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INTRODUCTION: Surgical capability in space is constrained by extreme conditions such as microgravity, communication latency, surgical training, and limited resources. Current robotic training platforms are optimized for terrestrial use. The objective is to explore The SETY© platform, developed under the SY-MIS program, designed as a compact and accessible mechatronic surgical platform for minimally invasive procedures with emphasis on operational feasibility in resource-limited and early robotic training exposure to prepare future surgeons for extreme and spaceflight conditions. The final goal is to overcome some barriers for surgeons in their initial phases of training such as earlier exposure to a robotic platform, limited training lab availability, portability issues, on demand practice, affordability of robotic platform, and improving overall surgical proficiency and patient care. DESIGN, SETTING, AND PARTICIPANTS: This experimental feasibility study (2022-2024) involved the SETY© system in terrestrial analog environments simulating microgravity constraints. The system incorporated ergonomic considerations, low-cost components, and an open-source control architecture to enhance accessibility for academic and clinical training. The platform consisted of dual articulated robotic arms mounted on a compact 400 × 500 mm base, driven by servomechanism motors via a curved rail mechanism. Structural components were produced using 3D-printed PLA and validated via finite element analysis. The electrical system employed an ESP32 microcontroller for console input and an Arduino Nano for arm control, enabling real-time coordination of eight servomotors through potentiometer and joystick inputs. Primary platform outcomes were mechanical stability, kinematic precision (velocity and torque control), synchronization between console and arms, and robustness under repetitive cycles. Secondary platforms outcomes included compactness, energy efficiency, and feasibility for integration into training curricula. RESULTS: Finite element analysis confirmed a maximum Von Mises stress of 0.482 MPa and minimal deformation (0.0007 mm), yielding a safety factor of 15. The system maintained joint velocities below 10°/s and torques under 10 N·m. Simulation with sinusoidal inputs showed stable motion patterns, velocity peaks at ± 4°/s, torque oscillations around ± 0.05 N·m, and acceleration up to 1500°/s². Electrical integration achieved smooth real-time synchronization without predictive filtering, although the absence of ROS-based frameworks reduced interoperability and limited integration with higher-level control systems. Minor mechanical tolerances and sensor variance were observed but did not compromise functionality. CONCLUSIONS: The SETY© platform demonstrated mechanical robustness, precise motion control, and functional reliability within a compact, energy-efficient design. Its low-cost, open-source configuration supports adoption in surgical and medical engineering education and has potential applicability for space mission surgical preparedness. Future refinements should optimize mechanical damping and material stiffness to enhance performance under high-load or rapid-maneuver conditions.

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Se realizó una revisión a través de la base de datos PubMed y el buscador Google Scholar que incluyó publicaciones desde 1995 hasta julio 2024, también se utilizó la inteligencia artificial Perplexy®. Se hallaron reportados hasta la fecha, en los diferentes motores de búsqueda, 164 casos de la variante Warthin Like de carcinoma papilar de tiroides, con una estimación general entre 0,2 % y 1,9 % de todos los tipos de carcinomas papilares de tiroides. A continuación, presentamos tres nuevos casos no reportados aun en la bibliografía mundial(AU)

A review was carried out through the PubMed database and the Google Scholar search engine that included the publications from 1995 to July 2024, the Perplexy® artificial intelligence was also used. To the actual date, 164 cases of the Warthin Like variant of the papillary thyroid carcinoma were found and reported in the different search engines, with a general estimate between 0.2 % and 1.9 % of the all types of the papillary thyroid carcinomas. Next, we present three new cases not yet reported in the world literature(AU)

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Liver transplantation (LT) is a high-risk surgery requiring costly hospital resources. Robust multicenter data on the incidence of postoperative complications and their risk factors remain very limited. The objectives of this study were to describe the incidence and variability of postoperative complications in adult LT recipients and identify their determinants. We conducted a cohort study that included consecutive LT recipients over at least 1 year between January 2021 and May 2023 in 8 LT centers in Canada and France. Our primary outcome was 7-day early allograft dysfunction or primary graft non-function. Our secondary outcomes included acute kidney injury (AKI) and severe complications. We measured the incidence and variability of these outcomes and their association with potential preoperative determinants using multivariable models. We reported incidences and risk ratios (RR) with 95% CIs. We included 852 patients. The incidence of our primary outcome, AKI, and severe complications was, respectively 28% [95% CI, 25%-31%], 50% [95% CI, 47%-54%], and 59% [95% CI, 55%-62%]. Most outcomes were variable across centers. The primary outcome was mostly determined by donor age, body mass index, static cold ischemia time, and type of donation (RR from 0.64 to 1.21). MELD 3.0 score and preoperative requirement for organ support were important determinants of transfusions, AKI, and severe complications. The incidence of most outcomes was variable across centers. In conclusion, postoperative complications, such as graft dysfunction, AKI, and severe complications, were frequent after LT. We identified risk factors, such as donor and graft characteristics, MELD 3.0, and preoperative requirement for organ support, that may inform transplant risk evaluation.

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RESUMEN Introducción. En 2022, el virus monkeypox (mpox) causó una pandemia que afectó particularmente a hombres que tienen sexo con hombres (HSH), siendo más vulnerables aquellas personas viviendo con VIH/ SIDA (PVVS). Objetivo. Describir las características epidemiológicas y clínico-laboratoriales de pacientes diagnosticados con mpox, y del subgrupo con coinfección por mpox y VIH. Métodos. Estudio descriptivo observacional multicéntrico. Incluimos 160 pacientes ingresados entre julio del 2022 y febrero del 2023 en la Red Sabogal EsSalud de la Región Callao (Perú), con mpox confirmado mediante reacción en cadena de la polimerasa (PCR). Utilizamos estadística descriptiva (medidas de tendencia central y varianza) analizados mediante STATA 19.5. Las variables fueron CD4, carga viral de VIH, terapia antirretroviral, presentación clínica y duración de la hospitalización. El protocolo del estudio fue aprobado por el Comité de Ética del Hospital Alberto Sabogal Sologuren. Resultados. Incluimos 160 pacientes, la edad media fue 32,4 (desviación estándar de 7,2 años), 70,6% fue HSH, 59,4% tuvieron coinfección con VIH. De los pacientes con coinfección, la mediana de CD4 fue 387 células, la mediana de carga viral de VIH fue 149 copias/µL, 55% usó terapia antirretroviral, 100% presentó exantemas y 50% pústulas. El 9,4% fue hospitalizado con media de 277 células CD4 y una media de carga viral de VIH de 149 583,5 copias. Conclusiones. La mayoría de los pacientes diagnosticados con mpox fueron participantes HSH jóvenes, el 60% tuvo coinfección por VIH. De los hospitalizados, todos tuvieron CD4 < 300 células, y una carga viral de VIH detectable.

ABSTRACT Introduction. In 2022, the monkeypox virus (mpox) caused a pandemic that particularly affected men who have sex with men (MSM), with people living with HIV/AIDS (PLWHA) being more vulnerable. Objectives. To describe the epidemiological and clinical-laboratory characteristics of patients diagnosed with mpox, highlighting those with mpox and HIV coinfection (2022-2023). Methods. A multicenter, observational, descriptive study was conducted. One hundred and sixty patients admitted between July 2022 and February 2023 to the Sabogal Network EsSalud in the Callao Region (Peru) with mpox confirmed by polymerase chain reaction (PCR) were included. Descriptive statistics (measures of central tendency and variance) were analyzed using STATA 19.5. The variables were: CD4 count, HIV viral load (VL), antiretroviral therapy (ART), clinical presentation, and length of hospitalization. The protocol was approved by the Ethics Committee of the Alberto Sabogal Sologuren Hospital. Results. Of the 160 patients, the mean age was 32.4±7.2 years, 70.6% were MSM, and 59.4% had HIV coinfection. Of the patients with coinfection, the median CD4 count was 387 cells, median HIV VL 149 copies/mcL, 55% were on ART, 100% had rashes, and 50% had pustules. Of the, ninety-four percent were hospitalized with a mean CD4 count of 277 cells and a mean HIV VL of 149,583.5 copies. Conclusions. Most patients diagnosed with MPOX were young MSM participants, and 60% had HIV coinfection on ART. Of those hospitalized, all had CD4 counts <300 cells and a detectable HIV VL.

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BACKGROUND: Explicit recall occurring during sedation/regional anesthesia is common but has long been assumed to have no sequelae. A prospective cohort study was conducted to determine the incidence of explicit recall experience under sedation/regional anesthesia, as well as to assess the recall experiences that are associated with psychological consequences. METHODS: The study prospectively recruited 2,500 adults who underwent elective total hip or knee arthroplasty under sedation/regional anesthesia from September 2021 to March 2024 at University Hospital in London, Ontario, Canada. The primary exposure was recall experience, assessed using the modified Brice questionnaire. The co-primary outcomes included probable depression (defined as a Patient Health Questionnaire score of 8 or higher) and suspected posttraumatic stress disorder (PTSD) symptoms (defined as a Post-traumatic Stress Disorder Checklist for Civilians score of 13 or higher) at 6 weeks postoperatively. The association between specific recall experiences and the co-primary outcomes was evaluated by multivariable regression analysis. Additionally, the incidence and mental health burden related to the psychological effects of surgery in the entire cohort were assessed. RESULTS: A total of 2,138 patients were included in the final analysis. Explicit recall was reported by 475 participants (22.2%) but was not associated with the co-primary outcomes. Regarding surgery's overall impact, 61 participants (5%) developed new probable depression, 105 participants (5%) reported suspected PTSD, and 95 patients (4.4%) developed new suicidal ideation postoperatively. The authors estimated that 1 in 18 patients required new psychiatric consultation. CONCLUSIONS: Explicit recall per se during sedation/regional anesthesia did not increase the odds of developing psychiatric illness. Surgery itself carries significant risks of triggering depression and PTSD that are severe enough to reach levels associated with suicidal ideation, requiring immediate mental care. This study reveals a significant, yet underappreciated, mental healthcare burden.

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Antecedentes: El parto humanizado prioriza las necesidades físicas y emocionales de la madre, con mínimas intervenciones médicas. La FIGO y OMS busca adecuar prácticas obstétricas respetando la autonomía femenina y evitando las intervenciones innecesarias que afectan negativamente la experiencia de parto. Objetivo: Identificar el nivel de conocimientos, actitudes y prácticas sobre el parto humanizado, con el fin de sensibilizar al personal asistencial de la sala de labor y parto de dos hospitales nacionales. Métodos: Estudio transversal, descriptivo con muestreo de 160 médicos. Se empleó medidas de tendencia central, dispersión, frecuencias y porcentajes para analizar los resultados. Resultados: La edad varió de 25.2 a 42 años. Las mujeres predominaban en todos los grupos. El conocimiento sobre el parto humanizado fue alto, con un 100% de especialistas y un 94.3% de médicos generales familiarizados con sus beneficios. La mayoría valoraba la privacidad y el respeto a las decisiones maternas, aunque casi la mitad de los internos y generales conocían protocolos específicos. La actitud positiva hacia prácticas recomendadas fue generalizada, especialmente en médicos generales. Conclusiones/recomendaciones: El estudio reveló un alto nivel de conocimientos sobre el parto humanizado entre los profesionales de la salud, especialmente entre los especialistas, con actitudes positivas hacia las prácticas recomendadas. (provisto por Infomedic International)

Background: Humanized childbirth prioritizes the physical and emotional needs of the mother, with minimal medical interventions. FIGO and WHO seek to adapt obstetric practices respecting female autonomy but unnecessary interventions that negatively affect the birthing experience. Objectiv: To identify the level of knowledge, attitudes and practices on humanized childbirth in order to sensitize the labor and delivery room staff of two national hospitals. Methods: Cross-sectional, descriptive study with a sample of 160 physicians. Measures of central tendency, dispersion, frequencies and percentages were used to analyze the results. Results: Age ranged from 25.2 to 42 years. Women predominated in all groups. Knowledge of humanized childbirth was high, with 100% of specialists and 94.3% of general practitioners familiar with its benefits. Most valued privacy and respect for maternal decisions, although almost half of the interns and general practitioners were aware of specific protocols. Positive attitudes towards recommended practices were widespread, especially among general practitioners. Conclusions/recommendations: The study revealed a high level of knowledge about humanized childbirth among health professionals, especially among specialists, with positive attitudes toward recommended practices. (provided by Infomedic International)

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Pertussis, caused primarily by Bordetella pertussis and occasionally by Bordetella parapertussis, remains a major public health issue despite widespread vaccination efforts. Immunocompromised children, such as those with acute lymphoblastic leukemia, are particularly susceptible to vaccine-preventable diseases, underscoring the importance of ensuring adequate vaccination coverage. We report a case of a 3-year-old boy with ALL who developed a Bordetella parapertussis infection during chemotherapy. The child's lack of documented pertussis vaccination underscores critical gaps in primary healthcare and immunization practices. His case highlights the increased risk of severe infections in unvaccinated, immunocompromised patients and underscores the necessity of maintaining comprehensive vaccination records and robust primary healthcare systems to prevent such infections. The rapid diagnosis and initiation of appropriate antimicrobial therapy, highlights the critical role of early detection and tailored interventions in preventing severe outcomes.

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PURPOSE: Limited information exists on the possible effects of ethnicity on corneal endothelial cell parameters and their changes during cataract surgery. Thus, we evaluated corneal endothelial cell density (ECD) and endothelial cell loss (ECL) during surgery for senile cataract in Hispanic and non-Hispanic White adults. METHODS: This retrospective study included 312 eyes of 227 patients ≥50 years who underwent phacoemulsification with intraocular lens implantation for senile cataract. Preoperatively and 1 to 2 months after surgery, specular microscopy was performed to measure ECD, coefficient of variation (CV), and hexagonal cell percentage (HEX). Regression analysis was used to compare baseline values as well as surgery-related changes in corneal endothelial cell parameters between Hispanic and non-Hispanic patients considering demographics, biometric parameters, and intraoperative cumulative dissipated energy (CDE). RESULTS: There were 109 Hispanics and 118 non-Hispanics. Anterior chamber depth (ACD) was significantly lower in Hispanics (3.12±0.36 mm) compared with non-Hispanics (3.25±0.37 mm, P =0.009). There were no significant differences in baseline ECD between Hispanics (2,547±365 cells/mm 2 ) and non-Hispanics (2,483±380 cells/mm 2 , P =0.17). There were also no significant differences in ECL (16.8%±17.0% vs. 17.4%±18.1%, P =0.46), increase in CV (3.8%±20.7% vs. 1.5%±21.6%, P =0.51), and decrease in HEX (-2.7%±8.5% vs. -1.8%±7.0%, P =0.33) between these two groups. Regression analysis showed that ECL was associated with a shallower ACD ( P =0.003), a higher CDE ( P <0.001), but not with ethnicity ( P =0.46). CONCLUSION: There are no significant differences in ECD and ECL between Hispanics and non-Hispanics undergoing cataract surgery. Although Hispanics have a shallower ACD, the ethnic difference seems to be clinically insignificant.

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RESUMEN Objetivos: Este artículo tiene por objetivo realizar una revisión sistemática de publicaciones científicas acerca del nivel de cobertura de vacunación contra el neumococo en adultos mayores en Latinoamérica. Materiales y métodos: Se realizó una revisión sistemática mediante la búsqueda de artículos científicos relacionados con el tema. Se utilizó la pregunta PEO: ¿Cuál es el nivel de cobertura de vacunación contra neumococo en adultos mayores en Latinoamérica? Las fuentes de búsqueda fueron PubMed, Scielo y Google Scholar. Las palabras clave fueron: "Aged", en combinación con "Pneumococcal Vaccines", "Vaccination Coverage"; "adulto mayor", "Vacunas Neumocócicas" junto con "Cobertura de Vacunación". Se seleccionaron los artículos publicados desde el 1 de enero de 2017 hasta el 31 de diciembre del 2022. Resultados: De los 571 artículos encontrados en la revisión, 559 fueron prescindidos por no cumplir con los criterios de inclusión y exclusión, quedando 5 artículos para esta revisión. Basado en 5 artículos revisados, se evidenció que el porcentaje de cobertura de vacunación en adultos mayores en Latinoamérica es deficiente. Conclusiones: Se evidencia una baja cobertura de vacunación y tasa de incidencia alta de neumonía en adultos mayores, a causa de la insuficiente programación de actividades de prevención por el establecimiento de salud, insuficientes campañas de difusión a la población objetivo, limitado acceso a servicios de salud de la población vulnerable lo que predispone a una baja sensibilización y vacunación de este vulnerable, grupo etario; resultando en un incremento directamente proporcional de casos de neumonía con la mayor edad.

ABSTRACT Objectives: The aim of this article is to conduct a systematic review of scientific publications on the level of pneumococcal vaccination coverage in older adults in Latin America. Materials and methods: A systematic review was conducted by searching for scientific articles related to the topic. The PEO question we used was: What is the level of pneumococcal vaccination coverage in older adults in Latin America? The search sources were PubMed, Scielo and Google Scholar. The keywords were: "Aged", in combination with "Pneumococcal Vaccines", "Vaccination Coverage"; "older adult", "Pneumococcal Vaccines" in combination with "Vaccination Coverage". Articles published from 1 January 2017 to 31 December 2022 were selected. Results: Of the 571 articles found in the review, 559 were disregarded as they did not meet our inclusion and exclusion criteria, leaving 5 articles for this review. Based on only 5 articles reviewed, it was evident that the percentage of vaccination coverage in older adults in Latin America is deficient. Conclusions: There is evidence of low vaccination coverage and a high incidence rate of pneumonia in older adults, due to insufficient programming of prevention activities by the health establishment, insufficient dissemination campaigns to the target population, limited access to health services for the vulnerable population, which predisposes to low awareness and vaccination of this vulnerable age group, resulting in a directly proportional increase in cases of pneumonia with increasing age.

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Resumen Contexto: La injuria renal aguda asociada al uso de medios de contraste yodados (IRA-ACI) es un desorden iatrogénico con potenciales implicaciones en morbilidad y mortalidad, motivo de preocupación en los servicios de imágenes médicas. Los últimos años han marcado cambios importantes en la concepción que poseemos sobre esta entidad desde una definición más precisa, verdadera incidencia, factores de riesgo y escalas predictivas, hasta el impacto real de algunas estrategias para su prevención. Objetivo: Generar recomendaciones basadas en la evidencia para el uso de medios de contraste yodados en pacientes sometidos a procedimientos radiológicos diagnósticos o terapéuticos, mediante de un consenso de expertos. . Metodología: A partir de la formulación de preguntas de investigación relacionadas con la injuria renal aguda asociada al uso medios de contraste yodados, se realiza la búsqueda de evidencia en Pubmed, Embase y Scopus entre enero del 2013 y agosto del 2022. Los artículos se seleccionaron por medio de una revisión sistemática y a través de la metodología de consenso Delphi modificado. Los documentos fueron analizados usando instrumentos que evalúan la calidad de su evidencia. Resultados: Se formularon 22 recomendaciones para el manejo de pacientes que requieren la administración de medios de contraste yodados. Un panel de 11 expertos, entre los que se contó con 4 nefrólogos, 4 radiólogos, 1 nefrólogo pediatra y 2 epidemiólogos, participaron de forma activa en la elaboración del consenso, con un total de cinco sesiones virtuales y 15 horas de trabajo. Conclusiones: El término injuria renal aguda asociada al uso de medios de contraste yodados (IRA-ACI) debe usarse idealmente y abandonar otras definiciones que infieren una causalidad manifiesta; con relación a su incidencia, los datos recientes demuestran que ha sido sobreestimada en la literatura y percibida de forma exagerada por el personal del área de la salud, de igual forma, solo una baja tasa de filtración glomerular estimada (TFGe) se considera como un factor de riesgo independiente para el desarrollo de IRA-ACI. Finalmente, respecto a su prevención, únicamente la hidratación ha mostrado un potencial beneficio como medida nefroprotectora.

Abstract Background: Contrast-Associated Acute Kidney Injury (CA-AKI) is an iatrogenic disorder with potential implications for morbidity and mortality, a matter of concern in medical imaging services. In recent years, significant changes have been made in our understanding of this condition, from a more precise definition, real incidence, risk factors, and predictive scales, to the actual impact of certain prevention strategies. Purpose: To generate evidence-based recommendations about the use of iodinated contrast media in patients undergoing diagnostic and/or therapeutic radiological procedures, through expert consensus. Methodology: Based on the formulation of research questions related to Contrast-Associated Acute Kidney Injury, evidence was searched in Pubmed, Embase, and Scopus from January 2013 to August 2022. Articles were selected through a systematic review and a modified Delphi consensus methodology. The documents were assessed using instruments that evaluate quality of their evidence. Results: A total of 22 recommendations were formulated for the management of patients requiring administration of iodinated contrast media. An expert panel consisting of 11 members, including 4 nephrologists, 4 radiologists, 1 pediatric nephrologist, and 2 epidemiologists, actively participated in the consensus development. The process involved 5 virtual sessions and 15 hours of work. Conclusions: The term Çontrast-Associated Acute Kidney Injury"(CA-AKI) should ideally be used and other definitions implying a clear causality should be abandoned. Regarding its incidence, recent data show that it has been overestimated in the literature and perceived exaggeratedly by healthcare personnel. Similarly, only a low estimated glomerular filtration rate (eGFR) is considered an independent risk factor for the development of CA-AKI. Finally, in terms of prevention, hydration alone has shown potential benefits as a nephroprotective measure.

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Objective: Airway fires are a rare but devastating complication of airway surgery. Although protocols for managing airway fires have been discussed, the ideal conditions for igniting airway fires remain unclear. This study examined the oxygen level required to ignite a fire during a tracheostomy. Study Design: Porcine Model. Setting: Laboratory. Methods: Porcine tracheas were intubated with a 7.5 air-filled polyvinyl endotracheal tube. A tracheostomy was performed. Monopolar and bipolar cautery were used in independent experiments to assess the ignition capacity. Seven trials were performed for each fraction of inspired oxygen (FiO2): 1.0, 0.9, 0.7, 0.6, 0.5, 0.4, and 0.3. The primary outcome was ignition of a fire. The time was started once the cautery function was turned on. The time was stopped when a flame was produced. Thirty seconds was used as the cut-off for "no fire." Results: The average time to ignition for monopolar cautery at FiO2 of 1.0, 0.9, 0.8, 0.7, and 0.6 was found to be 9.9, 6.6, 6.9, 9.6, and 8.4 s, respectively. FiO2 ≤ 0.5 did not produce a flame. No flame was created using the bipolar device. Dry tissue eschar shortened the time to ignition, whereas moisture in the tissue prolonged the time to ignition. However, these differences were not quantified. Conclusion: Dry tissue eschar, monopolar cautery, and FiO2 ≥ 0.6 are more likely to result in airway fires.

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RESUMEN Este artículo da cuenta de una aproximación al fenómeno de duelo migratorio de las madres migrantes en Chile. Entre 2021 y 2022 se realizó un estudio cualitativo y exploratorio sustentado en el interaccionismo simbólico, en el que se realizaron entrevistas semiestructuradas a 39 madres migrantes: 18 de origen venezolano, 11 peruano y 9 haitiano. A partir del análisis de contenido temático y de la teorización, se obtuvieron tres categorías de análisis: 1) la pérdida de los vínculos y la lejanía con el origen, 2) expectativas versus realidad y 3) validando sobreesfuerzos. Las madres migrantes manifiestan el duelo migratorio con distintos matices según su país de origen e imprimen en cada una de sus experiencias, en mayor o menor grado, el desarraigo y la ausencia de redes de apoyo como principal detonante de la tristeza que viven día a día. Esta tristeza se acrecienta al negociar su ideal de criar personalmente a sus hijos e hijas en pro de la subsistencia material para alcanzar la ansiada vida mejor, para la cual validan el sobreesfuerzo como estrategia de superación. Estas presiones traen consigo consecuencias psíquicas y físicas que impiden la elaboración del duelo migratorio, comprometiendo su salud mental y la de sus hijos e hijas.

ABSTRACT This article presents an approach to the phenomenon of migratory mourning of migrant mothers in Chile. Between 2021 and 2022, a qualitative exploratory study based on symbolic interactionism was carried out, in which semi-structured interviews were conducted with 39 migrant mothers of Venezuelan (18), Peruvian (11) and Haitian (9) origin. Based on a theoretically-informed thematic analysis, three analytical categories emerged: 1) the loss of social ties and distance to their place of origin; 2) expectations versus reality; and 3) the validation of overexertion. Migrant mothers express migratory mourning with varying levels of nuance depending on their country of origin, and to a greater or lesser degree signify their experiences in terms of uprooting and the absence of support networks, which they identify as the main cause of the sadness they experience on a daily basis. This sadness increases when they negotiate their ideals regarding the upbringing of their sons and daughters in favor of material subsistence in order to achieve the goals of a better life, and for which they justify overexertion as a strategy for improvement. These pressures bring with them psychological and physical consequences and interfere with their processes of migratory mourning, compromising their mental health and that of their children.

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La investigación se refiere a un estudio de la rentabilidad de la acción del viraje del estilo libre en nadadoras escolares. El objetivo para la investigación se centró en evaluar las características temporales durante la acción del viraje en nadadoras de la categoría 13 y 14 años de la provincia de Sancti Spíritus. Para la recogida de la información, se utilizaron los métodos del nivel empírico: la observación científica, así como la de medición. Se utilizaron dos cámaras de videos, ubicadas en serie, y una cámara subacuática marca Sony. Para el análisis temporal, se requirió del software Kinovea, ver 0.9.3. Se aplicó el test de 15 m. para comprobar la rentabilidad del viraje. Se pudo comprobar una pobre efectividad de este elemento técnico en el estilo libre en las nadadoras evaluadas, lo que mostró, de forma generalizada, deficiencias durante la fase de impulso y se comprobó la formación de ángulos muy abiertos de las piernas que favoreció un déficit en la utilización de la potencia de las piernas durante el empuje de la pared, aspecto este que ayudó a disminuir el deslizamiento y comenzar a realizar los movimientos de salida a la superficie de forma prematura, aumentó el tiempo de forma general en la ejecución del viraje, concluyendo que para las categorías escolares es oportuno obtener ángulos entre las articulaciones de tobillos, rodillas y cadera en el rango de los 90° y 110° al momento de iniciar el impulso de la pared.

A pesquisa diz respeito a um estudo sobre a rentabilidade da ação de viragem em estilo livre em nadadores escolares. O objectivo da investigação foi centrado na avaliação das características temporárias durante a ação de viragem em nadadores de 13 e 14 anos de idade na província de Sancti Spíritus. Para a recolha de informação, foram empregues métodos empíricos: observação científica e medição. Foram instaladas duas câmaras de vídeo, colocadas em série, e uma câmara subaquática Sony. Para a análise temporal, foi utilizado o software Kinovea, ver 0.9.3. O teste de 15 m foi executado para verificar a relação custo-benefício da curva. Foi possível constatar uma baixa eficácia deste elemento técnico no estilo livre dos nadadores avaliados, que mostraram, em geral, deficiências durante a fase de impulso e a formação de ângulos de pernas muito abertos que favoreceram um défice na utilização da força das pernas durante o impulso para a parede, Este aspecto permitiu reduzir o deslizamento e começar a realizar os movimentos de saída para a superfície antecipadamente, aumentou o tempo total na execução da curva, concluindo-se que para as categorias escolares é adequado obter ângulos entre o calcanhar, o joelho e as articulações da anca na gama de 90° e 110° no momento de iniciar o impulso da parede.

The research refers to a study of the profitability of the freestyle turning action in school swimmers. The objective of the research was focused on evaluating the temporal characteristics during the action of the turn in swimmers of the 13 and 14 years old category in the province of Sancti Spíritus. For the collection of information, the empirical level methods used were: scientific observation, as well as measurement. Two video cameras, placed in series, and a Sony underwater camera were used. For the temporal analysis, the Kinovea software, ver 0.9.3, was used. The 15 m test was applied to check the profitability of the turn. It was possible to verify a poor effectiveness of this technical element in the freestyle in the swimmers evaluated, which showed, in a generalized way, deficiencies during the impulse phase and the formation of very open angles of the legs that favored a deficit in the use of the power of the legs during the wall push, This aspect helped to decrease the sliding and to begin to perform the exit movements to the surface prematurely, increased the time in general in the execution of the turn, concluding that for the school categories it is appropriate to obtain angles between the ankle, knee and hip joints in the range of 90° and 110° at the moment of initiating the wall push.

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En la formación deportiva, tener presente cómo desarrollar la fuerza en tierra y su transferencia al medio acuático es de vital importancia en la formación de los atletas que comienzan la práctica del polo acuático. La presente investigación tuvo como objetivo determinar cómo los ejercicios de transferencia de fuerza influyen en las acciones motrices del polo acuático, lo que ayudaría a una adecuada conducción del proceso de formación deportiva de las atletas investigadas. Para lograr las metas propuestas, los autores se apoyaron en métodos teóricos y empíricos, se utilizó la herramienta de la estadística descriptiva (cálculo porcentual) para procesar la información, tomando como muestra a atletas que se iniciaban en el polo acuático en el área deportiva masiva de Polo Acuático. Para ello, se realizó una encuesta a entrenadores y se analizaron sus opiniones y criterios durante la conducción de este proceso. El resultado final es que son insuficientes los conocimientos de cómo seleccionar los ejercicios para que se desarrolle una transferencia positiva al medio acuático de los ejercicios de fuerza en tierra. No dominan los métodos, procedimientos, contenidos y metodologías, a partir de las investigaciones realizadas sobre el principio y ejercicios de transferencia. Entre las conclusiones más relevantes de esta investigación, se encuentran los referentes teóricos sobre los ejercicios de transferencia de fuera en tierra al medio acuático, lo que aportará desde la teoría una argumentación sólida para su aplicación a la práctica.

No treino desportivo, é de importância primordial ter em conta como evoluir a força em terra e a sua transferência para o meio aquático ou entorno hídrico, no treino dos atletas iniciantes na prática de pólo aquático. O objectivo desta investigação era descobrir como os exercícios de transferência de força influenciam as ações motoras no pólo aquático, o que contribuiria para a correta condução do processo de treino desportivo dos atletas inquiridos. Para alcançar os objectivos propostos, os autores apoiaram-se em métodos teóricos e empíricos, recorrendo à ferramenta da estatística descritiva (cálculo de percentagens) para processar a informação, tomando como modelo os atletas que estavam a começar no pólo aquático no campo do pólo aquático de desportos coletivos. Para este efeito, foi realizado um inquérito com os treinadores e as suas opiniões e critérios foram analisados durante a realização deste processo. O resultado final é que não há conhecimentos suficientes sobre como escolher exercícios para desenvolver uma transferência positiva de força em terra, para o ambiente aquático. Não dominam os métodos, procedimentos, conteúdos e metodologias, com base na investigação efetuada sobre o princípio e exercícios de transferência. Entre as conclusões mais relevantes desta investigação figuram as referências teóricas sobre os exercícios de transferência da terra para o meio aquático, que fornecerão da teoria uma argumentação sólida para a sua aplicação à prática.

In sports training, having in mind how to develop strength on land and its transfer to the aquatic environment is of vital importance in the training of athletes who begin the practice of water polo. The present research had the objective of determining how the strength transfer exercises influence the motor actions of water polo, which would help in an adequate conduction of the sports training process of the female athletes studied. To achieve the proposed goals, the authors relied on theoretical and empirical methods, the descriptive statistics tool (percentage calculation) was used to process the information, taking as a sample athletes who were starting in water polo in the massive sports area of Water Polo. For this purpose, a survey was made to coaches and their opinions and criteria were analyzed during the conduction of this process. The final result is that there is insufficient knowledge of how to select exercises so that a positive transfer to the aquatic environment of strength exercises on land is developed. They do not master the methods, procedures, contents and methodologies, based on the research carried out on the principle and exercises of transfer. Among the most relevant conclusions of this research are the theoretical references on the transfer exercises from land to the aquatic environment, which will provide from the theory a solid argumentation for its application to practice.

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Introducción: La lesión renal aguda asociada con el uso de medios de contrastes yodados (LRA-MCI) es un trastorno iatrogénico con potenciales implicaciones en morbilidad y mortalidad, motivo de preocupación en los servicios de imágenes. Los últimos años han marcado cambios importantes en la concepción que se tiene sobre esta entidad, desde una definición más precisa y su verdadera incidencia hasta el impacto real de algunas estrategias para su prevención.Objetivo: Generar recomendaciones basadas en la evidencia para el uso de medios de contraste yodados e n pacientes sometidos a procedimientos radiológicos terapéuticos y de diagnóstico, mediante un consenso de expertos. Metodología: A partir de la formulación de preguntas de investigación relacionadas con la LRA-MCI se realizó la búsqueda de evidencia en PubMed, Embase y Scopus, entre enero de 2013 y agosto de 2022. Los artículos se seleccionaron por medio de una revisión sistemática y con la metodología de consenso Delphi modificado. La calidad de los documentos se valoró aplicando instrumentos de evaluación de calidad de la evidencia de los documentos. Resultados:Se formularon 22 recomendaciones para el manejo de pacientes que requieren administración de medio de contraste yodado. Un panel de 11 expertos, entre los que se contó con 4 nefrólogos, 4 radiólogos y 1 nefrólogo pediatra, participaron en la elaboración del consenso en 5 sesiones virtuales y 15 horas de trabajo.Conclusiones: El término lesión renal aguda asociada al uso de medios de contraste yodados (LRA-MCI) debe usarse idealmente y abandonar otras definiciones que infieren una causalidad manifiesta. Su incidencia: los datos recientes demuestran que se ubica muy por debajo de lo tradicionalmente considerado. Solo una baja tasa de filtración glomerular estimada (TFGe) se considera factor de riesgo independiente. Respecto a su prevención, únicamente la hidratación ha mostrado un potencial beneficio como medida nefroprotectora.

Introduction: Acute kidney injury associated with the use of iodinated contrast media (AKI-ICM) is an iatrogenic disorder with potential implications in morbidity and mortality, a cause for concern in imaging services. The last few years have marked important changes in the conception of this entity, from a more precise definition and its true incidence to the real impact of some strategies for its prevention. Objective: To generate evidence-based recommendations for the use of iodinated contrast media in patients undergoing diagnostic and therapeutic radiological procedures, by means of an expert consensus. Methodology: Based on the formulation of research questions related to AKI-ICM, a search for evidence was carried out in PubMed, Embase and Scopus, between January 2013 and August 2022. The articles were selected by means of a systematic review and with the modified Delphi consensus methodology. The quality of the papers was assessed by applying paper evidence quality assessment instruments. Results: Twenty-two recommendations were formulated for the management of patients requiring administration of iodinated contrast medium. A panel of 11 experts, including 4 nephrologists, 4 radiologists and 1 pediatric nephrologist, participated in the development of the consensus in 5 virtual sessions and 15 hours of work. Conclusions: The term acute kidney injury associated with the use of iodinated contrast media (AKI-ICM) should ideally be used and other definitions that infer overt causality abandoned. Its incidence: recent data show that it is well below that traditionally considered. Only a low estimated glomerular filtration rate (eGFR) is considered an independent risk factor. Regarding its prevention, only hydration has shown a potential benefit as a nephroprotective measure

RESUMEN

Introducción: Un correcto estilo de vida es vital en los adultos mayores para reducir su riesgo de enfermedades y de perder funcionalidad. Objetivo: Determinar las características coligadas al estilo de vida en pacientes adultos mayores en un Centro de Salud de los andes peruanos. Método: Estudio observacional, descriptivo con pacientes adultos mayores de un centro de salud. Se trabajó con una base de datos previamente recolectada. Se usó estadística descriptiva. El estudio fue aprobado por el comité de ética institucional. Resultados: De los 74 pacientes evaluados, la media de edad fue de 75,4 años y el 52% fue de sexo femenino. La media del IMC fue de 24,8 Kg/m2 y la del perímetro abdominal de 86,8 cm. 32,7% tuvieron una agudeza visual de 70 en el ojo derecho y 36,4% de 50 en el ojo izquierdo. La glucosa (mg/dL), hemoglobina (g/dL) y el ácido úrico (mg/dL) tuvieron una mediana de 97, 15,4 y 7; respectivamente. Los triglicéridos y el colesterol tuvieron una media de 182,2 mg/dL y 189,9 mg/dL; respectivamente. Un 5,4% de hombres tuvieron PSA reactivo. 4% tuvieron diabetes, 21,6% hipertensión arterial y 22,2% anemia; mientras que 70,3% consumía alcohol, 6,8% tenía tabaquismo y 89,2% consumía bebidas gaseosas. Conclusiones: Se encontraron algunos indicadores de mal estilo de vida, como el consumo de alcohol y bebidas gaseosas, así como indicadores de condiciones relacionadas a un mal estilo de vida como una media del IMC cercano al sobrepeso, de triglicéridos y colesterol elevados.

Introduction: A correct lifestyle is vital in older adults to reduce their risk of diseases and loss of functionality. Objective: To determine the lifestyles of elderly patients in a Health Center in the Peruvian Andes. Method: Observational, descriptive study with elderly patients from a health center. We worked with a previously collected database. Descriptive statistics were used. The study was approved by the institutional ethics committee. Results: Of the 74 patients evaluated, the mean age was 75.4 years and 52% were females. The mean BMI was 24.8 kg / m2 and that of the abdominal circumference was 86.8 cm. 32.7% had a visual acuity of 70 in the right eye and 36.4% of 50 in the left eye. Glucose (mg / dL), hemoglobin (g / dL) and uric acid (mg / dL) had a median of 97, 15.4 and 7; respectively. Triglycerides and cholesterol had a mean of 182.2 mg / dL and 189.9 mg / dL; respectively. 5.4% of men had reactive PSA. 4% had diabetes, 21.6% hypertension, and 22.2% anemia; while 70.3% consumed alcohol, 6.8% smoked and 89.2% consumed soda. Conclusions: Some indicators of poor lifestyle were found, such as the consumption of alcohol and soft drinks, as well as indicators of conditions related to a poor lifestyle such as an average BMI close to being overweight, high triglycerides and cholesterol.

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El dolor pélvico crónico (DPC) se define como un dolor de localización pélvica con una duración mayor a 6 meses. Es una causa importante de consulta médica, y afecta entre el 24 % y el 45 % de las mujeres en el mundo. El síndrome de congestión pélvica (SPC) es una fuente notable y muchas veces poco diagnosticada de dolor pélvico crónico en pacientes, en su mayoría premenopáusicas, que afecta de forma relevante la calidad de vida. El principal objetivo de este artículo es demostrar las múltiples opciones diagnósticas y diferentes dispositivos terapéuticos que se usan para la embolización selectiva, para dar un adecuado manejo y resolución al síndrome de congestión pélvica. En conclusión, el SPC es una entidad altamente dolorosa, incapacitante e importante para tener en cuenta por su alta prevalencia y morbilidad asociadas. El tratamiento endovascular ha demostrado ser una opción altamente confiable, segura, con bajas tasas de complicaciones, menor tiempo de recuperación y estancias hospitalarias más cortas, en comparación con la opción quirúrgica. Es importante conocer el material y utilizarlo correctamente, lo cual ayudará a evitar complicaciones.

Chronic pelvic pain (CPP) is defined as pain in the pelvic area with a duration more than 6 months. It's an important cause of medical consultation, affecting approximately between 24 and 45% of women in the world. Pelvic congestion syndrome (PCS) is a notable and often under-diagnosed cause of chronic pelvic pain in patients, mostly premenopausal, that significantly affects quality of life. The main objective of this paper is to demonstrate the multiple diagnostic options and different therapeutic devices that are used for selective embolization, giving adequate management and resolution of pelvic congestion syndrome. In conclusion, PCS is a highly painful, disabling and important pathology to take into account due to its high prevalence and associated morbidity. Endovascular treatment has proven to be a highly reliable and safe option, with low complication rates, shorter recovery time, and briefer hospital stays compared to the surgical option. It's important to know the material and use it correctly which will help avoid complications.

RESUMEN

EL HOMA-IR (homeostasis model assessment-insulin-resistance) es un estimador de insulinorresistencia (IR) pero depende de la determinación de insulina. Los índices triglicéridos-glucosa (T-G)-circunferencia de la cintura (CC) (T-G-CC) o triglicéridos-glucosa-índice de masa corporal (TG- IMC) podrían ser sustitutos. Los objetivos de este trabajo consistieron en investigar en personas con riesgo de desarrollar diabetes tipo 2 (DT2): a) los índices T-G, T-G-CC y T-G-IMC como estimadores de HOMA-IR>2,1; b) determinar su poder discriminante. Se realizó un estudio prospectivo en el que se estudiaron 223 individuos ≥45 años con riesgo de desarrollar diabetes tipo 2 (DT2). La relación T-G se calculó como ln [triglicéridos (mg/dL) x glucemia (mg/dL)/2]. La relación T-G-CC y T-G-IMC fue el producto de T-G por CC o IMC. Se utilizó análisis de regresión logística y se calcularon las áreas bajo las curvas ROC (receiver operating characteristic curves) (ABC) para comparar las asociaciones de T-G, T-G-CC y T-G-IMC con HOMA-IR>2,1. Mediante análisis discriminante se evaluó la clasificación de los sujetos entre HOMA-IR>2,1 y HOMA-IR≤2,1. ABC, sensibilidad, especificidad, poder predictivo positivo y negativo para T-G-CC y T-G-IMC fueron mayores que para T-G, con los siguientes valores de corte: T-G=8,75, T-G-CC=821 y T-G-IMC=255. Los odds ratios (OR) para HOMA-IR>2,1, ajustados para confusores, fueron: T-G>8,75, OR: 4,85 (IC 95% 2,73-8,62); T-G-CC>821, OR: 10,41 (IC 95% 5,55-19,53); T-GIMC> 255, OR: 10,41 (IC 95% 5,55-19,53). Con el análisis discriminante T-G>8,75 clasificó correctamente 69,2% individuos con HOMA-IR≤2,1 y 68,3% con HOMA-IR>2,1; T-G-CC y T-G-IMC clasificaron 74,4% y 78,2% respectivamente (p<0,001 en todos los casos). Se concluyó que T-GCC> 821 y T-G-IMC>255 fueron mejores estimadores de HOMA-IR>2,1 que T-G>8,75. Estas son determinaciones simples y accesibles y podrían ser útiles en la práctica clínica y en estudios epidemiológicos.

HOMA-IR ((homeostasis model assessment-insulin-resistance) is a surrogate estimator of insulin resistance (IR) but it depends on insulin determination. Triglyceride-glucose-waist circumference (T-G-WC) or triglyceride-glucose-body mass index (BMI) (T-G-BMI) could be substitutes. The objectives of this work were: to investigate in people at risk of developing type 2 diabetes (T2D): a) T-G, T-G-CC and T-G-BMI as estimators of HOMA-IR>2.1 and b) to determine their discriminating power. A prospective study was conducted studying 223 individuals ≥45 years of age at risk of developing type 2 diabetes (T2D). The T-G ratio was calculated as ln [triglycerides (mg/dL) x glycemia (mg/dL)/2]. The T-G-CC and T-G-BMI ratio was the product of T-G by CC or BMI. Logistic regression analysis was used and the areas under the receiver operating characteristic curves (ROC) curves were calculated to compare the associations of T-G, T-G-CC and T-G-BMI with HOMA-IR>2.1. Using a discriminant analysis, the classification of the subjects between HOMA-IR>2.1 or HOMA-IR≤2.1 was evaluated. AUC, sensitivity, specificity, positive and negative predictive powers for T-G-CC and T-G-BMI were higher than for T-G, with the following cut-off values: TG=8.75, T-G-CC=821 and T-G-BMI=255. Odds ratios (OR) for HOMA-IR>2.1, adjusted for confounders, were: T-G>8.75, OR 4.85 (95% CI 2.73-8.62); T-G-CC>821, OR 10.41 (95% CI 5.55-19.53); T-G-BMI>255, OR 10.41 (95% CI 5.55-19.53). With the discriminant analysis T-G>8.75, 69.2% correctly classified with HOMA-IR≤2.1 and 68.3% with HOMA-IR>2.1; T-G-CC and T-G-BMI correctly classified 74.4% and 78.2% respectively (p <0.001 in all cases). It is concluded that T-G-CC>821 and T-G-BMI>255 were better estimators of HOMA-IR>2.1 than T-G>8.75. T-G-WC and T-G-BMI are simple and reliable determinations and could be useful in clinical practice and epidemiological studies.

O HOMA-IR (homeostasis model assessment-insulin-resistance) e um estimador de resistencia a insulina (RI), mas depende da determinacao da insulina. Triglicerideos-glicose (T-G), circunferencia da cintura (CC) (T-G-CC) ou triglicerideos-glicose-indice de massa corporal (T-G-IMC) poderiam ser substitutos. Os objetivos desse trabalho foram investigar em pessoas com risco de desenvolver diabetes tipo 2 (DT2): a) os indices T-G, T-G-CC e T-G-IMC como estimadores de HOMA-IR> 2,1; b) determinar seu poder discriminante. Um estudo prospectivo foi realizado em 223 pessoas ≥45 anos com risco de desenvolver diabetes tipo 2 (DT2). A razao T-G foi calculada como ln [triglicerideos (mg/dL) x glicemia (mg/dL)/2]. A razao T-G-CC e T-G-IMC foi o produto de T-G por CC ou IMC. A analise de regressao logistica foi utilizada e as areas sob as curvas ROC (receiver operating features) ABC foram calculadas para comparar as associacoes de T-G, T-G-CC e T-G-IMC com HOMA-IR>2.1. Por meio de analise discriminante, avaliou-se a classificacao dos sujeitos entre HOMA-IR>2,1 e HOMA-IR≤2,1. ABC, sensibilidade, especificidade, poder preditivo positivo e negativo para TG-CC e TG-IMC foram maiores que para TG, com os seguintes valores de corte: TG=8,75, TG-CC=821 e TG-IMC=255. Odds Ratios (OR) para HOMA-IR>2,1, ajustados para fatores de confusao, foram: TG>8,75, OR 4,85 (IC95% 2,73-8,62); T-G-CC>821, OR 10,41 (IC 95% 5,55-19,53); T-G-IMC>255, OR 10,41 (IC 95% 5,55-19,53). Com a analise discriminante T-G>8,75, 69,2% foram classificados corretamente com HOMA-IR≤2,1 e 68,3% com HOMA-IR>2,1; T-G-CC e T-G-IMC classificaram 74,4% e 78,2%, respectivamente (p<0,001 em todos os casos). Conclui-se que T-G-CC>821 e TG- IMC>255 foram melhores estimadores de HOMA-IR>2,1 que T-G>8,75. Elas sao determinacoes simples e acessiveis e poderiam ser uteis na pratica clinica e em estudos epidemiologicos.

RESUMEN

RESUMEN Objetivos: Determinar la probabilidad de control del brote de la COVID-19 en el Perú, en un escenario pre y poscuarentena en modelos de simulaciones matemáticas. Materiales y métodos: Se realizan simu laciones de brotes para la pandemia de COVID-19, usando ecuaciones estocásticas bajo los siguientes supuestos: un R0 poblacional precuarentena de 2,7 o 3,5, y un R0 poscuarentena de 1,5, 2 o 2,7, positivos asintomáticos del 18% o 40%, y una capacidad resolutiva máxima de 50 o 150 pacientes en las unidades de cuidados intensivos. Se evalúa el éxito del aislamiento y rastreo de contactos, no se incluyen otras medidas de mitigación. Resultados: En la etapa precuarentena, el éxito en el control de más del 80% de las simulaciones se daba solo si el aislamiento de casos positivos se implantaba desde el primer caso, luego se tenía menos de un 40% de probabilidad de éxito. En la poscuarentena, con 60 casos positivos es necesario aislarlos precozmente, rastrear al 100% sus contactos y disminuir el R0 a 1,5 para que el control del brote tenga éxito en más del 80% de los casos. Otros escenarios tienen baja probabilidad de éxito. Conclusiones: El control del brote en el Perú en la etapa precuarentena demandaba requisitos de difícil cumplimiento, por ello la cuarentena era necesaria; para suspenderla con éxito se requeriría una impor tante reducción de la dinámica de propagación de la enfermedad, el aislamiento precoz de los positivos y el seguimiento de todos los contactos.

ABSTRACT Objectives: To determine the probability of controlling the outbreak of COVID-19 in Peru, in a pre- and post-quarantine scenario using mathematical simulation models. Materials and methods: Outbreak si mulations for the COVID-19 pandemic are performed, using stochastic equations under the following assumptions: a pre-quarantine population R0 of 2.7 or 3.5, a post-quarantine R0 of 1.5, 2 or 2.7, 18% or 40%, of asymptomatic positives and a maximum response capacity of 50 or 150 patients in the intensive care units. The success of isolation and contact tracing is evaluated, no other mitigation measures are included. Results: In the pre-quarantine stage, success in controlling more than 80% of the simulations occurred only if the isolation of positive cases was implemented from the first case, after which there was less than 40% probability of success. In post-quarantine, with 60 positive cases it is necessary to isolate them early, track all of their contacts and decrease the R0 to 1.5 for outbreak control to be successful in more than 80% of cases. Other scenarios have a low probability of success. Conclusions: The control of the outbreak in Peru during pre-quarantine stage demanded requirements that were difficult to comply with, therefore quarantine was necessary; to successfully suspend it would require a significant reduction in the spread of the disease, early isolation of positives and follow-up of all contacts of positive patients.