ABSTRACT Introduction: Adherence to treatment and level of knowledge in patients with arterial hypertension are key factors to control this condition and avoid complications. Objectives: To determine the degree of adherence to treatment, the level of knowledge and comorbidities in patients with arterial hypertension in an urban area of Asunción, Paraguay, in 2022. Methodology: An observational, descriptive, cross-sectional design was applied. Men and women over 18 years of age, known carriers of arterial hypertension, residing in Sajonia neighborhood between May and October 2022, were included. The data were obtained through house-to-house interviews. Demographic variables, the level of adherence with the Morisky Green test and the level of knowledge about the disease with the Batalla test were measured. The research was approved by the Ethics Committee of the Universidad Privada del Este, Paraguay. Results: Four hundred twenty-five subjects participated in the study, predominantly female (61.1%). Diabetes mellitus was referred to by 28.9% of the interviewees. The Morisky Green test detected that 60% of the subjects forget to take their medication, 25% do not take it at the indicated time, 29% take it if they feel well, and 44% stop taking it if they feel undesirable effects. The Batalla test found that 7% believe that arterial hypertension is not for life, 9% believe that the condition is not controlled with diet and medication, and 5.8% could not refer to at least one target organ. Conclusion: Adherence to the treatment of arterial hypertension and the level of knowledge about this condition was not adequate.

RESUMEN Introducción: la adherencia al tratamiento y el nivel de conocimientos en pacientes con hipertensión arterial son factores claves para controlar esta afección y evitar complicaciones. Objetivos: determinar el grado de adherencia al tratamiento, el nivel de conocimientos y comorbilidades en pacientes con hipertensión arterial de un área urbana de Asunción, Paraguay, en 2022. Metodología: se aplicó un diseño observacional, descriptivo, transversal. Se incluyeron varones y mujeres mayores de 18 años, conocidos portadores de hipertensión arterial, que residen en el barrio Sajonia entre mayo y octubre del 2022. Los datos fueron obtenidos con entrevistas realizadas casa por casa. Se midieron variables demográficas, el nivel de adherencia con el cuestionario de Morisky Green y el de conocimientos sobre la enfermedad con el cuestionario de Batalla. La investigación fue aprobada por el Comité de ética de la Universidad Privada del Este, Paraguay. Resultados: participaron del estudio 425 sujetos, con predominio del sexo femenino (61,1%). La diabetes mellitus fue referida en 28,9% de los entrevistados. El cuestionario de Morisky Green detectó que 60% de los sujetos olvida de tomar su medicación, 25% no la toma en el horario indicado, 29% de la toma si se siente bien y 44% deja de tomarla si siente efectos indeseables. El cuestionario de Batalla halló 7% cree que la hipertensión arterial no es para toda la vida, 9% cree que la afección no se controla con dieta y medicación, y 5,8% no pudo referir al menos un órgano blanco. Conclusión: la adherencia al tratamiento de la hipertensión arterial y el nivel de conocimientos sobre esta afección no fue adecuada.

Abstract Introduction Acute myeloid leukemia (AML) is a heterogeneous disease and approximately one-third of its carriers do not have evident genetic abnormalities. The mutation of specific molecular markers, such as fms-like tyrosine kinase 3 (FTL3) internal tandem duplication (ITD), FLT3 tyrosine kinase domain (TKD) and nucleophosmin (NPM1), are associated with an adverse and favorable prognosis, respectively. Objective The objective was to determine the prevalence of FLT3/ITD and NPM1 in Chilean patients and their association with clinical data and prognosis. Method and Results Two hundred and thirty-two children were studied between 2011 and 2017, the median being 8.6 years (ranging from 1 to 18 months). Acute promyelocytic leukemia (APL) was diagnosed in 29%. The FLT3/ITD-mutated in non-promyelocytic AML was at 10% (14/133) and the FLT3/TKD, at 3.7% (2/54). In APL, it was at 25.4% (16/63). In non-promyelocytic AML, the FLT3/ITD-mutated was associated with a high leucocyte count, the median being 28.5 x mm3 (n= 14) versus 19.4 x mm3 (n= 119), (p= 0.25), in non-mutated cases. In APL, the median was 33.6 x mm3 (n= 15) versus 2.8 x mm3 (n= 47), (p < 0.001). The five-year overall survival (OS) in non-promyelocytic AML with non-mutated and mutated FLT3/ITD were 62.7% and 21.4%, respectively, (p < 0.001); the 5-year event-free survival (EFS) were 79.5% and 50%, respectively, (p < 0.01). The five-year OS in APL with non-mutated and mutated FLT3/ITD was 84.7% and 62.5%, respectively, (p= 0.05); the 5-year EFS was 84.7% and 68.8%, respectively, (p= 0.122). The NPM1 mutation was observed in 3.2% (5/155), all non-promyelocytic AML with the normal karyotype. Conclusion The FLT3/ITD mutation was observed more frequently in APL and associated with a higher white cell count at diagnosis. However, the most important finding was that the FLT3/ITD mutation was associated with a shorter survival in non-promyelocytic AML.

ABSTRACT Introduction: People living with human immunodeficiency virus (PLWH) still face high morbidity and mortality resulting from lymphoma. Aim: To describe a population of PLWH and lymphoma in a Chilean public hospital and compare the overall survival (OS) with a previously reported cohort from the same institution. Methods: Retrospective single-center cohort study. All the patients diagnosed between 2010 and 2017 were included. Demographic and clinical variables were obtained from medical records. The overall survival (OS) was estimated in treated patients from diagnosis until death or October 2020. The OS was then compared with a cohort of patients diagnosed between 1992 and 2008. Main Results: Eighty-four patients were included. The most common histological types were Burkitt's lymphoma (BL), diffuse large B-cell lymphoma (DLBCL), Hodgkin's lymphoma (HL) and plasmablastic lymphoma (PBL) at 31%, 27%, 21% and 14%, respectively. The three-year OS for the whole cohort of BL, DLBCL, HL and PBL was 58.9%, 65.2%, 47.4%, 76.4% and 50%, respectively. Compared to the cohort of 1992 to 2008, a global increase in the OS was found after excluding HL and adjusting for age and clinical stage (HR 0.38, p = 0.002). However, when the main types were analyzed individually, the increase in the OS was statistically significant only in DLBCL (HR 0.29, p = 0.007). Most patients with DLBCL received CHOP chemotherapy, as in the previous cohort. Conclusion: The OS has improved in this population, despite no major changes in chemotherapy regimens, mainly due to the universal access to antiretroviral therapy.

Resumen Objetivo principal: el objetivo de esta investigación es describir los hábitos de consumo alimentario y determinar qué variables sociodemográficas, dentro del colectivo de los estudiantes jóvenes universitarios, están implicadas en la elección de los alimentos. Metodología: se aplicó un cuestionario ad hoc, anónimo y auto-administrado a 599 estudiantes de la Universidad de Alicante, matriculados en el curso académico 2018/2019. Resultados principales: los resultados muestran que los jóvenes universitarios concentran sus ingestas en la comida (90,2%) y la cena (82%). Se evidenció, además, que los alimentos incluidos en la dieta mediterránea se consumen dos o tres veces por semana en esta población, pero en porcentajes diferentes. Los datos confirman que los educados en un estilo democrático consumen, en un 59%, alimentos enriquecidos con vitaminas y minerales por encima de otros estilos educativos familiares. De los estudiantes que afirmaban consumir alimentos precocinados un 51,9% pertenecen a un estilo educativo democrático, un 32,3% al permisivo, un 14,6% al autoritario y un 1,2% al negligente, lo que confirma la influencia de la cultura educativa familiar en los hábitos de alimentación de este grupo etario para esta variable. Conclusión principal: se concluye que las pautas definitorias de la dieta mediterránea han perdido protagonismo en este grupo poblacional, al comparar sus resultados con los de otros momentos históricos. Además, los resultados obtenidos muestran que los estilos de crianza no influyen de forma determinante en la elección de la alimentación en la etapa universitaria, a excepción del consumo alimentos precocinados.

Abstract Objective: the objective of this research is to describe food consumption habits and determine which sociodemographic variables, within the group of young university students, are involved in the choice of food. Methods: an ad hoc, Anonymous and self-administered questionnaire was applied to 599 students from the University of Alicante, enrolled in the 2018/2019 academic year. Results: the results show that university students concentrate their intakes at lunch (90.2%) and dinner (82%). It was also shown that the foods included in the Mediterranean diet are consumed two or three times a week in this population, but in different percentages. The data confirm that those educated in a democratic style consume, in 59%, foods enriched with vitamins and minerals above other family educational styles. Of the students who claimed to consume precooked foods, 51.9% belong to a democratic educational style, 32.3% to permissive, 14.6% to authoritarian and 1.2% to negligent, which confirms the influence of family educational culture in the eating habits of this ade group for this variable. Conclusions: it is concluded that the defining guidelines of the Mediterranean diet have lost prominence in this population group, when comparing their results with those od other historical moments. In addition, it is confirmed that the defining guidelines of the Mediterranean diet have been losing prominence along the years.

ABSTRACT The present article is an approach, of what has been studied and contributed by researchers in the theoretical field, in relation to the methodological work that from pedagogic sciences, and especially from Didactics, is carried out in Cuban Higher Education. The authors' experience in the educational practice during the conduction of different organs and levels of methodological direction, advising of diverse activities, such as meetings, workshops, seminars and methodological concentrates, as well as the use of other methods, allowed elaborating basic ideas, which can be enriched with the action of the different technical-methodological organs, in order to organize, plan and control the fundamental processes to develop regarding the methodological work in the university of Camagüey.

RESUMEN El presente artículo es un acercamiento a lo que en lo teórico se ha estudiado y aportado por los investigadores, en relación con el trabajo metodológico que, desde las ciencias pedagógicas, y especialmente desde la Didáctica, se realiza en la Educación Superior Cubana. La experiencia de las autoras en la práctica educativa durante la conducción de diferentes órganos y niveles de dirección metodológica, asesoría de diversas actividades, como reuniones, talleres, seminarios y concentrados metodológicos, así como el empleo de otros métodos, permitieron elaborar ideas básicas, que pueden enriquecerse con el accionar de los diferentes órganos técnico-metodológicos, para organizar, planificar y controlar los procesos fundamentales a desarrollar con respecto al trabajo metodológico en la universidad camagüeyana.

Resumen El presente estudio tuvo como objetivo describir los parámetros hematológicos, bioquímicos y endocrinos en la respuesta aguda al ejercicio de intensidad creciente en caballos de Paso colombianos (CPC). Se realizó una prueba estandarizada de ejercicio de campo en 11 CPC adultos no entrenados de ambos sexos. Las variables de interés se midieron antes y después de la prueba (esto es, hematocrito, proteínas plasmáticas totales, creatina quinasa, creatinina, nitrógeno ureico en sangre -NUS, aspartato aminotransferasa, gamma glutamil transpeptidasa, triglicéridos, colesterol, fosfatasa alcalina, cortisol, insulina, niveles de azúcar en sangre). Se encontró evidencia de activación de la respuesta simpática-adrenérgica, descrita para otras razas y disciplinas deportivas ecuestres (esto es, hemoconcentración, cambio negativo en el volumen plasmático, ligero aumento de la creatinina y NUS). Además, se encontró evidencia de movilización y uso de fuentes de energía como glucosa y triglicéridos. En conclusión, el ejercicio de intensidad creciente realizado durante una prueba de campo estandarizada produjo un cambio negativo en el volumen plasmático y la activación de la clásica respuesta simpática-adrenérgica en los CPC.

Abstract The present study aimed to describe the hematological, biochemical, and endocrine parameters in acute response to increasing-intensity exercise in Colombian Paso horses (CPHs). A standardized field exercise test was carried out on 11 untrained adult CPHs of both sexes. The variables of interest were measured before and after the test (i.e. hematocrit, total plasma proteins, creatine kinase, creatinine, blood urea nitrogen -BUN, aspartate aminotransferase, gamma glutamyl transpeptidase, triglycerides, cholesterol, alkaline phosphatase, cortisol, insulin, blood sugar levels). Evidence of sympathetic-adrenergic response activation, described for other breeds and equestrian sports disciplines (i.e. hemoconcentration, negative change in plasma volume, slight increase in creatinine and BUN) was found. In addition, evidence of mobilization and use of energy sources such as glucose and triglycerides was found. In conclusion, the increasing-intensity exercise carried out during a standardized field test produced a negative change in plasma volume and the activation of the classic sympathetic-adrenergic response in CPHs.

RESUMEN Mujer de 32 años, asmática en tratamiento irregular con prednisona (ultima dosis hace 1 mes), Enfermedad de Graves Basedow desde hace 3 años, reinició tratamiento hace 3 meses (metimazol 40 mg/día), antecedente de aborto dos semanas previas al ingreso. Acude por pérdida del conocimiento, constatándose hipoglucemia. Al persistir el cuadro de hipoglucemia a pesar del tratamiento instaurado y descartadas otras causas etiológicas, la evaluación endocrinológica confirma hipoglucemia autoinmune, niveles de autoanticuerpos contra la insulina e insulina extremadamente elevados.

ABSTRACT A 32-year-old woman, asthmatic on irregular treatment with prednisone (last dose 1 month ago), Graves Basedow's disease for 3 years, restarted treatment 3 months before (methimazole 40 mg / day). History of abortion two weeks prior to admission. She came for loss of consciousness, finding hypoglycemia. As hypoglycemia persists despite the treatment instituted and other etiological causes ruled out, the endocrinological evaluation confirms autoimmune hypoglycemia, autoantibody levels against insulin and extremely high insulin.

Background: Philadelphia-negative myeloproliferative neoplasms (Ph-MPN) are chronic hematological disorders characterized by the overproduction of one or more mature myeloid blood cell lineages. Classical Ph-MPN are polycythemia vera (PV), essential thrombocytopenia (ET) and primary myelofibrosis (PMF). Aim: To assess the epidemiological, clinical and diagnostic characteristics of Ph-MPN in Chile. Material and Methods: Retrospective review of medical records of all patients referred as MPN from 2012 to 2017. Patients with (9;21) translocation were excluded. Results: Data of 462 cases with a median age of 69 years from 10 public hospitals was reviewed. ET was the most frequently Ph-MNP found. The incidence of Ph-MPN was 1.5 x 100.000 cases. The JAK2 V617F mutation study was performed in 96% of patients and only 30% had a bone marrow biopsy. Thrombotic events were observed in 29% of patients. Bleeding events were observed in 7%. Five-year overall survival was 87%. Conclusions: ET is the most frequent Ph-MPN. The mean incidence was lower than reported in the literature, in part because of a sub diagnosis.

Background: Before the advent of tyrosine kinase inhibitors (TKIs), patients with Philadelphia-positive Acute Lymphoblastic Leukemia (Ph+ALL) had a poor prognosis. The association of TKIs to intensive chemotherapy (CT) improved outcome. Aim: To evaluate results of an intensive CT protocol including TKI in a public hospital in Santiago, Chile. Material and Methods: All patients with Ph+ALL diagnosed between January 2010 and February 2019, and who met inclusion criteria for intensive CT, received the Ph+ALL national protocol in association with imatinib and were included in this analysis. Results: Thirty-five patients aged 15 to 59 years received treatment. Complete response (CR) was obtained in 97%. Measurable residual disease (MRD) was negative in 61% (19/31 evaluable cases) during follow-up, and 55% (16/29) were MRD (-) before three months. Relapse was observed in 13 cases. Three patients underwent allogeneic hematopoietic stem cell transplant (HSCT), two in CR1. The overall survival (OS) and event-free survival (EFS) at three years were 52 and 34%, respectively. In patients who achieved MRD negativity before three months, no statistically significant differences in OS (64 and 42% respectively, p = 0.15) or EFS (35 and 32% respectively, p = 0.37) were observed. Conclusions: The prognosis of Ph+ALL improved with the association of imatinib to intensive CT. MRD-negative status before three months in this series was not significantly associated with better outcomes. Our series suggests that the Ph+ALL national protocol associated to TKI is a therapeutic alternative with high CR and aceptable MRD (-) rates.

Abstract Meningiomas are the most common primary brain tumors. Primary intraosseous meningioma is a rare extradural meningioma subtype. They are usually asymptomatic but may cause proptosis or neurological symptoms depending on size and location. The most common finding in imaging tests is hyperostosis although a lytic or even mixed pattern can also be observed, so it should be considered in the differential diagnosis of cranial sclerotic bone tumors. Although most are benign, they are more likely to develop malignancy than intradural meningiomas. Imaging techniques (CT and MRI) are very useful in preoperative diagnosis and evaluation of adjacent anatomical structures. Surgical resection followed by cranial reconstruction is the treatment of choice.

Resumen Los meningiomas son los tumores cerebrales primarios más comunes, si bien el meningioma intraóseo primario constituye un subtipo de meningioma extradural infrecuente. Normalmente son asintomáticos pero pueden causar proptosis o síntomas neurológicos en función del tamaño y de la localización. El hallazgo más común en pruebas de imagen es la hiperostosis aunque también se puede observar un patrón lítico o incluso mixto, por lo que debe ser considerado en el diagnóstico diferencial de tumores óseos escleróticos craneales. Aunque la mayoría son benignos, son más propensos a desarrollar malignidad que los meningiomas intradurales. Las técnicas de imagen (TC y RM) son muy útiles en el diagnóstico preoperatorio y valoración de estructuras anatómicas adyacentes. La resección quirúrgica seguida de reconstrucción craneal es el tratamiento de elección.

Abstract Background: The Order Commelinales includes five families, 68 genera, and ca. 780 species worldwide; in Mexico, is represented by Commelinaceae, Haemodoraceae and Pontederiaceae. Aguascalientes is located in the center-north region of Mexico, represents an area of floristic transition, between the Mexican Xerophytic region and the Mesoamerican Mountain region, and counts with the families Commelinaceae and Pontederiaceae. Questions and/or Hypothesis: What is the diversity of Commelinales in Aguascalientes? What is the distribution of its species? Studied species: Species of Commelinales in Aguascalientes, Mexico. Study site and dates: Aguascalientes, Mexico. July 2013 to October 2015. Methods: Fifty-two field trips were conducted sampling 142 collection points. A total of 167 specimens were processed and identified with the support of specialist and specialized literature. Additionally, herbaria material from of the region was reviewed and distribution maps were elaborated. Results: Eight genera and 23 species of Commelinales are reported for Aguascalientes, of which six genera and 20 species belong to Commelinaceae, and two genera and three species to Pontederiaceae; eight species are endemic of Mexico; two genera and six species are new records for Aguascalientes; Tradescantia hirsutiflora Bush is a new record for Mexico. Commelinaceae is mainly distributed in the north-eastern part of the state, predominantly in subtropical scrub, whereas Pontederiaceae are aquatic and is mainly distributed in the south-eastern part. Conclusions: This study increases and updates the number of species for Commelinales in Aguascalientes and Mexico, as well as the distribution and types of vegetation in which they are found.

Resumen Antecedentes: El orden Commelinales incluye cinco familias, 68 géneros, y cerca de 780 especies a nivel mundial; en México, está representado por Commelinaceae, Haemodoraceae y Pontederiaceae. Aguascalientes se ubica en la región centro-norte de México, representa una zona de transición florística, entre la región Xerofítica Mexicana y la Mesoamericana de Montaña, y cuenta con las familias Commelinaceae y Pontederiaceae. Preguntas y/o Hipótesis: ¿Cuál es la diversidad de Commelinales en Aguascalientes?, ¿Cuál es la distribución de sus especies? Especies de estudio: Especies de Commelinales en Aguascalientes, México. Sitio y años de estudio: Aguascalientes, México. Julio de 2013 a octubre de 2015. Métodos: Se realizaron 52 recolectas abarcando 142 puntos de muestreo. En total 167 ejemplares fueron recolectados e identificados con el apoyo de especialistas y literatura especializada. Adicionalmente, se revisó material de herbarios de la región y se elaboraron mapas de distribución. Resultados: Se reportan ocho géneros y 23 especies de Commelinales para Aguascalientes, de los cuales seis géneros y 20 especies pertenecen a Commelinaceae, y dos géneros y tres especies a Pontederiaceae; ocho especies son endémicas de México; dos géneros y seis especies son nuevos registros para Aguascalientes; Tradescantia hirsutiflora Bush es nuevo registro para México. Commelinaceae se distribuye principalmente al noreste del estado, predominantemente en matorral subtropical, mientras que Pontederiaceae son acuáticas y se distribuyen principalmente al sureste. Conclusiones: Este estudio amplía y actualiza el número de especies de Commelinales en Aguascalientes y en México, así como la distribución y tipos de vegetación en la que se encuentran.

ABSTRACT Introduction: Seric albumin constitutes one of the parameters used to predict the risk of complications in patients surgically intervened. Objective: To evaluate the utility of seric albumin as prediction factor of multiple failure of organs in patients with secondary diffuse peritonitis. Method: An observational, cohorts analytic study of 54 patients with secondary diffuse peritonitis was carried out, they were assisted in the Intensive Cares Unit of Carlos Manuel de Céspedes University General Hospital in Bayamo, Granma, during 2016. The marker variable of prediction was the multiple failures of organs that was evaluated with the Sequential scale Organ Failure Assessment. Results: In the 37.7 % of patients multiple failure of organs was developed; also, the average value of seric albumin at admission (standard deviation) was 30.3 g/L (+ 3.4) in patients with this disorder and 33.2 g/L (+ 4.1) without this disorder (p=0.012). The relative risk of multiple failure of organs was 1.9 (CI: 95 % 1.1-3.2) with albumin of 30 g/L or less. In the multivariate analysis seric albumin constituted an independent factor of multiple failure of organs along with APACHE II index; while the area under the curve receiving operator presented a value of 0.7 when the discriminative capacity of the albumin was considered to predict if the multiple failure of organs was not present and 0.2 to predict its development. Conclusions: Seric albumin is useful as prediction factor of multiple failure of organs in patients with secondary diffuse peritonitis.

RESUMEN Introducción: La albúmina sérica constituye uno de los parámetros utilizados para predecir el riesgo de complicaciones en pacientes intervenidos quirúrgicamente. Objetivo: Evaluar la utilidad de la albúmina sérica como factor pronóstico de fallo múltiple de órganos en pacientes con peritonitis difusa secundaria. Método: Se realizó un estudio observacional, analítico, de cohortes de 54 pacientes con peritonitis difusa secundaria atendidos en la Unidad de Cuidados Intensivos del Hospital General Universitario Carlos Manuel de Céspedes de Bayamo, de la provincia de Granma, durante el 2016. La variable marcadora del pronóstico fue el fallo múltiple de órganos, que se evaluó con la escala Secuencial Organ Failure Assessment. Resultados: En 37,7 % de los pacientes se desarrolló fallo múltiple de órganos; asimismo, el valor promedio de la albúmina sérica al ingreso (desviación estándar) fue 30,3 g/L (+ 3,4) en pacientes con dicha afectación y 33,2 g/L (+ 4,1) sin esta (p=0,012). El riesgo relativo de fallo múltiple de órganos resultó ser de 1,9 (IC: 95 % 1,1-3,2) con albúmina de 30 g/L o menos. En el análisis multivariado la albúmina sérica constituyó un factor independiente de fallo múltiple de órganos junto al índice de APACHE II; mientras que el área bajo la curva receptor operador presentó un valor de 0,7 cuando se estimó la capacidad discriminativa de la albúmina para predecir la no aparición de fallo múltiple de órganos y de 0,2 para predecir su desarrollo. Conclusiones: La albúmina sérica es útil como factor pronóstico de fallo múltiple de órganos en pacientes con peritonitis difusa secundaria.

ABSTRACT Adult T-cell leukemia/lymphoma (ATL) is an aggressive disease of mature activated T cell caused by human T-cell lymphotropic virus type 1 (HTLV-1). ATL carries a bad prognosis due to intrinsic chemoresistance and severe immunosuppression. The aggressive ATL forms, acute and lymphoma, are treated with chemotherapy associated with antiretroviral agents (AZT/IFN) the acute form. However, they have failed to achieve an impact on survival, that ranges from 8-10 months, respectively. Patients with chronic and smoldering ATL forms, have a better prognosis, but long term survival is poor as well, when these patients are managed with a watchful waiting policy or with chemotherapy. Apparently, AZT/IFN seams to benefit these patients. Meanwhile, prevention of dissemination of HTLV-1, is a must in public health policies, performing screening in blood banks and a screening to pregnant women to reduce/avoid vertical transmission of the virus.

RESUMEN La leucemia / linfoma de células T en adultos (LLTA) es una enfermedad agresiva de células T maduras activadas causada por el virus linfotrópico de células T humano tipo 1 (HTLV-1). ATL tiene un mal pronóstico debido a la quimiorresistencia intrínseca y la inmunosupresión severa. Las formas agresivas de LLTA, aguda y linfoma, se tratan con quimioterapia asociada con agentes antirretrovirales (AZT / IFN). Sin embargo, no han logrado lograr un impacto en la supervivencia, que oscila entre 8 y 10 meses, respectivamente. Los pacientes con formas de LLTA crónicas y latentes tienen un mejor pronóstico, pero la supervivencia a largo plazo también es deficiente, tanto cuando estos pacientes se manejan con una política de espera vigilante o con quimioterapia. Aparentemente, las costuras AZT / IFN benefician a estos pacientes. Mientras tanto, la prevención de la diseminación del HTLV-1 es imprescindible en las políticas de salud pública, tanto por tamizaje del virus en bancos de sangre como a mujeres embarazadas para reducir / evitar la transmisión vertical del virus.

ABSTRACT Objective: to provide evidence based clinical recommendations for the diagnosis and therapy of the acute stage of ischemic cerebrovascular accident in EsSalud. Materials and methods : a group for producing the guideline was conveyed, including specialized physicians and methodologists. The group prepared 8 clinical questions to be answered by the guideline. Systematic searches of previous reviews were performed, and - when it was deemed necessary - primary studies in Medline and the Cochrane Controlled Registry of Trials for 2018 were reviewed. Evidence was selected aiming to respond each one of the proposed clinical questions. Certainty of the evidence was determined using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work sessions, the group used GRADE methodology for reviewing the evidence and generated recommendations, good clinical practice items, and designed flow charts for both diagnosis and therapy. Finally, the guide was approved with the decree N° 128-IETSI-ESSALUD-2019. Results : this clinical practice guideline focused in 8 clinical questions, which were divided into four topics: screening, diagnosis, therapy, support and rehabilitation. On the basis of these questions, 28 recommendations were formulated (8 strong and 20 conditional), 38 items for good clinical practice, 1 implementation note, and 2 flow charts. Conclusion : this paper summarizes both evidence based methodology and conclusions from a new clinical practice guide for diagnosis and therapy of the acute stage of a cerebrovascular accident in EsSalud.

RESUMEN Objetivo: proveer recomendaciones clínicas basadas en evidencia para el diagnóstico y tratamiento de la etapa aguda del ataque cerebrovascular isquémico en EsSalud. Materiales y métodos: se conformó un grupo elaborador de la guía (GEG) que incluyó médicos especialistas y metodólogos. El GEG formuló 8 preguntas clínicas a ser respondidas por la presente GPC. Se realizó búsquedas sistemáticas de revisiones sistemáticas y -cuando fue considerado pertinente- estudios primarios en Medline y Cochrane Controlled Register of Trials durante el 2018. Se seleccionó la evidencia para responder cada una de las preguntas clínicas planteadas. La certeza de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). En reuniones de trabajo periódicas, el GEG usó la metodología GRADE para revisar la evidencia y formular las recomendaciones, los puntos de buenas prácticas clínicas y el flujograma de diagnóstico y tratamiento. Finalmente, la GPC fue aprobada con Resolución N° 128-IETSI-ESSALUD-2019. Resultados: la presente GPC abordó 8 preguntas clínicas, divididas en cuatro temas: tamizaje, diagnóstico, tratamiento, soporte y rehabilitación. En base a estas preguntas se formularon 28 recomendaciones (8 fuertes y 20 condicionales), 38 puntos de buena práctica clínica, 1 nota de implementación y 2 flujogramas. Conclusión: el presente artículo resume la metodología y las conclusiones basadas en evidencias de la GPC para el diagnóstico y tratamiento de la etapa aguda del ataque cerebrovascular isquémico en EsSalud.