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Objetivo. Determinar si la edad es un factor importante en la prestación de los servicios de teleconsulta por parte de los profesionales de salud, mediante una revisión de la literatura disponible. Materiales y métodos. En las bases de datos se encontraron 34.000 resultados. Se escogieron 50 artículos donde se mencionaba la teleconsulta. El mayor número de investigaciones se llevó a cabo en Estados Unidos, España, Australia, India y Suecia. Se tuvieron en cuenta criterios de inclusión y exclusión. Resultados. En los 50 artículos seleccionados se pudieron establecer cinco categorías: normatividad, importancia de la telemedicina, grupos de edad, factores diferenciales y aceptabilidad por parte de los profesionales de la salud. Se evidencia que los adultos mayores son menos tolerantes a los cambios y a la adherencia a las nuevas tecnologías comparados con los pacientes en edades pediátricas. Sin embargo, son los primeros quienes utilizan con mayor frecuencia los servicios de teleconsulta dado los requerimientos frecuentes de asistencia propios de la edad adulta. Además, en los adultos mayores que necesitan de personal cuidador la atención se vio limitada porque este no ofreció los datos requeridos por dificultad en el uso de los dispositivos tecnológicos. Conclusiones. Esta investigación demuestra que la edad puede comportarse como un factor determinante en la atención por teleconsulta, sobre todo la edad adulta en la que ocurren los cambios fisiológicos propios de la senectud y el requerimiento de acompañantes permanentes se convierte en una necesidad. La escasa adherencia a nuevas tecnologías, secundaria a limitaciones físicas y motrices, impiden una consulta efectiva desde la virtualidad en tal grupo etario

Objective. To determine whether age is an important factor in the provision of teleconsultation services by health professionals, through a review of the available literature. Materials and methods. A total of 34,000 results were found in the databases. Fifty articles mentioning teleconsultation were selected. The largest number of investigations were carried out in the United States, Spain, Australia, India and Sweden. Inclusion and exclusion criteria were taken into account. Results. Five categories could be established in the 50 articles selected: normativity, importance of telemedicine, age groups, differential factors and acceptability by health professionals. It is evident that older adults are less tolerant to changes and adherence to new technologies compared to pediatric patients. However, it is the former who use teleconsultation services more frequently, given the frequent requests for assistance typical of adulthood. In addition, in older adults who need personal caregivers, care was limited because the latter did not provide the required data due to difficulties in the use of technological devices. Conclusions. This research shows that age can be a determining factor in teleconsultation care, especially in adulthood, when physiological changes typical of senescence occur and the need for permanent companions becomes a necessity. The scarce adherence to new technologies, secondary to physical and motor limitations, prevent an effective virtual consultation in this age group.

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Management of protected areas must adapt to climate impacts, and prepare for ongoing ecological transformation. Future-Proofing Conservation is a dialogue-based, multi-stakeholder learning process that supports conservation managers to consider the implications of climate change for governance and management. It takes participants through a series of conceptual transitions to identify new management options that are robust to a range of possible biophysical futures, and steps that they can take now to prepare for ecological transformation. We outline the Future-Proofing Conservation process, and demonstrate its application in a pilot programme in Colombia. This process can be applied and adapted to a wide range of climate adaptation contexts, to support practitioners in developing positive ways forward for management and decision-making. By acknowledging scientific uncertainty, considering social values, and rethinking the rules that shape conservation governance, participants can identify new strategies towards "future-oriented conservation" over the long term.

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Se reporta el caso de un hombre de 47 arios con intoxicación crónica por plomo, secundaria a exposición laboral de 5 años, con sintomatología típica de saturnismo. Consultó por debilidad muscular generalizada, disfagia y parestesias en extremidades. Se documentaron altos niveles de plomo en sangre, asociados a neuropatía periférica, confirmada por electromiografía, y disminución de la fuerza muscular en cintura escapular y pélvica (deltoides y vasto medial), así como atrofia de músculos del cuello (flexores y extensores) manifestada como cefaloparesia. Adicional al cuadro de saturnismo se diagnosticó miopatía inflamatoria con base en la elevación de enzimas musculares, miositis por resonancia magnética nuclear y biopsia muscular compatible, siendo, hasta donde se sabe, el primer reporte conocido de la coexistencia de estas 2 enfermedades

A case is presented on a 47-year-old man with chronic lead poisoning with typical symptoms after 5 years of occupational exposure. He consulted for generalised muscle weakness, early dysphagia, cephaloparesia, and paresthesias in upper and lower limbs. He also had atrophy and decreased proximal muscle strength (deltoid and medial vast) and in both flexor and extensor muscles of the neck. He had a history of high blood lead levels and peripheral neuropathy documented by electromyography. In addition to the diagnosis of lead poisoning, inflammatory myopathy was confirmed based on muscle enzyme elevation, muscular inflammation in magnetic resonance imaging, and typical findings in a muscle biopsy. To our knowledge, this is the first report where both conditions are documented in one patient

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Background Paroxysmal nocturnal haemoglobinuria (PNH) presents as two major entities: the classical form, predominantly haemolytic and a secondary type with marrow failure and resultant aplastic anaemia (AA-PNH). Currently, the treatment of choice of the haemolytic variant is eculizumab; however, the most frequent form of PNH in México is AA-PNH. Patients and methods Six consecutive AA-PNH patients with HLA-identical siblings were allografted in two institutions in México, employing a reduced-intensity conditioning regimen for stem cell transplantation (RIST) conducted on an outpatient basis. Results Median age of the patients was 37 years (range 25-48). The patients were given a median of 5.4 × 10(6)/kg allogeneic CD34(+) cells, using 1-3 apheresis procedures. Median time to achieve above 0.5 × 10(9)/l granulocytes was 21 days, whereas median time to achieve above 20 × 10(9)/l platelets was 17 days. Five patients are alive for 330-3150 days (median 1437) after the allograft. The 3150-day overall survival is 83.3%, whereas median survival has not been reached, being above 3150 days. Conclusion We have shown that hypoplastic PNH patients can be allografted safely using RIST and that the long-term results are adequate, the cost-benefit ratio of this treatment being reasonable. Additional studies are needed to confirm the usefulness of RIST in the treatment of AA-PNH.

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