La hemorragia digestiva alta es una patología frecuente en los servicios de urgencia de nuestro país y del mundo. Su forma de presentación es variable y dado su riesgo de mortalidad la hacen una condición que debe ser conocida y manejada por el médico general y especialista en medicina de urgencia. Es necesario protocolizar su manejo, lo que permite el diagnóstico oportuno y tratamiento adecuado de cada paciente. Sin embargo, el manejo caso a caso requiere el conocimiento del verdadero impacto de las distintas medidas disponibles para así obtener el mayor provecho de los recursos limitados en un servicio de urgencia, sobre todo en casos de hemorragia digestiva alta exsanguinante. Objetivo: presentar el enfrentamiento, correcto diagnóstico, categorización de riesgo y manejo terapéutico de la hemorragia digestiva alta desde la perspectiva de la medicina de urgencias. Método: se realizó una revisión bibliográfica de la literatura científica sobre esta condición, presentándose la evidencia actual de las evaluaciones diagnósticas e intervenciones terapéuticas más utilizadas actualmente. Resultados: se presenta la evidencia actual respecto a la sospecha, diagnóstico, manejo inicial y disposición de la hemorragia digestiva alta, en el contexto de la atención en un servicio de urgencia.
Systemic insecticides are recognized as one of the drivers of the worldwide bee decline as they are exposed to them through multiple pathways. Specifically, neonicotinoids, some of which are banned for outdoor use in the European Union (EU), have been pointed out as a major cause of bee collapse. Thus, farmers have had to look for alternatives for pest control and use known insecticides or new substances reportedly less harmful to bees. We evaluated the oral acute toxicity of six insecticides (three of them systemic: imidacloprid, thiacloprid and sulfoxaflor) with four different modes of action on buff-tailed bumblebee workers (Bombus terrestris): two banned neonicotinoids (imidacloprid, thiacloprid), two pyrethroids (deltamethrin, esfenvalerate), one sulfoximine (sulfoxaflor) and a microbial insecticide based on Bacillus thuringiensis toxins, present in genetically modified (Bt) maize. The microbial insecticide only caused mortality to bumblebee workers at extremely high concentrations, so it is expected that Bt maize does not pose a risk to them. The toxicity of the other five insecticides on bumblebees was, from highest to lowest: imidacloprid, sulfoxaflor, deltamethrin, esfenvalerate and thiacloprid. This outcome suggests that certain insecticides in use are more toxic to B. terrestris than some banned neonicotinoids. Further chronic toxicity studies, under realistic conditions, are necessary for a proper risk assessment.
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