ERC5D) en diversos países del mundo. Objetivos: Determinar si la falta de educación adecuada y suficiente en DPC en algunos programas de postgrado de nefrología, es la causa principal por la cual los nefrólogos prefieren utilizar HDC, la terapia mejor conocida. Material y Métodos: Se analizó el programa de entrenamiento en DPC que reciben los estudiantes de postgrado de nefrología en diversos países de Centro y Suramérica. La información se obtuvo con base en la respuesta a una encuesta que se envió a uno o más nefrólogos de cada país, entre febrero 1 y julio 31 de 2011, dirigida a quienes trabajan en el medio académico y conocen, dirigen o pertenecen a programas de postgrado de nefrología. Resultados: 114 programas de postgrado de Nefrología existen en Latinoamérica en la actualidad. Se encuentra una clara variedad en el periodo de entrenamiento en diálisis peritoneal crónica, de acuerdo con cada programa y en cada país. El volumen de pacientes en diálisis peritoneal crónica varía entre 25 y más de 280, con lo cual es claro que el entrenamiento y la experiencia adquirida en el manejo de pacientes con DPC es diferente. Discusión: El entrenamiento insuficiente en DPC podría traer como consecuencia que el nefrólogo al momento de escoger una terapia se decida por la mejor conocida, y esta podría ser una de las razones por la cual la DPC sea menos utilizada en muchas partes del mundo. La unificación de programas de entrenamiento podría favorecer un mayor conocimiento de la terapia, pudiéndose utilizar así en forma más balanceada.

Introduction: Several factors may influence the preferential use of chronic hemodialysis (CHD) over chronic peritoneal dialysis (CKD) as a therapy for stage 5 chronic kidney disease patients in chronic dialysis (5DCKD) programs in several countries around the world. Objectives: To determine if a lack of adequate chronic peritoneal dialysis (CPD) education in some nephrology postgraduate programs is the main reason why nephrologists prefer to use HDC, the best known therapy. Material and Methods: We analyzed the CPD training program received by nephrology postgraduate students in several countries of Central and South America. The obtained information was based on a survey that was sent to one or more nephrologists from each country between February 1 and July 31, 2011, addressed to those who work in the academic environment and who know, direct or belong to nephrology postgraduate programs. Results: 114 postgraduate nephrology programs exist in Latin America today. A clear variation is found in CPD training period, according to each program and country. The volume of patients on CPD varies from 25 to more than 280, thus making clear that training and experience gained in care of patients with CPD is unbalanced. Discussion: Insufficient DPC training may end-up in nephrologists choosing the best known therapy, being this way one of the reasons why DPC is less often used in many parts of the world. Unification of training programs could favor a better knowledge of this therapy, being then able to use it in a more balanced way.

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Upwelling of global deep waters to the sea surface in the Southern Ocean closes the global overturning circulation and is fundamentally important for oceanic uptake of carbon and heat, nutrient resupply for sustaining oceanic biological production, and the melt rate of ice shelves. However, the exact pathways and role of topography in Southern Ocean upwelling remain largely unknown. Here we show detailed upwelling pathways in three dimensions, using hydrographic observations and particle tracking in high-resolution models. The analysis reveals that the northern-sourced deep waters enter the Antarctic Circumpolar Current via southward flow along the boundaries of the three ocean basins, before spiraling southeastward and upward through the Antarctic Circumpolar Current. Upwelling is greatly enhanced at five major topographic features, associated with vigorous mesoscale eddy activity. Deep water reaches the upper ocean predominantly south of the Antarctic Circumpolar Current, with a spatially nonuniform distribution. The timescale for half of the deep water to upwell from 30° S to the mixed layer is ~60-90 years.Deep waters of the Atlantic, Pacific and Indian Oceans upwell in the Southern Oceanbut the exact pathways are not fully characterized. Here the authors present a three dimensional view showing a spiralling southward path, with enhanced upwelling by eddy-transport at topographic hotspots.

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Oxygen concentrations are hypothesized to decrease in many areas of the ocean as a result of anthropogenically driven climate change, resulting in habitat compression for pelagic animals. The oxygen partial pressure, pO2 , at which blood is 50% saturated (P50 ) is a measure of blood oxygen affinity and a gauge of the tolerance of animals for low ambient oxygen. Tuna species display a wide range of blood oxygen affinities (i.e., P50 values) and therefore may be differentially impacted by habitat compression as they make extensive vertical movements to forage on subdaily time scales. To project the effects of end-of-the-century climate change on tuna habitat, we calculate tuna P50 depths (i.e., the vertical position in the water column at which ambient pO2 is equal to species-specific blood P50 values) from 21st century Earth System Model (ESM) projections included in the fifth phase of the Climate Model Intercomparison Project (CMIP5). Overall, we project P50 depths to shoal, indicating likely habitat compression for tuna species due to climate change. Tunas that will be most impacted by shoaling are Pacific and southern bluefin tunas-habitat compression is projected for the entire geographic range of Pacific bluefin tuna and for the spawning region of southern bluefin tuna. Vertical shifts in P50 depths will potentially influence resource partitioning among Pacific bluefin, bigeye, yellowfin, and skipjack tunas in the northern subtropical and eastern tropical Pacific Ocean, the Arabian Sea, and the Bay of Bengal. By establishing linkages between tuna physiology and environmental conditions, we provide a mechanistic basis to project the effects of anthropogenic climate change on tuna habitats.

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This paper aimed to describe the basic aspects of uterine transplant (UTx) research in humans, including preliminary experiences in rodents and domestic species. Studies in rats, domestic species, and non-human primates validated and optimized the UTx procedure in terms of its surgical aspects, immunosuppression, rejection diagnosis, peculiarities of pregnancy in immunosuppressed patients, and patients with special uterine conditions. In animal species, the first live birth from UTx was achieved in a syngeneic mouse model in 2003. Twenty-five UTx procedures have been performed in humans. The first two cases were unsuccessful, but established the need for rigorous research to improve success rates. As a result of a controlled clinical study under a strictly designed research protocol, nine subsequent UTx procedures have resulted in six healthy live births, the first of them in 2014. Further failed UTx procedures have been performed in China, Czech Republic, Brazil, Germany, and the United States, most of which using living donors. Albeit still an experimental procedure in, UTx is the first potential alternative for the treatment of absolute uterine factor infertility (AUFI).

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Climate change is expected to modify ecological responses in the ocean, with the potential for important effects on the ecosystem services provided to humankind. Here we address the question of how rapidly multiple drivers of marine ecosystem change develop in the future ocean. By analysing an ensemble of models we find that, within the next 15 years, the climate change-driven trends in multiple ecosystem drivers emerge from the background of natural variability in 55% of the ocean and propagate rapidly to encompass 86% of the ocean by 2050 under a 'business-as-usual' scenario. However, we also demonstrate that the exposure of marine ecosystems to climate change-induced stress can be drastically reduced via climate mitigation measures; with mitigation, the proportion of ocean susceptible to multiple drivers within the next 15 years is reduced to 34%. Mitigation slows the pace at which multiple drivers emerge, allowing an additional 20 years for adaptation in marine ecological and socio-economic systems alike.

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Photosynthesis fuels marine food webs, yet differences in fish catch across globally distributed marine ecosystems far exceed differences in net primary production (NPP). We consider the hypothesis that ecosystem-level variations in pelagic and benthic energy flows from phytoplankton to fish, trophic transfer efficiencies, and fishing effort can quantitatively reconcile this contrast in an energetically consistent manner. To test this hypothesis, we enlist global fish catch data that include previously neglected contributions from small-scale fisheries, a synthesis of global fishing effort, and plankton food web energy flux estimates from a prototype high-resolution global earth system model (ESM). After removing a small number of lightly fished ecosystems, stark interregional differences in fish catch per unit area can be explained (r = 0.79) with an energy-based model that (i) considers dynamic interregional differences in benthic and pelagic energy pathways connecting phytoplankton and fish, (ii) depresses trophic transfer efficiencies in the tropics and, less critically, (iii) associates elevated trophic transfer efficiencies with benthic-predominant systems. Model catch estimates are generally within a factor of 2 of values spanning two orders of magnitude. Climate change projections show that the same macroecological patterns explaining dramatic regional catch differences in the contemporary ocean amplify catch trends, producing changes that may exceed 50% in some regions by the end of the 21st century under high-emissions scenarios. Models failing to resolve these trophodynamic patterns may significantly underestimate regional fisheries catch trends and hinder adaptation to climate change.

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Resumen Introducción: Durante el examen de pediatría, genética, ecográfico o de anatomía patológica de fetos de gestaciones gemelares, suelen aparecer interrogantes en el diagnóstico diferencial, especialmente cuando los casos se asocian con maceración, malformaciones o duplicación de estructuras. Objetivo: Proponer un algoritmo para el enfoque de la autopsia perinatal en gestaciones múltiples de difícil diagnóstico. Materiales y Métodos: Estudio observacional descriptivo del universo de gestaciones gemelares vistas en el Departamento de Patología del Hospital Universitario San Ignacio (HUSI) entre 2007 y 2013. Definimos como "gestación múltiple de difícil diagnóstico" aquella en la que el examen del (de los) feto(s) planteó uno de los diagnósticos diferenciales: feto macerado/evanescente, gemelo siamés, fetus in fetu, feto acárdico o teratoma congénito. Se realizó el estudio anatomopatológico y junto con la literatura revisada, los gemelos se analizaron y clasificaron según el algoritmo propuesto. Resultados: Hubo 59 casos de gestaciones gemelares en las que al menos uno de los fetos requirió autopsia perinatal. Las principales causas de muerte fueron las infecciones ascendentes seguidas del síndrome de transfusión feto-fetal. Como gestaciones múltiples de difícil diagnóstico observamos tres fetos acárdicos y ocho fetos macerados. Se aplicó el algoritmo propuesto en este artículo. Conclusiones: El diagnóstico en las gestaciones gemelares puede ser en ocasiones difícil. Identificamos los aspectos más importantes a tener en cuenta de la historia clínica y de la autopsia perinatal para llegar al diagnóstico definitivo. Desarrollamos un algoritmo para ser aplicado en estas circunstancias durante las autopsias perinatales.

Abstract Introduction: During pediatric, genetic, sonographic, or pathological anatomy examination on complicated twin gestational fetuses, questions arise concerning differential diagnosis, especially when cases are associated with malformations, maceration of several months duration, or complex structural duplications. Objective: To propose an algorithm for approaching perinatal autopsy in complicated multiple gestations. Materials and Methods: Descriptive observational study on twin gestations seen in the Hospital Universitario San Ignacio (HUSI) in 2007-2013. We defined "complicated twin gestation" as one in which an examination of the fetus or fetuses raised one of the following differential diagnoses: macerated fetus, conjoined fetuses, fetus in fetu, acardiac fetus, or congenital teratoma. An anatomopathological study was performed and twins were classified according to the proposed algorithm. Results: Analysis of 59 cases in which at least one fetus required a perinatal autopsy. The leading causes of death were ascending infections and fetal-twin transfusion syndrome. Among complicated multiple gestations we observed eight fetuses including three acardiac macerated fetuses. We applied the algorithm proposed in this article. Conclusion: Diagnosis in twin pregnancies can sometimes be difficult. We identify the most important aspects of medical records and perinatal autopsy to be considered in reaching a definitive diagnosis; we develop an algorithm to be applied in these circumstances.

Resumo Introdução: Durante o exame de pediatria, genética, ecográfico ou de anatomia patológica de fetos de gestações gemelares, costumam aparecer interrogantes no diagnóstico diferencial, especialmente quando os casos se associam com maceração, com malformações ou com duplicação de estruturas. Objetivo: Propor um algoritmo para o enfoque da autopsia perinatal em gestações múltiplas de difícil diagnóstico. Materiais e Métodos: Estudo observacional descritivo do universo de gestações gemelares vistas no Departamento de Patologia do Hospital Universitário San Ignacio (HUSI) entre 2007 e 2013. Definimos como "gestação múltipla de difícil diagnóstico" aquela na que o exame do(s) feto(s) apresentou um dos diagnósticos diferenciais: feto macerado/evanescente, gêmeo siamês, fetus in fetu, feto acárdico ou teratoma congênito. Realizou-se o estudo anatomopatológico e junto com a literatura revisada, os gêmeos se analisaram e classificaram segundo o algoritmo proposto. Resultados: Houve 59 casos de gestações gemelares nas que pelo menos um dos fetos requereu autopsia perinatal. As principais causas de morte foram as infeções ascendentes seguidas da síndrome de transfusão feto-fetal. Como gestações múltiplas de difícil diagnóstico observamos três fetos acárdicos e oito fetos macerados. Aplicou-se o algoritmo proposto neste artigo. Conclusões: O diagnóstico nas gestações gemelares pode ser em ocasiões difícil. Identificamos os aspectos mais importantes a ter em conta da história clínica e da autopsia perinatal para chegar ao diagnóstico definitivo; desenvolvemos um algoritmo para ser aplicado nestas circunstâncias durante as autopsias perinatais.

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Introducción: Es importante proveer un adecuado y oportuno manejo a largo plazo de la ERC, por medio de estrategias farmacológicas y no farmacológicas, sin embargo, la baja adherencia de los pacientes al tratamiento farmacológico pone en riesgo la efectividad de la intervención. Objetivo: Traducir al español, validar y adaptar la escala de adherencia al tratamiento de Morisky de 8 items a pacientes con ERC. Materiales y Métodos: La traducción del MMAS-8 se realizó de acuerdo con las directrices para la traducción y la adaptación de instrumentos de medida para ser utilizados en investigación médica, se validó mediante juicio de expertos siguiendo el método Delphi. Se realizó un estudio piloto corte transversal, donde se encuesto a 30 pacientes que acudieron a consulta de predialisis de la unidad renal del hospital militar central en Bogotá Colombia. Resultados: La escala MMAS-8 traducida al español fue sometida a los jueces para su validación obteniéndose un porcentaje de acuerdo igual o mayor al 80% para todas las preguntas, se calculó el coeficiente de concordancia W de Kendall que en este caso fue 0,8 con un p valor de 0,0001 y se interpretó como un alto grado de concordancia entre las valoraciones hechas por los jueces a los diferentes ítems del cuestionario. Se aplicó el MMAS-8 a 30 pacientes con una media de edad de 75,9 años (+/- 15), el nivel de adherencia al tratamiento se analizó según el puntaje de la escala de Morisky de 8 items, clasificándose como baja adherencia al tratamiento en el 62,5% de los casos con puntaje menor de 6, mediana adherencia 28,1% de los pacientes puntaje entre 6 y 7 y alta adherencia solo el 9,4% de los pacientes con puntaje mayor de 8. Conclusiónes: La escala de medición de adherencia al tratamiento de Morisky de 8 items es válida para medir la adherencia al tratamiento farmacológico de pacientes con enfermedad renal crónica según juicio de expertos.

Introduction: It is important to provide long-term, adequate and timely treatment of the Chronic kidney disease, by pharmacological and non-pharmacological strategies, however, low adherence of patients to drug treatment puts at risk the effectiveness of the intervention. Objective: Translate to Spanish, validate and adapt the scale of adherence Morisky 8 items patients with chronic kidney disease. Materials and methods: Translation from MMAS-8 was performed according to the guidelines for the translation and adaptation of measuring instruments for use in medical research. It was validated by expert judgment following the Delphi method. A pilot study was conducted cross-sectional, where 30 patients who consulted predialysis renal unit of the central military hospital in Bogota Colombia was surveyed. Results: MMAS-8 Scale translated into Spanish was submitted to the judges for validation, obtaining a percentage of agreement equal to or greater than 80% for all questions, the coefficient of Kendall W in this case was 0.8 with a p value of 0.0001 was calculated and it is interpreted as a high degree of consistency between the assessments made by the judges to the different items of the questionnaire. MMAS-8 is applied to 30 patients with a mean age 75.9 years (+/- 15), the level of adherence to treatment is performed according to the scale score Morisky 8 items, classified as low adherence to treatment in 62.5% of cases with lower score of 6, adhesion median 28.1% of patients score between 6 and 7, and high adhesion only 9.4% of patients with major score of 8. Conclusions: The scale measuring adherence Morisky 8 items It is valid to measure adherence to drug treatment of patients with chronic kidney disease according to expert judgment.

Introdução: É importante fornecer um tratamento a longo prazo, adequado e oportuno da doença renal crónica, através de estratégias farmacológicas e não farmacológicas, no entanto, a baixa adesão dos doentes ao tratamento medicamentoso põe em risco a eficácia da intervenção. Objetivo: Traduzir para o espanhol, validar e adaptar a escala de adesão Morisky 8 itens pacientes com doença renal crônica. Materiais e métodos: A tradução do MMAS-8 foi realizada de acordo com as diretrizes para a tradução e adaptação de instrumentos de medição para uso em uma investigação médica. Foi validado por um juízo especialista seguindo o método Delphi. Um estudo piloto foi realizado em corte transversal, onde foram entrevistados 30 pacientes que consultaram a unidade pré-diálise renal do hospital militar central em Bogotá Colômbia. Resultados: A escala de MMAS-8 traduzida para o espanhol foi submetida aos juízes para validação, obtendo-se uma percentagem de concordância igual ou superior a 80% para todas as questões, o coeficiente de Kendall W neste caso 0,8 com um valor de p de 0,0001 foi calculado e interpretado como um alto grau de consistência entre as avaliações feitas pelos juízes aos diferentes itens do questionário. O MMAS-8 é aplicado a 30 pacientes com idade média de 75,9 anos (+/- 15), o nível de aderência ao tratamento é realizado de acordo com o escore Morisky 8 itens, classificados como baixa adesão ao tratamento em 62,5% dos casos com Menor pontuação de 6, adesão mediana 28,1% dos pacientes pontuação entre 6 e 7, e alta adesão apenas 9,4% dos pacientes com pontuação maior de 8. Conclusões: A adesão escala de medição para tratamento Morisky 8 itens é válido para medir a adesão ao tratamento medicamentoso de pacientes com doença renal crônica, de acordo com o julgamento cientistas de investigação.

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