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Current advances in the management of the autonomic nervous system in various cardiovascular diseases, and in treatments for pain or sympathetic disturbances in the head, neck, or upper limbs, necessitate a thorough understanding of the anatomy of the cervicothoracic sympathetic trunk. Our objective was to enhance our understanding of the origin and distribution of communicating branches and visceral cervicothoracic sympathetic nerves in human fetuses. This was achieved through a comprehensive topographic systematization of the branching patterns observed in the cervical and upper thoracic ganglia, along with the distribution of communicating branches to each cervical spinal nerve. We conducted detailed sub-macroscopic dissections of the cervical and thoracic regions in 20 human fetuses (40 sides). The superior and cervicothoracic ganglia were identified as the cervical sympathetic ganglia that provided the most communicating branches on both sides. The middle and accessory cervical ganglia contributed the fewest branches, with no significant differences between the right and left sides. The cervicothoracic ganglion supplied sympathetic branches to the greatest number of spinal nerves, spanning from C5 to T2. The distribution of communicating branches to spinal nerves was non-uniform. Notably, C3, C4, and C5 received the fewest branches, and more than half of the specimens showed no sympathetic connections. C1 and C2 received sympathetic connections exclusively from the superior ganglion. Spinal nerves that received more branches often did so from multiple ganglia. The vertebral nerve provided deep communicating branches primarily to C6, with lesser contributions to C7, C5, and C8. The vagus nerve stood out as the cranial nerve with the most direct sympathetic connections. The autonomic branching pattern and connections of the cervicothoracic sympathetic trunk are significantly variable in the fetus. A comprehensive understanding of the anatomy of the cervical and upper thoracic sympathetic trunk and its branches is valuable during autonomic interventions and neuromodulation. This knowledge is particularly relevant for addressing various autonomic cardiac diseases and for treating pain and vascular dysfunction in the head, neck, and upper limbs.

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PIK3CA-related overgrowth spectrum (PROS) encompasses different clinical entities caused by somatic activating mutations in PIK3CA. Among PROS, CLOVES syndrome represents a severe phenotype with poor survival rate. We present the case of a 4-month-old girl with CLOVES syndrome successfully treated with alpelisib, a PIKC3A inhibitor.

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Background: Policymakers urgently need evidence to adequately balance the costs and benefits of mass vaccination against COVID-19 across all age groups, including children and adolescents. In this study, we aim to assess the effectiveness of CoronaVac's primary series among children and adolescents in Chile. Methods: We used a large prospective national cohort of about two million children and adolescents 6-16 years to estimate the effectiveness of an inactivated SARS-CoV-2 vaccine (CoronaVac) in preventing laboratory-confirmed symptomatic SARS-CoV-2 infection (COVID-19), hospitalisation, and admission to an intensive care unit (ICU) associated with COVID-19. We compared the risk of individuals treated with a complete primary immunization schedule (two doses, 28 days apart) with the risk of unvaccinated individuals during the follow-up period. The study was conducted in Chile from June 27, 2021, to January 12, 2022, when the SARS-CoV-2 Delta variant was predominant but other variants of concern were co-circulating, including Omicron. We used inverse probability-weighted survival regression models to estimate hazard ratios of complete immunization over the unvaccinated status, accounting for time-varying vaccination exposure and adjusting for relevant demographic, socioeconomic, and clinical confounders. Findings: The estimated adjusted vaccine effectiveness for the inactivated SARS-CoV-2 vaccine in children aged 6-16 years was 74.5% (95% CI, 73.8-75.2), 91.0% (95% CI, 87.8-93.4), 93.8% (95% CI, 87.8-93.4) for the prevention of COVID-19, hospitalisation, and ICU admission, respectively. For the subgroup of children 6-11 years, the vaccine effectiveness was 75.8% (95% CI, 74.7-76.8) for the prevention of COVID-19 and 77.9% (95% CI, 61.5-87.3) for the prevention of hospitalisation. Interpretation: Our results suggest that a complete primary immunization schedule with the inactivated SARS-CoV-2 vaccine provides effective protection against severe COVID-19 disease for children 6-16 years. Funding: Agencia Nacional de Investigación y Desarrollo (ANID) Millennium Science Initiative Program and Fondo de Financiamiento de Centros de Investigación en Áreas Prioritarias (FONDAP).

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The outbreak of the B.1.1.529 lineage of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Omicron) has caused an unprecedented number of Coronavirus Disease 2019 (COVID-19) cases, including pediatric hospital admissions. Policymakers urgently need evidence of vaccine effectiveness in children to balance the costs and benefits of vaccination campaigns, but, to date, the evidence is sparse. Leveraging a population-based cohort in Chile of 490,694 children aged 3-5 years, we estimated the effectiveness of administering a two-dose schedule, 28 days apart, of Sinovac's inactivated SARS-CoV-2 vaccine (CoronaVac). We used inverse probability-weighted survival regression models to estimate hazard ratios of symptomatic COVID-19, hospitalization and admission to an intensive care unit (ICU) for children with complete immunization over non-vaccination, accounting for time-varying vaccination exposure and relevant confounders. The study was conducted between 6 December 2021 and 26 February 2022, during the Omicron outbreak in Chile. The estimated vaccine effectiveness was 38.2% (95% confidence interval (CI), 36.5-39.9) against symptomatic COVID-19, 64.6% (95% CI, 49.6-75.2) against hospitalization and 69.0% (95% CI, 18.6-88.2) against ICU admission. The effectiveness against symptomatic COVID-19 was modest; however, protection against severe disease was high. These results support vaccination of children aged 3-5 years to prevent severe illness and associated complications and highlight the importance of maintaining layered protections against SARS-CoV-2 infection.

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RESUMEN La acidez del suelo limita la disponibilidad, la absorción y la concentración de nutrientes y el rendimiento del cultivo de cacao. El objetivo fue evaluar el efecto del pH del suelo sobre la concentración de nutrientes en hoja, cáscara y grano, para cuatro clones de cacao autocompatibles (ICS-1, CCN-51) y autoincompatibles (ICS-39, TSH-565), en el departamento del Caquetá. El diseño experimental consistió en un arreglo factorial con cuatro clones (factor A), cuatro niveles de pH y fertilidad (factor B) y cuatro repeticiones. Los resultados indican diferencias en la concentración de nutrientes por efecto del clon y tratamiento, siendo la acumulación de N, P y Mg en grano>hoja>cáscara, K en cáscara>hoja>grano, Ca, Fe, Mn, Zn y B en hoja>cáscara>grano, S en cáscara>hoja>grano y Cu en grano>cáscara>hoja. La concentración de P, Mg y S fue mayor y, a su vez, menor Mn, cuando aumentó el pH. El orden de extracción nutrimental en grano fue N>K>P>Mg>S>Ca>Fe>Mn>Zn>Cu>B. Con relación a los clones, CCN-51 presentó habilidad para la toma de nutrientes y alcanzar mayores producciones, incluso, en suelos con pH ≥ 5,5, lo que sugiere efecto de las condiciones edafoclimáticas y, por lo tanto, la necesidad de evaluar los clones para cada zona de cultivo.

ABSTRACT The soil acidity limits availability, absorption and concentration of nutrients and yield of the cocoa crop. The objective was to evaluate the effect of soil pH on the concentration of macro and micronutrients in leaf, husk and grain for four cocoa clones, self-compatible (ICS-1, CCN-51) and self-incompatible (ICS-39, TSH-565) in the department of Caquetá. The experimental design consisted in a factorial arrangement with four clones (factor A), four pH and fertility levels (factor B) and four repetitions. The results indicate differences in the concentration of nutrients due to the effect of the clone and the treatment, being the accumulation of N, P and Mg in grain>leaf>husk, K in husk>leaf>grain, Ca, Fe, Mn, Zn y B in leaf>husk>grain, S in husk>leaf>grain and Cu in grain>husk>leaf. The concentration of P, Mg and S was higher, and in turn Mn lower, when the pH increased. The order of nutrient extraction in grain was N>K>P>Mg>S>Ca>Fe>Mn>Zn>Cu>B. Regarding clones, CCN-51 showed ability to take nutrients and reach higher productions, even in soils with pH ≥ 5.5, suggesting effect of edaphoclimatic conditions, and therefore, the need to evaluate the clones for each growing area.

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RESUMEN La producción orgánica de seda incluye la aplicación de compost como practica de cultivo en morera (Morus alba), sin embargo, el efecto de la fertilización orgánica en las poblaciones de bacterias rizosféricas no siempre es positivo. Para evaluar el efecto del compost en la diversidad de bacterias rizosféricas en cultivos de morera (Morus alba), se aplicaron 0, 0.25, 0.5 y 1 kg.m-2 de compost a parcelas con morera dispuestas en un diseño en bloques completos al azar. De cada parcela se extrajo ADN del suelo rizosférico a los 0, 5, 10 y 90 días de aplicado el compost y se amplificó la región V4 del gen ADNr 16S para su secuenciación y asignación taxonómica de los OTUS. Los índices de diversidad alpha mostraron la dominancia de algunos grupos taxonómicos, como los phyla Proteobacteria y Acidobacteria y los géneros Pseudomonas, Opitutus, Luteolibacter y Nitrospir. La diversidad beta indicó similitud entre las muestras influenciadas por la aplicación compost y el incremento de la diversidad en las parcelas muestreadas al final del experimento (90 días). Los grupos taxonómicos dominantes se caracterizan por su función en el ciclo del nitrógeno. Así, se concluyó que la aplicación de 1 kg.m-2 llevó al aumento de la humedad del suelo, el pH y la disponibilidad de nutrientes, lo que incremento la diversidad de bacterias rizosféricas con cambios positivos en composición, riqueza y abundancia en los niveles de orden, familia y género.

ABSTRACT The organic silk production includes the application of compost as cultivation practice to the mulberry crop. However, the effect of the organic fertilization on populations of rhizospheric bacteria is not always positive. To evaluate the effect of compost on the diversity of rhizospheric bacteria in mulberry crops (Morus alba), 0, 0.25, 0.5 and 1 kg.m-2 of compost was applied to mulberry plots arranged in a completely randomized blocks design. From each plot, DNA was extracted from the rhizospheric soil at 0, 5, 10 and 90 days after compost was applied and the V4 region of the 16S rDNA gene was amplified for its sequencing and taxonomic assignment of the OTUS. Alpha diversity indices showed the dominance of some taxonomic groups, such as the phyla Proteobacteria and Acidobacteria, and the genera Pseudomonas, Opitutus, Luteolibacter and Nitrospira. The beta diversity indicated similarity between the samples influenced by the compost application and the increase of the biodiversity in the plots sampled at the end of the experiment (90 days). The taxonomic groups dominated are characterized by their role in the nitrogen cycle. Thus, it was concluded that the application of 1 kg.m-2 of compost led to the increase of ground humidity, soil pH and nutrient availability which increased the rhizospheric bacteria diversity with positive changes in composition, richness and abundance at order, family and genera levels.

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Human respiratory syncytial virus (RSV) infection remains as a major cause of morbidity and mortality among pediatric population. Immune response is poor and unable to establish a long term effective protection against this virus. Of particular interest has been the description of extrapulmonary manifestations of RSV infection in liver, kidney, endocrine system, heart and brain, associated to infection of peripheral blood. In the central nervous system (CNS), recent studies in animals have suggested long term neurocognitive impairment due to a direct damage from the virus. This was prevented in rats by a recombinant BCG vaccine expressing a nucleoprotein N of RSV that produces an effective immune response against the virus, not allowing its dissemination to the CNS. These findings in animal models highlight the importance of conducting more specific studies in children affected with severe infection by RSV. Therefore, our group is currently conducting an assessment of the possible long-term cognitive impairment in children under 2 years. The results of this study could be a strong argument to continue looking for an effective method for protecting against RSV infection.

La infección por virus respiratorio sincicial humano (VRS) es una de las principales causas de morbimortalidad en población pediátrica. La respuesta inmune generada contra VRS es poco eficiente para su eliminación y logra establecer sólo protección parcial contra infecciones posteriores. De especial interés en los últimos años ha sido la descripción de manifestaciones extra-pulmonares de la infección por VRS en hígado, riñón, sistema endocrino, corazón y cerebro. A nivel de sistema nervioso central (SNC), estudios recientes en modelos animales han sugerido problemas neurocognitivos a largo plazo derivados de un daño directo del virus en el cerebro. Este daño logró ser prevenido con vacuna experimental BCG recombinante, que expresa la nucleoproteína N de VRS e induce inmunidad efectiva, impidiendo la diseminación del virus hacia el SNC. Estos hallazgos en modelo animal han dado cuenta de la importancia de efectuar estudios más detallados en niños afectados por VRS grave. Por tal motivo, actualmente se está realizando una evaluación de la posible alteración cognitiva a largo plazo en niños bajo dos años de edad por parte de nuestro grupo. Los resultados de este estudio podrían significar un argumento muy importante para continuar en la búsqueda de un método efectivo de protección contra esta infección.

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Human respiratory syncytial virus (RSV) infection remains as a major cause of morbidity and mortality among pediatric population. Immune response is poor and unable to establish a long term effective protection against this virus. Of particular interest has been the description of extrapulmonary manifestations of RSV infection in liver, kidney, endocrine system, heart and brain, associated to infection of peripheral blood. In the central nervous system (CNS), recent studies in animals have suggested long term neurocognitive impairment due to a direct damage from the virus. This was prevented in rats by a recombinant BCG vaccine expressing a nucleoprotein N of RSV that produces an effective immune response against the virus, not allowing its dissemination to the CNS. These findings in animal models highlight the importance of conducting more specific studies in children affected with severe infection by RSV. Therefore, our group is currently conducting an assessment of the possible long-term cognitive impairment in children under 2 years. The results of this study could be a strong argument to continue looking for an effective method for protecting against RSV infection.

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La posición cráneo-cervical representa un factor importante en el diagnostico morfológico de discrepancias óseas, articulares y miofuncionales. En base a las diversas clases esqueletales se observan diferencias en la ubicación de puntos craneométricos que resultan determinantes en el diagnóstico del equilibrio ortostático del cráneo con la porción cervical de la columna vertebral. El objetivo de este estudio fue evaluar y comparar la posición cráneo-cervical en clases esqueletales II y III. Se recolectaron 114 radiografías laterales de cráneo, se analizaron y compararon los puntos craneométricos por medio de cefalometría con la Técnica de Rocabado. Los resultados muestran diferencias estadísticamente significativas en las posiciones craneales para cada clase esquelética tanto en distancias como rotación entre cráneo y porción cervical de la columna vertebral.

The skull-cervical position is an important factor in the morphological diagnosis of bone, joint and myofunctional discrepancies. Based on the various classes skeletal differences are observed in the locations that are critical points Craneometric diagnosis of orthostatic balance skull with the cervical portion of the spine. The aim of this study was to evaluate and compare Skull-cervical position in skeletal class II and III. Hundred fourteen lateral skull radiographs were collected, analyzed and compared the craniometric points through cephalometric with Rocabado technique. The results show a statistically significant difference in the positions for each skeletal cranial both class distances as rotation between the skull and cervical portion of the spine.

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BACKGROUND: "Children with special health care needs" (CSHCN) is a novel definition for pediatric patients with chronic diseases, adopted by the Chilean Pediatric Society in 2008. As life expectancy in Chile increases, prevalence of CSHCN is progressively growing, leading to higher health costs. AIM: To describe the epidemiological profile and clinical characteristics of hospitalized CSHCN, and compare the risk assessment of adverse events during hospitalization using two definitions for CSHCN. PATIENTS AND METHODS: A cohort of hospitalized CSHCN in a Pediatric Center at Santiago, Chile, was followed from September to December 2009. Clinical and demographic data were registered in a database, including admission to intensive care unit (ICU), nosocomial infections and prolonged hospitalization (> 7 days). Incidence ratios for these events were compared between CSHCN and non-CSHCN, and between children attended by three or more health care professionals (CSHCN-3) and non-CSHCN. RESULTS: Nine hundred twenty patients were included (54% male), with a median age 14 months (0-221) and median days of hospitalization 4 days (1-229). Prevalence of CSHCN was 60.8% of hospitalized children. When using CSHCN definition and comparing with non-CSHCN, no excess of risk was documented. On the other hand, prevalence of CSHCN-3 was 19.9%. Compared to non-CSHCN, these patients had a higher risk of ICU admission (relative risk (RR) 1.58; 95% confidence intervals (CI) = 1.22-2.05; p < 0.01), nosocomial infections (RR 2.28; 95% CI = 1.54-3.39; p < 0.001) and prolonged hospitalization (RR 1.99; 95% CI = 1.52-2.60; p < 0.001). CONCLUSIONS: One in five hospitalized children met CSHCN-3 definition. These patients had an increased risk of adverse events during their hospitalization compared to non-CSHCN.

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Background: "Children with special health care needs" (CSHCN) is a novel definition for pediatric patients with chronic diseases, adopted by the Chilean Pediatric Society in 2008. As life expectancy in Chile increases, prevalence of CSHCN is progressively growing, leading to higher health costs. Aim: To describe the epide-miological profile and clinical characteristics of hospitalized CSHCN, and compare the risk assessment of adverse events during hospitalization using two definitions for CSHCN. Patients and Methods: A cohort of hospitalized CSHCN in a Pediatric Center at Santiago, Chile, was followed from September to December 2009. Clinical and demographic data were registered in a database, including admission to intensive care unit (ICU), nosocomial infections and prolonged hospitalization (> 7 days). Incidence ratios for these events were compared between CSHCN and non-CSHCN, and between children attended by three or more health care professionals (CSHCN-3) and non-CSHCN. Results: Nine hundred twenty patients were included (54% male), with a median age 14 months (0-221) and median days of hospitalization 4 days (1-229). Prevalence of CSHCN was 60.8% of hospitalized children. When using CSHCN definition and comparing with non-CSHCN, no excess of risk was documented. On the other hand, prevalence of CSHCN-3 was 19.9%. Compared to non-CSHCN, these patients had a higher risk of ICU admission (relative risk (RR) 1.58; 95% confidence intervals (CI) = 1.22-2.05; p < 0.01), nosocomial infections (RR 2.28; 95% CI = 1.54-3.39; p < 0.001) and prolonged hospitalization (RR 1.99; 95% CI = 1.52-2.60; p < 0.001). Conclusions: One in five hospitalized children met CSHCN-3 definition. These patients had an increased risk of adverse events during their hospitalization compared to non-CSHCN.

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Leifsonia aquatica is an aquatic coryneform rod that is capable of forming biofilms in environmental water sources. It has rarely been associated with human infections and its pathogenicity and clinical significance are uncertain. We describe a case of catheter-related bloodstream infection in a haemodialysis patient. The isolate grew on conventional media as a yellow-pigmented colony, but identification required molecular methods. Although the strain displayed reduced sensitivity to vancomycin, the clinical outcome was favourable after catheter removal and intravenous treatment with this antibiotic. Our report gives further evidence of the capability of this aquatic bacterium to cause human infection.

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La amiloidosis conjuntival es una condición infrecuente en la práctica clínica, que se caracteriza por el depósito de material amiloide de la conjuntiva. Se estima que es la causa del 0,002 por ciento de las lesiones conjuntivales. Dada la baja incidencia de esta patología, existen pocos reportes en la literatura. En este trabajo se presentan los casos clínicos de tres pacientes con amiloidosis conjuntival que fueron atendidos en nuestro centro y se propone una aproximación diagnóstica para evaluar la existencia de amiloidosis sistémica.

Conjunctival amyloidosis is a rare condition characterized by the localized deposition of amyloid material in the conjunctiva. It's supossed to be the cause of 0.002 percent of conjunctival lesions. Given the low incidence of this disease, there are few reports in the literature. In this manuscript we present the cases of three patients with primary conjunctival amyloidosis who were attended at our institution. We also propose a diagnostic algorithm to rule out systemic amyloidosis in patients in whom the finding is conjunctival amyloidosis.

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Introducción: Las ciencias de la decisión conforman el conjunto de técnicas y teorías surgido del método cuantitativo y matemático dirigido al auxilio de una toma de decisiones con criterio aplicable a varias disciplinas y en los más variados contextos, donde la multicausalidad y la influencia de múltiples factores hace difícil la elección de una decisión unívoca, dado que la incertidumbre es el patrón común situacional. Se presenta a continuación el caso concreto de un paciente de 50 años portador de una cefalea en racimos, en el que se aplica el análisis de decisión de abordaje diagnóstico-terapéutico, y se elige la conducta a seguir basándose en esta metodología. Objetivos: Aplicar este modelo de análisis de la decisión a un problema clínico individual: un paciente de 50 años, portador de una cefalea en racimos o acuminada. Demostrar que en este caso clínico puntual, ante varias opciones diagnósticas y terapéuticas, el intervencionismo antálgico es una de las herramientas más efectivas y elegidas por los pacientes, teniendo en cuenta aspectos tales como la evidencia científica de respaldo de cada alternativa, la calidad de vida de los pacientes con dolor crónico no oncológico de tipo invalidante y el uso de una metodología concreta para la toma de decisión. Material y métodos: Aplicación de un análisis de decisión diagnóstico (terapéutico concreto), presentando un caso clínico real de cefalea en racimos. Búsqueda bibliográfica en Medline y OVID. Para la formulación de los valores umbrales, el análisis de sensibilidad y la graficación del árbol de decisión se utilizó el paquete estadístico STATA - DATA TREE AGE 3.5. Como outcome principal se determinó la expectativa de vida ajustada por calidad (medida en QALYs)...

Introduction: The science of decision-making is a set of techniques and theories arising from the quantitative and mathematic method, aimed at assisting in decision-making with criterion, applicable to many disciplines and numerous different contexts in which multi-causality and the influence of multiple factors make the choice of an unequivocal decision difficult, as uncertainty is the common pattern of the situation. Following is the case history of a 50-year-old patient suffering from cluster headaches; the analysis of decision-making as to the diagnostic-therapeutic approach is applied and the choice of conduct is based on this methodology. Objectives: To apply this decision-making analysis model to a clinical problem: a 50-year-old patient with cluster or acuminate headaches. To prove that in this specific clinical case, faced with different diagnostic and therapeutic options, antalgic interventionism is one of the most effective tools and is chosen by patients, taking into account aspects such as scientific backing proof of each alternative, quality of life of patients with chronic non-oncology invalidating pain and the use of a specific methodology for making the decision. Material and methods: Application of a diagnostic decision analysis, with a real clinical case of cluster headaches. Bibliographic research in Medline and OVID. To formulate threshold values, the sensitivity analysis and graphing the decision tree, the STATA - DATA TREE AGE 3.5 was used. As main outcome, the life expectancy adjusted by quality (measured in QALYs) was determined. Results: Once the sequence of the analysis was developed, the model firmly showed that the best diagnosis prognosis decision is to make a best diagnosis-prognosis block with local anesthetics and, should it be positive, to proceed to denervate the sphenoid-palatine ganglion by radiofrequency...

Introdução: As ciências da decisão conformam um conjunto de técnicas e teorias surgido do método quantitativo e matemático direcionado ao auxílio de uma tomada de decisão criteriosa, aplicável a diversas disciplinas e nos mais variados contextos, onde a multicausalidade e a influencia de múltiplos fatores torna difícil a escolha de uma decisão unívoca, já que a incerteza é o padrão situacional genérico. Apresenta-se o caso de um paciente de 50 anos, portador de cefaléia em cacho, em que foi aplicado o processo de análise de decisão de abordagem diagnóstica-terapêutica, sendo escolhida a conduta a seguir tomando como base esta metodologia. Objetivos: Aplicar este modelo de análise de decisão a um problema clínico individual: um paciente de 50 anos, portador de uma cefaléia em cacho ou acuminada. Provar que neste caso clínico particular, a intervenção antálgica, diante de várias opções diagnósticas e terapêuticas, é uma das ferramentas mais eficazes e escolhidas pelos pacientes, considerando aspectos tais como a evidência científica de apoio a cada alternativa, a qualidade de vida dos pacientes com dor crônica não oncológica incapacitante e o uso de uma metodologia concreta para a tomada de decisão. Material e métodos: Aplicação de uma análise de decisão diagnóstica (terapêutica concreta), apresentando um caso clínico real de cefaléia em cacho. Busca bibliográfica na Medline e na OVID. Para a formulação dos valores limiares, a análise de sensibilidade e a representação gráfica da árvore de decisão, foi utilizado o pacote estatístico STATA - DATA TREE AGE 3.5. Como outcome principal, determinou-se a expectativa de vida ajustada à qualidade (medida em QALYs). Resultados: Desenvolvida a seqüência da análise, o modelo mostra, de forma contundente, que a melhor decisão diagnóstica-terapêutica é o bloqueio diagnóstico-prognóstico com anestésicos locais, e caso esse bloqueio seja satisfatório, fazer a denervação por radiofreqüência do ganglio esfenopalatino...

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Introducción: Las ciencias de la decisión conforman el conjunto de técnicas y teorías surgido del método cuantitativo y matemático dirigido al auxilio de una toma de decisiones con criterio aplicable a varias disciplinas y en los más variados contextos, donde la multicausalidad y la influencia de múltiples factores hace difícil la elección de una decisión unívoca, dado que la incertidumbre es el patrón común situacional. Se presenta a continuación el caso concreto de un paciente de 50 años portador de una cefalea en racimos, en el que se aplica el análisis de decisión de abordaje diagnóstico-terapéutico, y se elige la conducta a seguir basándose en esta metodología. Objetivos: Aplicar este modelo de análisis de la decisión a un problema clínico individual: un paciente de 50 años, portador de una cefalea en racimos o acuminada. Demostrar que en este caso clínico puntual, ante varias opciones diagnósticas y terapéuticas, el intervencionismo antálgico es una de las herramientas más efectivas y elegidas por los pacientes, teniendo en cuenta aspectos tales como la evidencia científica de respaldo de cada alternativa, la calidad de vida de los pacientes con dolor crónico no oncológico de tipo invalidante y el uso de una metodología concreta para la toma de decisión. Material y métodos: Aplicación de un análisis de decisión diagnóstico (terapéutico concreto), presentando un caso clínico real de cefalea en racimos. Búsqueda bibliográfica en Medline y OVID. Para la formulación de los valores umbrales, el análisis de sensibilidad y la graficación del árbol de decisión se utilizó el paquete estadístico STATA - DATA TREE AGE 3.5. Como outcome principal se determinó la expectativa de vida ajustada por calidad (medida en QALYs)...(AU)

Introduction: The science of decision-making is a set of techniques and theories arising from the quantitative and mathematic method, aimed at assisting in decision-making with criterion, applicable to many disciplines and numerous different contexts in which multi-causality and the influence of multiple factors make the choice of an unequivocal decision difficult, as uncertainty is the common pattern of the situation. Following is the case history of a 50-year-old patient suffering from cluster headaches; the analysis of decision-making as to the diagnostic-therapeutic approach is applied and the choice of conduct is based on this methodology. Objectives: To apply this decision-making analysis model to a clinical problem: a 50-year-old patient with cluster or acuminate headaches. To prove that in this specific clinical case, faced with different diagnostic and therapeutic options, antalgic interventionism is one of the most effective tools and is chosen by patients, taking into account aspects such as scientific backing proof of each alternative, quality of life of patients with chronic non-oncology invalidating pain and the use of a specific methodology for making the decision. Material and methods: Application of a diagnostic decision analysis, with a real clinical case of cluster headaches. Bibliographic research in Medline and OVID. To formulate threshold values, the sensitivity analysis and graphing the decision tree, the STATA - DATA TREE AGE 3.5 was used. As main outcome, the life expectancy adjusted by quality (measured in QALYs) was determined. Results: Once the sequence of the analysis was developed, the model firmly showed that the best diagnosis prognosis decision is to make a best diagnosis-prognosis block with local anesthetics and, should it be positive, to proceed to denervate the sphenoid-palatine ganglion by radiofrequency...(AU)

IntroduþÒo: As ciÛncias da decisÒo conformam um conjunto de técnicas e teorias surgido do método quantitativo e matemático direcionado ao auxílio de uma tomada de decisÒo criteriosa, aplicável a diversas disciplinas e nos mais variados contextos, onde a multicausalidade e a influencia de múltiplos fatores torna difícil a escolha de uma decisÒo unívoca, já que a incerteza é o padrÒo situacional genérico. Apresenta-se o caso de um paciente de 50 anos, portador de cefaléia em cacho, em que foi aplicado o processo de análise de decisÒo de abordagem diagnóstica-terapÛutica, sendo escolhida a conduta a seguir tomando como base esta metodologia. Objetivos: Aplicar este modelo de análise de decisÒo a um problema clínico individual: um paciente de 50 anos, portador de uma cefaléia em cacho ou acuminada. Provar que neste caso clínico particular, a intervenþÒo antálgica, diante de várias opþ§es diagnósticas e terapÛuticas, é uma das ferramentas mais eficazes e escolhidas pelos pacientes, considerando aspectos tais como a evidÛncia científica de apoio a cada alternativa, a qualidade de vida dos pacientes com dor cr¶nica nÒo oncológica incapacitante e o uso de uma metodologia concreta para a tomada de decisÒo. Material e métodos: AplicaþÒo de uma análise de decisÒo diagnóstica (terapÛutica concreta), apresentando um caso clínico real de cefaléia em cacho. Busca bibliográfica na Medline e na OVID. Para a formulaþÒo dos valores limiares, a análise de sensibilidade e a representaþÒo gráfica da árvore de decisÒo, foi utilizado o pacote estatístico STATA - DATA TREE AGE 3.5. Como outcome principal, determinou-se a expectativa de vida ajustada O qualidade (medida em QALYs). Resultados: Desenvolvida a seq³Ûncia da análise, o modelo mostra, de forma contundente, que a melhor decisÒo diagnóstica-terapÛutica é o bloqueio diagnóstico-prognóstico com anestésicos locais, e caso esse bloqueio seja satisfatório, fazer a denervaþÒo por radiofreq³Ûncia do ganglio esfenopalatino...(AU)

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This research integrates data procedures for the delineation of regional ground water flow systems in arid karstic basins with sparse hydrogeologic data using surface topography data, geologic mapping, permeability data, chloride concentrations of ground water and precipitation, and measured discharge data. This integrative data analysis framework can be applied to evaluate arid karstic aquifer systems globally. The accurate delineation of ground water recharge areas in developing aquifer systems with sparse hydrogeologic data is essential for their effective long-term development and management. We illustrate the use of this approach in the Cuatrociénegas Basin (CCB) of Mexico. Aquifers are characterized using geographic information systems for ground water catchment delineation, an analytical model for interbasin flow evaluation, a chloride balance approach for recharge estimation, and a water budget for mapping contributing catchments over a large region. The test study area includes the CCB of Coahuila, Mexico, a UNESCO World Biosphere Reserve containing more than 500 springs that support ground water-dependent ecosystems with more than 70 endemic organisms and irrigated agriculture. We define recharge areas that contribute local and regional ground water discharge to springs and the regional flow system. Results show that the regional aquifer system follows a topographic gradient that during past pluvial periods may have linked the Río Nazas and the Río Aguanaval of the Sierra Madre Occidental to the Río Grande via the CCB and other large, currently dry, upgradient lakes.

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En los últimos 30 años, el uso de técnicas para el tratamiento del dolor en Europa, América del Norte, Australia, Japón, etc. pasó a ser habitual. Las emplean principalmente médicos anestesiólogos que las informan en un gran número de publicaciones científicas. En dichas regiones existen servicios de tratamiento del dolor en hospitales y organismos que acreditan servicios de salud, y en los últimos 10 años se comenzó a exigirlos en conexión con los servicios de anestesiología; además, se conoce alguna legislación que obliga a su utilización. Los tratamientos alternativos desarrollados en una investigación sumados a las mejoras introducidas en la tecnología disponible producen buenos resultados que crecen en forma logarítmica. El análisis de la evidencia científica a través de la evaluación de ECCAs aumenta su criticismo, y el creciente número de revisiones sistemáticas y meta-análisis es suficientemente concluyente para justificar el empleo de esas técnicas e informa lo que acontece en buena parte del mundo. Otras razones justifican asimismo la búsqueda de soluciones para pacientes que sufren dolor; dolor refractario o intratable con las opciones de tratamiento clásicas, menores o convencionales; aumento de la incidencia de depresión por dolor; elevada incidencia de suicidios recientemente registrados en meta-análisis; la existencia de guías de procedimientos publicados por sociedades científicas sobre distintas técnicas respaldadas por sólida evidencia; la demostración de la conveniencia en términos de costo/beneficio y costo/eficacia de la aplicación de estas técnicas para devolverle a la persona la calidad de vida perdida y disminuir el grado de discapacidad, además, desde luego, de aumentar la eficacia del sistema de salud en su conjunto y aumentar la accesibilidad de la población a soluciones simples y de impacto global. La medicina no cura la mayoría de las enfermedades, pero puede aliviar el dolor que las mismas provocan y prever algunos de sus más lamentables resultados, como la discapacidad, la depresión y el suicidio.

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