Centro Universitario de Occidente

IntroductionPeople in prison experience disproportionate health burdens compared with community-based populations, including elevated rates of infectious and non-communicable diseases, mental illness and substance use disorders. Previous studies have consistently shown increased rates of mortality following release from incarceration, particularly from external (unnatural) causes such as suicide and violence. However, evidence on mortality incidence during imprisonment is scarce, and many deaths may be preventable through targeted health and prevention interventions. This study aims to synthesise worldwide evidence on all-cause mortality incidence in prisons.Methods and analysisWe will conduct a worldwide registry study combined with a systematic literature review and meta-regression analysis. Eligible sources will report deaths among incarcerated people between 2005 and 2025 at the national or, where more appropriate, the subnational jurisdictional level. Mortality data will be retrieved from official reports of prison administrations and direct contact with prison authorities. Also, data from international databases and the scientific literature will be reviewed. Incidence rates of all-cause mortality per 100 000 person-years will be calculated and reported for each jurisdiction, alongside standardised mortality ratios comparing imprisoned populations with general population estimates.Ethics and disseminationSince the study relies on anonymised routine data registries available from different sources, an exemption certificate was granted by the Ethics Committee of Diego Portales University (UDP) in Santiago, Chile. Findings will be submitted for publication in a peer-reviewed academic journal.Trial registration numberhttps://osf.io/vkzae.

Renal lithiasis, commonly known as kidney stones, is a prevalent condition characterized by the formation of crystalline mineral concretions within the urinary tract. The pathogenesis involves supersaturation of urine with stone-forming elements, crystal nucleation, growth, and aggregation, often influenced by metabolic, dietary, and genetic factors. While some stones remain asymptomatic, others can cause severe complications such as obstructive uropathy, urinary tract infections, and progressive renal impairment. Untreated stones increase the risk of acute kidney injury, chronic kidney disease, and systemic issues including cardiovascular morbidity. Diagnosis relies on imaging modalities, and management encompasses pain control, stone removal, and preventative strategies targeting metabolic abnormalities. Recognizing the potential complications and implementing timely, individualized treatment are critical to preserving renal function and improving patient outcomes.

Open tibial fractures are a major cause of disability in low- and middle-income countries (LMICs), with high rates of complications such as non-union, infection, and delayed healing. This study aimed to assess the impact of a targeted educational intervention for surgeons on improving clinical outcomes in the management of open tibial fractures in LMICs. A prospective, non-controlled before-and-after study was conducted across four hospitals in El Salvador, Honduras, and the Dominican Republic. Surgeons participated in a tailored AO Foundation course that included both online and hands-on cadaveric training in open fracture management, with techniques such as debridement, external fixation, and intramedullary nailing. Data were collected pre- and post-intervention, with consecutive sampling of patients based on eligibility criteria. The primary outcomes were return to work, return to recreational activities, and SF-12 physical and mental health scores at 180days post-treatment. Secondary outcomes included bone healing (RUST score), infection and malunion rates. A total of 159 patients with open tibial fractures were enrolled, with 99 completing the 180-day follow-up (50 pre-intervention and 49 post-intervention). Post-intervention, the use of reamed intramedullary nails for definitive fracture treatment increased significantly (44.0% vs. 67.3%, p = 0.019), and antibiotic regimens were better aligned with recommended practices (p < 0.001). The return-to-work rate improved significantly after the intervention (44.0% vs. 65.3%, p = 0.033), as did participation in recreational activities (28.0% vs. 55.1%, p = 0.006). Fracture healing rates also improved (28.0% vs. 53.1%, p = 0.011). There was a trend towards improvement in the SF-12 Physical Component Score (PCS) (median 36.9 vs. 46.8, p = 0.06), while the SF-12 Mental Component Score (MCS) showed no significant difference between the groups. The tailored educational intervention significantly improved clinical outcomes for patients with open tibial fractures, particularly in return-to-work rates, recreational activity participation, and fracture healing. These findings highlight the potential of tailored educational programs for surgeons in LMICs to enhance patient outcomes, even in resource-limited settings. Further research is needed to evaluate the long-term impact and sustainability of such interventions.

En Guatemala la prisión preventiva es un medio de coerción personal por el cual se restringe el derecho a la libertad y tiene por objeto asegurar la presencia del sindicado dentro del proceso instituido en su contra, no obstante, para su aplicación el juez deberá analizar de forma razonable, si existe alguna otra medida menos lesiva que pueda sustituir la imposición de la prisión preventiva; la no ponderación de los Derechos Humanos del sindicado acarrearía una serie de vulneraciones a derechos convencionalmente valiosos, a pesar de ello, Guatemala adiciona y reforma el artículo 264 del Código Procesal Penal en el cual se enlista un abanico de delitos en los que de forma taxativa se prohíbe el otorgamiento de alguna otra medida sustitutiva legalmente reconocida, siendo la prisión preventiva la única medida aplicable a quienes resultan sindicados del cometimiento de uno de dichos delitos; resultando esta acción contraria a las garantías procesales plenamente reconocidas, teniendo como consecuencia la vulneración de Derechos Humanos tales como el derecho a la presunción de inocencia, el principio favor libertis y el principio de proporcionalidad, los cuales son garantías que se encuentran estrechamente vinculadas a la prisión preventiva como medida de aplicación de última instancia.

Introduction: Esophageal prosthesis is crucial in managing end-stage esophageal diseases, relieving patients with obstructive conditions. However, the accessibility of esophageal prostheses in Guatemala remains a topic of concern due to the country's healthcare infrastructure and regional disparities. Handmade prostheses in Latin America have shown acceptability and the ability to resolve dysphagia, although they are not without complications, such as perforations, bleeding, infection, and a more invasive surgical approach. This case aims to report the experience of using a handmade prosthesis in an environment where self-expanding esophageal devices are not affordable due to their high cost. Case Description/Methods: A 71-year-old man patient, originally from Totonicapán, Guatemala, CA, presented to a third-level public hospital in the West with a chief complaint of dysphagia and progressive weight loss over the past 2 years. Paraneoplastic syndrome was observed during the physical examination. Diagnostic procedures, including endoscopy with biopsy and thoracoabdominal CT scan (Figure 1A), led to a diagnosis of end-stage adenocarcinoma of the lower esophagus with lung and liver metastasis. Given the palliative nature of the disease, surgical intervention was planned, and an esophageal endoprosthesis with an orotracheal tube (Figure 1B) was placed. The procedure was uneventful, and the patient tolerated it well. A progressive liquid diet was initiated 24 hours postoperatively, with occasional episodes of emesis. The patient was discharged on the fourth day after surgery, showing good clinical evolution and tolerating a soft diet, with outpatient follow-up provided by a multidisciplinary team. Discussion: Esophageal cancer in Guatemala is frequently diagnosed at advanced stages. In this case, the handmade esophageal prosthesis was successfully placed using 2 basic techniques: Pulsion (Figure 1C), involving peroral tube insertion, and traction (Figure 1D), involving pulling the tube through the tumor from below via a high gastrotomy. Traction intubation is preferred for tumors in the lower esophagus, requiring laparotomy and gastrotomy. The alternative use of these handmade esophageal prostheses improves terminal patients' quality of life, as it resolves dysphagia and enables them to eat. However, the main post-surgical adverse effect is gastroesophageal reflux, resulting from the physiological alteration of the esophageal sphincter. Therefore, the implementation of an adequate educational plan is essential.Figure 1.: Handmade esophageal prosthesis placement: (a) bird peak sign, (b) handmade prothesis made with an endotracheal tube, (c) Pulsion technique, (d) traction technique.

El presente estudio tiene el propósito de dar a conocer las principales variables demográficas, comerciales y organolépticas que influyen de manera directa en el consumo de vinos de frutas, producidos en el Occidente del país. Las tendencias cambiantes de los compradores han provocado que el consumo de vinos haya crecido en Honduras, en conjunto con su producción, motivo por el cual existe un nicho para su comercialización regional. Entre los resultados se observó que la mayor frecuencia de consumo de vino de acuerdo a la investigación en el caso de las mujeres el 92% lo consume, en el caso de los hombres 90% consume la bebidas fermentadas como ser el vino de fruta, Así mismo las propiedades organolépticas, según los datos estudiados el sabor es una de las cualidades sápidas más determinantes para la compra de un vino, el diseño del producto debe ser con corcho, utilizar botella oscura y capsula termo adheridle, de igual manera se considera una bebida tradicional, que además su consumo aporta beneficio a la salud humana, finalmente los resultados son halagadores un 74% de los consumidores les es atractivo apoyar un emprendedor local y un 26% prefieren la calidad de los vinos importados.

La linfangioleiomiomatosis (LAM) es una enfermedad rara que afecta predominantemente a la mujer, sobre todo en edad fértil. Se da de forma esporádica o bien asociada al complejo de esclerosis tuberosa. Se presenta el caso de una paciente femenina de 25 años, con cuadro clínico consistente en fiebre y tos seca de un mes de evolución, asimismo, presentaba angiofibromas cutáneos faciales, parches de Shagreen en el cuello y hombros y tumores de Koenen ungueales en los pies.

La osteopetrosis es una enfermedad infrecuente, se caracteriza por el incremento de la densidad ósea observada en las radiografías, resultado de anormalidades en la diferenciación y función de los osteoclastos que les incapacita para la resorción ósea y cartilaginosa, formándose huesos más densos, pero más frágiles. Objetivo: describir la Osteopetrosis Autosómica Dominante mostrando nuestra experiencia el método de tratamiento. Con un amplio conocimiento de esta patología, los hallazgos radiográficos característicos y los manejos tera- péuticos adecuados podremos lograr un diagnóstico precoz certero y una mejor sobrevida de los pacientes. Reporte de caso: Paciente femenina de 13 años, con historia de fracturas espontáneas a repetición en los antebrazos principalmente, la madre niega antecedentes de trauma; asimismo refiere observar retraso en el crecimiento de la paciente, por lo cual acude al hospital regional de occidente, Quetzaltenango, Guatemala, para evaluación. Se le realizan radiografías en proyección anteroposterior (AP) y lateral de cráneo, de extremidades superiores e inferiores y de columna dorsal evidenciando en las radiografías de cráneo aumento de la densidad ósea y aumento de grosor de la misma, en la columna dorsal se observó aumento de la esclerosis a nivel de las placas terminales superiores e inferiores de los cuerpos vertebrales, dando la típica apariencia de “vertebra en sándwich”, signo patognomónico de esta enfermedad. La paciente recibió tratamiento con prednisolona, vitamina D y calcio en dosis de acuerdo a las medidas antropométricas de la paciente y control médico por año para evaluar estado clínico.

“Sustainable Development” has come a long way since the World Commission on Environment and Development first popularized the term in 1987. Virtually everyone is now familiar with the term Sustainable Development, from states to multinational corporations, and from affluent communities in the Global North to impoverished communities in the Global South. It received a new lease of life in 2015 when the United Nations General Assembly adopted Agenda 2030 and Sustainable Development Goals (SDGs). It is recognized that sustainable development requires an inter-disciplinary, multi-level, and bottom-up approach, and that this ideal is easy to state but difficult to operationalize. Pursuant to deliberations at an international workshop at the University of Wisconsin-Madison, which aimed at fostering the exchange of ideas among diverse experts and developing solutions for effective inclusion of women and youth in climate change response strategies, we propose an innovative, practical three-dimensional model that enhances sustainability theory and practice with cross-cutting integration of human rights, gender equity, and Indigenous and local knowledge. We evaluate the utility of the model in two ways: First, we analyze how the model informs current approaches to environmental sustainability and human wellbeing including the SDGs, agroecology, de-growth principles, and planetary health metrics. Then, we explore the feasibility and added value of the approach through seven case studies from Guatemala, Sri Lanka, Malawi, Peru, Côte D’Ivoire, and Aotearoa—New Zealand. We conclude that the proposed model is congruent with current theory and practice. It builds on existing principles by identifying and addressing gaps. It enables practical action in a variety of settings and fosters a more integrated approach to sustainable wellbeing for humanity and our earth. We recommend continued development of this theoretical framework and related guidelines for program design, implementation and evaluation.

INTRODUCTION: Obesity is associated with worse outcomes in a number of medical conditions ranging from cardiovascular disease to inflammatory bowel disease. Smaller studies have noted a positive association between diverticular bleed and BMI. However, inpatient outcomes in this patient population have not yet been examined at a national level. The aim of our study was to determine the odds of occurrence and inpatient outcomes of patients with admitted with diverticular bleed in relation to the body-mass index (BMI). METHODS: Case-control study using the 2016 NIS. All patients with ICD10CM codes for diverticular bleed were included. The cohort was stratified according to BMI values into two categories: 1) BMI 30.0-39.9 (obesity class 1 and 2), 2) BMI ≥40 (morbid obesity). These were compared to patients with BMI 18.5-29.9 (normal/overweight). The primary outcome was determining the odds of inpatient occurrence of diverticular bleed in both obesity categories relative to the normal/overweight patients. Secondary outcomes included determining inpatient mortality, morbidity, odds of colectomy, colonoscopy, resource utilization, hospital length of stay (LOS), and total hospital costs and charges. Multivariate regression analyses were used to adjust for age, gender, Charlson Comorbidity Index, income in patient zip code, hospital region, location, size and teaching status. RESULTS: A total of 63,733 patients underwent LT in the study period, of which 70 underwent simultaneous SG. The mean patient age was 42.9 years in patients who underwent simultaneous SG compared to 51.1 years in patients who underwent LT alone (37% and 63% were female, respectively). For the primary outcome, patients undergoing simultaneous BS had adjusted mortality odds of 2.16 compared to patients undergoing LT alone, although it did not reach statistical significance (P = 0.42). There were no significant differences in mortality, morbidity and resource utilization in patients with simultaneous SG and LT compared to LT alone. CONCLUSION: Patients undergoing simultaneous SG at the time of LT did not display different odds of inpatient mortality, morbidity, hospital costs, charges and length of hospitalization during the index admission for liver transplant compared to LT alone. This study adds to evidence that SG may be feasible at the time of LT in carefully selected patients. Studies should focus in determining which patients are the optimum candidates to undergo these simultaneous procedures.Table 1.: Adjusted odds ratio and additional adjusted means in patients undergoing simultaneous SG at the time of LT compared to patients undergoing LT alone. *ICU: intensive care unit, AKI: Acute kidney injury