Resumo A pesquisa tem por objetivo descrever o perfil sociodemográfico e de saúde dos profissionais de enfermagem no contexto da pandemia da COVID-19 e propõe uma análise reflexiva sobre a essencialidade da categoria frente às demandas intrínsecas dos pacientes e do sistema de saúde brasileiro, especialmente, no contexto da emergência de saúde pública deflagrada pelo avanço exponencial do vírus SARS-CoV-2. O estudo revela a relação entre as injustiças históricas e os diferentes tipos de desigualdade que afetam e causam a vulnerabilidade da profissão, com fulcro na apresentação de potenciais perspectivas decorrentes desse processo histórico e dos acontecimentos recentes.

Abstract The present study aims to describe the sociodemographic and health profile of nursing professionals in the context of the COVID-19 pandemic and propose a reflective analysis on the essentiality of the category facing the intrinsic demands of patients and the Brazilian health system, especially in the context of the public health emergency triggered by the exponential advance of the SARS-CoV-2 virus. This study reveals the relationship between historical injustices and the different types of inequality that impacted and caused the vulnerability of the profession, with an emphasis on the presentation of potential perspectives arising from this historical process and recent events.

Abstract The present study aims to describe the sociodemographic and health profile of nursing professionals in the context of the COVID-19 pandemic and propose a reflective analysis on the essentiality of the category facing the intrinsic demands of patients and the Brazilian health system, especially in the context of the public health emergency triggered by the exponential advance of the SARS-CoV-2 virus. This study reveals the relationship between historical injustices and the different types of inequality that impacted and caused the vulnerability of the profession, with an emphasis on the presentation of potential perspectives arising from this historical process and recent events.

Resumo A pesquisa tem por objetivo descrever o perfil sociodemográfico e de saúde dos profissionais de enfermagem no contexto da pandemia da COVID-19 e propõe uma análise reflexiva sobre a essencialidade da categoria frente às demandas intrínsecas dos pacientes e do sistema de saúde brasileiro, especialmente, no contexto da emergência de saúde pública deflagrada pelo avanço exponencial do vírus SARS-CoV-2. O estudo revela a relação entre as injustiças históricas e os diferentes tipos de desigualdade que afetam e causam a vulnerabilidade da profissão, com fulcro na apresentação de potenciais perspectivas decorrentes desse processo histórico e dos acontecimentos recentes.

Abstracto Introducción: En el 2008, el perfil de salud neurológico ecuatoriano presentaba importantes déficits, escasez de neurólogos e inaccesibilidad a residencias en neurología. Ese año una nueva constitución introdujo atención médica universal. Ninguna publicación ha analizado la capacidad de atención neurológica del Sistema de Salud Pública (SSP) del Ecuador. Un análisis actualizado del número de neurólogos y residencias neurológicas es necesario. Objetivo: Determinar el número de programas en neurología y si el SSP ecuatoriano cumple con el ratio ideal mínimo recomendado por la Organización Mundial de la Salud de 1 neurólogo por cada 100.000 habitantes. Métodos: Análisis transversal de datos hasta noviembre, 2022 del SSP y del Consejo de Educación Superior del Ecuador. Los ratio se calcularon acorde al Instituto Nacional de Estadística y Censos. Resultados: El SSP cuenta con noventa y cuatro neurólogos. Mayormente en Pichincha (37/39,4%) y Guayas (24/25,5%). Hay uno por provincia en cinco provincias; ninguno en ocho provincias. Dos provincias cumplieron el ratio ideal. Existen 0,54:100.000 neurólogos/habitantes y una residencia de neurología en Quito. Conclusión: El SSP ecuatoriano tiene escasez de neurólogos, incumpliendo el ratio ideal mínimo, y déficit de residencias en neurología. La descentralización de servicios neurológicos, soporte atención primaria, y financiamiento gubernamental para creación de residencias en neurología son necesidades urgentes.

Abstract Introduction: In 2008, Ecuador's neurologic healthcare profile displayed significant needs, a lack of neurologists, and neurology training accessibility. In that year, a new constitution introduced universal health care. No publication analyzes Ecuador's neurological Public Healthcare capacity. Hence, an up-to-date analysis of the number of neurologists and neurology training programs is required. Objective: Determine if Ecuador's public healthcare meets the minimum ideal ratio recommended by the World Health Organization of 1 neurologist per 100,000 population and the number of neurology training programs in Ecuador. Methods: Cross-sectional analysis of public data until November 2022 from Ecuador's Public Health System (PHS) and the Council of Higher Education. Ratios were calculated using the National Institute of Statistics and Censuses' information. Results: The public health network had ninety-four neurologists. Most found in Pichincha (37/39.4%) and Guayas (24/25.5%). There was one per province in five provinces. No neurologists were available in eight provinces. Two provinces met the ideal ratio. Ecuador’s ratio was 0.54:100,000 neurologists per population. One neurology training program was found in Quito. Conclusion: Ecuador's PHS has a shortage of neurologists, unfulfilling the minimum ideal ratio, and a severe lack of neurology training. Decentralizing neurological services, primary care support, and governmental funding for neurology training are an urgent need.

Abstract Non-timber forest products are transcendental for the well-being of rural households, rural and suburban communities, they provide them with priority goods and services for their subsistence. The present work tries to identify the use of non-timber forest resources for the elaboration of handicrafts in the community of Malinalco, State of Mexico; as well as register the habitat where the resources come from and the legal and economic framework for the use of said resources. Through the ethnographic method, the instrument for obtaining the information, which was a questionnaire, was carried out and validated. Key informants were obtained, and interviews were conducted. During five months through semi-structured interviews with three artisans and 17 artisans from the community, a list of 11 different crafts made and marketed in the Malinalco community was obtained. Forest diversity was 15 species, 19 genera and 12 families; of which 4 taxa were identified at the generic level. The most used species are Agave sp. Crescentia alata Kunth and Jacaranda mimosifolia D. Don. The most representative families were Bignoniaceae and Asparagaceae. 43.9% were tree species, and 22% climbers, obtained from the low deciduous forest (58.3%) or from home gardens (18.75%). Regarding the parts used, 46.34% correspond to fruits and 17.07% to seeds. The knowledge about the use of flora in the elaboration of handicrafts allowed us to know the importance of the low deciduous forest and family gardens to obtain resources for the elaboration and commercialization of handicrafts in the community of Malinalco, State of Mexico.

Resumen Los productos forestales no maderables son trascendentales para el bienestar de las unidades domésticas campesinas, de comunidades rurales y suburbanas, les aportan bienes y servicios prioritarios para su subsistencia. El presente trabajo pretende identificar el uso de los recursos forestales no maderables para la elaboración de artesanías en la comunidad de Malinalco, Estado de México; así como registrar el hábitat de donde provienen los recursos y el marco legal y económico para el uso de dichos recursos. Por medio del método etnográfico, se realizó y validó el instrumento de obtención de la información que fue un cuestionario. Se obtuvieron los informantes clave y se realizaron las entrevistas. Durante cinco meses mediante entrevistas semiestructuradas a 03 artesanas y 17 artesanos de la comunidad, se obtuvo un listado de 11 diferentes artesanías elaboradas y comercializadas en la comunidad de Malinalco. La diversidad forestal fue de 15 especies, 19 géneros y 12 familias; de los cuales 4 taxa se identificaron a nivel genérico. Las especies más utilizados son; Agave sp., Crescentia alata Kunth y Jacaranda mimosifolia D. Don. Las familias con mayor representatividad fueron Bignoniaceae y Asparagaceae. El 52.63% fueron especies arbóreas, y el 42.10% herbáceas, obtenidas de la selva baja caducifolia (58.3%) o de huertos familiares (18.75%). Respecto a las partes utilizadas el 46.34% corresponde a frutos y el 17.07% a semillas. El conocimiento sobre el aprovechamiento de la flora en la elaboración de artesanías permitió conocer la importancia de la selva baja caducifolia y de los huertos familiares para la obtención de recursos para la elaboración y comercialización de artesanías en la comunidad de Malinalco, Estado de México.

RESUMO Objetivo: identificar ocorrência de surto compatível com escorbuto e fatores de exposição associados aos sinais/sintomas típicos de hipovitaminose, em penitenciária masculina, Ceará, Brasil, 2019-2020. Métodos: estudo de caso-controle populacional; foram utilizados registros clínicos e entrevistas com casos compatíveis - sinais/sintomas iniciados no período - e com controles; realizou-se análise multivariável. Resultados: 62 casos; idade média de 40,6 anos (DP = 10,8); principais sinais/sintomas foram edema e dor em membros inferiores (100,0%), dificuldade para deambular (91,9%), hematoma/equimose em membros inferiores (90,3%), febre (88,7%); identificou-se, como fator de exposição, média de idade > 40 anos (ORa = 1,10; IC95% 1,05;1,17; p-valor = 0,001); e como fatores protetores, trabalho (ORa = 0,11; IC95% 0,03;0,36; p-valor < 0,001) e participação em aulas (ORa = 0,21; IC95% 0,08;0,59; p-valor = 0,003) dentro da penitenciária. Conclusão: surto da penitenciária compatível com escorbuto pelos sinais/sintomas característicos, associados aos fatores identificados; recomendou-se oferta regular de dieta rica em vitamina C para todos os internos e acompanhamento clínico dos casos.

RESUMEN Objetivo: identificar la ocurrencia del brote compatible con escorbuto y los factores de exposición asociados con signos/síntomas típicos de hipovitaminosis que ocurrieron en una penitenciaría masculina en Ceará, Brasil entre 2019-2020. Métodos: estudio poblacional de casos y controles; se utilizaron historias clínicas y entrevistas con casos compatibles, con inicio de signos/síntomas durante el período de estudio, y controles; se realizó análisis multivariable. Resultados: de los 62 casos, edad media fue 40,6 años (DE = 10,8); principales signos/síntomas fueron edema y dolor en miembros inferiores (100,0%), dificultad para caminar (91,9%), hematoma/equimosis en miembros inferiores (90,3%) y fiebre (88,7%); la edad mayor de 40 años se identificó como factor asociado (ORa = 1,10; IC95% 1,05;1,17; p-valor = 0,001); y como factores protectores: trabajo (ORa = 0,11; IC95% 0,03;0,36; p-valor < 0,001) y participación en clases (ORa = 0,21; IC95% 0,08;0,59; p-valor = 0,003) dentro del centro penitenciario. Conclusión: el brote en centro penitenciario fue considerado compatible con escorbuto debido a los signos/síntomas característicos, asociados a los factores identificados; se recomendó oferta regular de dieta rica en vitamina C a todos los internos y seguimiento clínico de los casos.

ABSTRACT Objective: to identify the occurrence of an outbreak compatible with scurvy and exposure factors associated with typical signs/symptoms of hypovitaminosis that occurred in a male penitentiary in Ceará, Brazil between 2019-2020. Methods: this was a population-based case-control study; we used clinical records and interviews with compatible cases - based on sign/symptom onset during the study period - and with controls; we carried out multivariate analysis. Results: out of 62 cases, mean age was 40.6 years (SD = 10.8); main signs/symptoms were edema and pain in the lower limbs (100.0%), difficulty in walking (91.9%), hematoma/ecchymosis in the lower limbs (90.3%) and fever (88.7%); we identified being over 40 years old as an associated factor (aOR = 1.10; 95%CI 1.05;1.17; p-value = 0.001); and as protective factors: working (aOR = 0.11; 95%CI 0.03;0.36; p-value < 0.001) and taking part in classes (aOR = 0.21; 95%CI 0.08;0.59; p-value = 0.003) in the prison. Conclusion: we considered the penitentiary outbreak to be compatible with scurvy due to characteristic signs/symptoms, associated with the identified factors; we recommended regular provision of a diet rich in vitamin C to all male inmates and clinical follow-up of cases.

BACKGROUND: An integrated primary health care approach, where primary care and public health efforts are coordinated, is a key feature of routine immunisation campaigns AIM: The aim of the study is to describe the approach used by a diverse group of international primary health care professionals in delivering their coronavirus disease 2019 (COVID-19) vaccination programmes, as well as their perspectives on public health and primary care integration while implementing national COVID-19 vaccination programmes in their own jurisdictions SETTING: This is a protocol for a study, which consists of a cross-sectional online survey disseminated among a convenience sample of international primary health care professional through member-based organisations and professional networks via email and online newsletters METHODS: Survey development followed an iterative validation process with a formative committee developing the survey instrument based on study objectives, existing literature and best practices and a summative committee verifying and validating content RESULTS: Main outcome measures are vaccination implementation approach (planning, coordination service deliver), level or type of primary care involvement and degree of primary care and public health integration at community level CONCLUSION: Integrated health systems can lead to a greater impact in the rollout of the COVID-19 vaccine and can ensure that we are better prepared for crises that threaten human health, not only limited to infectious pandemics but also the rising tide of chronic disease, natural and conflict-driven disasters and climate change CONTRIBUTION: This study will provide insight and key learnings for improving vaccination efforts for COVID-19 and possible future pandemics

ABSTRACT The objective of this study was to evaluate the potential of improving the economic value of integrated crop-livestock systems (ICLS) compared to conventional systems specialized in monoculture. The experimental area was 16.02 ha, divided into 18 paddocks of 0.89 ha each, organized in a randomized block design, with three replicates and six models of production systems: crop system [corn ( Zea mays ) grain production], livestock system (beef cattle under grazing conditions), and four ICLS, identified as: ICLS-1, corn integrated with Marandu palisadegrass [ Urochloa brizantha (Hoechst. ex A. Rich.) R.D. Webster cv. Marandu (syn. Brachiaria brizantha cv. Marandu] sown simultaneously without herbicide; ICLS-2, corn and Marandu palisadegrass sown simultaneously with herbicide; ICLS-3, corn and Marandu palisadegrass with lagged sowing; and ICLS-4, corn and Marandu palisadegrass sown simultaneously, with herbicide in rows and between-rows of corn. We demonstrated the economic impact analysis combined with the risk optimization and discounted cash flow techniques based on Monte Carlo simulation, considering price and productivity uncertainties. The indicators of added value and return on investment of ICLS had an economic advantage compared with conventional systems. It was also found that ICLS needed a smaller operational area than conventional systems for the economic break-even point. Integrated systems provide lower financial and operational risk levels and greater economic value per hectare compared with conventional systems specialized in monoculture.

Abstract This study aimed to evaluate the effect of including soy lecithin emulsifier (SL) in broiler diets with reduced metabolizable energy levels and to correlate it with nutrient metabolizability coefficients, as well as to determine apparent metabolizable energy (AME). Two metabolic trials were conducted in a completely randomized design with a 3x2 factorial arrangement (diet with three levels of metabolizable energy, with or without the inclusion of emulsifier), totaling six treatments. In the starter phase, chicks received diets with 2,950, 3,050, and 3,150 kcal/kg of metabolizable energy, with six replications of 10 birds each, totaling 360 birds. In the grower phase, the energy levels of 3,100, 3,150, and 3,200 kcal/kg of feed were tested in 210 birds were used in seven replications of five chicks each. An interaction effect was observed in the starter phase, with the nitrogen metabolizability coefficient increasing when the emulsifier was added to diets with reduced energy. Additionally, emulsifier inclusion increased nitrogen-corrected AME (AMEn). An interaction effect was also present in the grower phase, with AME and AMEn increasing when the emulsifier was added to diets with lower energy levels. In summary, emulsifier inclusion in broiler diets can reduce metabolizable energy while improving AMEn in both the starter and grower phases, as well as AME in growing broilers.

Resumo Objetivou-se avaliar a adição do emulsificante, lecitina de soja, nas rações de frangos com redução dos níveis de energia metabolizável e correlacioná-las com os coeficientes de metabolizabilidade de nutrientes, além da determinação da energia metabolizável aparente (EMA). Realizou-se dois ensaios metabólicos em delineamento inteiramente casualizados, esquema fatorial 3x2 (ração com três níveis de energia metabolizável, com ou sem a inclusão do emulsificante na dieta), totalizando seis tratamentos. Na fase inicial, os pintos receberam dieta com 2.950, 3.050 e 3.150 kcal/kg de energia metabolizável, com seis repetições com 10 aves, totalizando 360 aves. Na fase de crescimento foram utilizadas 210 aves, sendo sete repetições com cinco frangos e os níveis de energia testados foram: 3.100, 3.150 e 3.200 kcal/kg de ração. Na fase inicial, observou-se efeito de interação, apresentando aumento do coeficiente de metabolizabilidade do nitrogênio (CMN) ao adicionar o emulsificante em dietas com energia reduzida e também, efeito do emulsificante no aumento da energia metabolizável aparente corrigida pelo balanço do nitrogênio (EMAn). Na fase de crescimento, observou-se efeito de interação, apresentando aumento da EMA e EMAn ao adicionar o emulsificante em dietas com menores níveis de energia. Conclui-se que a inclusão do emulsificante é indicada para frangos de corte, pois permite reduzir a energia metabolizável da dieta, melhorando a EMAn nas fases inicial e de crescimento, bem como a da EMA com frangos em crescimento.

ABSTRACT Objective: to identify the occurrence of an outbreak compatible with scurvy and exposure factors associated with typical signs/symptoms of hypovitaminosis that occurred in a male penitentiary in Ceará, Brazil between 2019-2020. Methods: this was a population-based case-control study; we used clinical records and interviews with compatible cases - based on sign/symptom onset during the study period - and with controls; we carried out multivariate analysis. Results: out of 62 cases, mean age was 40.6 years (SD = 10.8); main signs/symptoms were edema and pain in the lower limbs (100.0%), difficulty in walking (91.9%), hematoma/ecchymosis in the lower limbs (90.3%) and fever (88.7%); we identified being over 40 years old as an associated factor (aOR = 1.10; 95%CI 1.05;1.17; p-value = 0.001); and as protective factors: working (aOR = 0.11; 95%CI 0.03;0.36; p-value < 0.001) and taking part in classes (aOR = 0.21; 95%CI 0.08;0.59; p-value = 0.003) in the prison. Conclusion: we considered the penitentiary outbreak to be compatible with scurvy due to characteristic signs/symptoms, associated with the identified factors; we recommended regular provision of a diet rich in vitamin C to all male inmates and clinical follow-up of cases.

RESUMEN Objetivo: identificar la ocurrencia del brote compatible con escorbuto y los factores de exposición asociados con signos/síntomas típicos de hipovitaminosis que ocurrieron en una penitenciaría masculina en Ceará, Brasil entre 2019-2020. Métodos: estudio poblacional de casos y controles; se utilizaron historias clínicas y entrevistas con casos compatibles, con inicio de signos/síntomas durante el período de estudio, y controles; se realizó análisis multivariable. Resultados: de los 62 casos, edad media fue 40,6 años (DE = 10,8); principales signos/síntomas fueron edema y dolor en miembros inferiores (100,0%), dificultad para caminar (91,9%), hematoma/equimosis en miembros inferiores (90,3%) y fiebre (88,7%); la edad mayor de 40 años se identificó como factor asociado (ORa = 1,10; IC95% 1,05;1,17; p-valor = 0,001); y como factores protectores: trabajo (ORa = 0,11; IC95% 0,03;0,36; p-valor < 0,001) y participación en clases (ORa = 0,21; IC95% 0,08;0,59; p-valor = 0,003) dentro del centro penitenciario. Conclusión: el brote en centro penitenciario fue considerado compatible con escorbuto debido a los signos/síntomas característicos, asociados a los factores identificados; se recomendó oferta regular de dieta rica en vitamina C a todos los internos y seguimiento clínico de los casos.

RESUMO Objetivo: identificar ocorrência de surto compatível com escorbuto e fatores de exposição associados aos sinais/sintomas típicos de hipovitaminose, em penitenciária masculina, Ceará, Brasil, 2019-2020. Métodos: estudo de caso-controle populacional; foram utilizados registros clínicos e entrevistas com casos compatíveis - sinais/sintomas iniciados no período - e com controles; realizou-se análise multivariável. Resultados: 62 casos; idade média de 40,6 anos (DP = 10,8); principais sinais/sintomas foram edema e dor em membros inferiores (100,0%), dificuldade para deambular (91,9%), hematoma/equimose em membros inferiores (90,3%), febre (88,7%); identificou-se, como fator de exposição, média de idade > 40 anos (ORa = 1,10; IC95% 1,05;1,17; p-valor = 0,001); e como fatores protetores, trabalho (ORa = 0,11; IC95% 0,03;0,36; p-valor < 0,001) e participação em aulas (ORa = 0,21; IC95% 0,08;0,59; p-valor = 0,003) dentro da penitenciária. Conclusão: surto da penitenciária compatível com escorbuto pelos sinais/sintomas característicos, associados aos fatores identificados; recomendou-se oferta regular de dieta rica em vitamina C para todos os internos e acompanhamento clínico dos casos.

Abstract A 100-year-old male patient was admitted with a ruptured abdominal aortic aneurysm due to type IA endoleak. Given the proximity of the ruptured site to the superior mesenteric artery (SMA) and renal arteries, a ChEVAR was indicated. Catheterization of the target visceral vessels was a challenging procedural step because of an intensely tortuous thoracic aorta. This hostile aortic anatomy also inhibited exchange for a super stiff guide-wire and selective cannulation with the diagnostic catheter was repeatedly lost when guidewire exchange was attempted. To overcome this issue, a 5 x 40 mm balloon catheter was placed 3cm into the target arteries. The balloon was then inflated below the nominal pressure limit enabling safe exchange for a super stiff guidewire and placement of three 90-cm long 7Fr guiding sheaths. The procedure was thus safely performed with deployment of an aortic extension and the bridging stents.

Resumo Um paciente de 100 anos foi diagnosticado com um aneurisma de aorta abdominal roto por um endoleak 1A. Pela proximidade do ponto de ruptura com a artéria mesentérica superior (AMS) e as artérias renais, um ChEVAR foi indicado. A cateterização das artérias-alvo foi um passo desafiador pela intensa tortuosidade da aorta torácica. Essa anatomia aórtica hostil também impediu a troca por um fio-guia extra-rígido, e a cateterização seletiva foi repetidamente perdida quando a troca de fio-guia foi tentada. Para superar essa dificuldade, um cateter balão 5mm x 40mm foi posicionado nas artérias-alvo. O balão foi, então, insuflado abaixo da pressão nominal, permitindo uma troca segura do fio-guia por um fio-guia extra-rígido e o posicionamento de três bainhas longas 7Frx 90cm. Assim, o procedimento foi executado de forma segura, com o implante de uma extensão aórtica e dos stents recobertos.

Abstract Impediment to local anesthetic solution in the epidural space results in unsatisfactory pain relief during labor epidural. Patients with a history of back trauma and spinal instrumentation have increased rates of epidural failure due to patchy spread of local anesthetic with obliterated epidural space. Dual Epidural Catheters (DEC) can be used in such clinical scenarios with complete labor analgesia and improved patient satisfaction. We present the successful management of a parturient with vertebral fracture at risk for epidural failure and neurologic injury due to bone fragments and inserted cranial and caudal to the fractured vertebra using ultrasound to avoid neurologic sequelae. DEC (DEC satisfaction sequelae

RESUMEN La materia prima del fitomejoramiento es la variabilidad genética, que se presenta baja, en especies en proceso de domesticación, que no han sido sometidas a selección, como en Solanum betaceum. Una de las tecnologías para incrementar la variabilidad genética es la inducción de mutagénesis. El objetivo del estudio fue evaluar, a través de marcadores RAMs, las variaciones moleculares presentes en plántulas de S. betaceum, provenientes de semillas sometidas a diferentes concentraciones del agente mutante dietil sulfato (DES). Los loci polimórficos oscilaron entre 87,5 y 100 % y el número de alelos efectivos (Ne), entre 1,0 y 1,99. Los loci más polimórficos se observaron en TG, AG, ACA y CGA, que mostraron una heterosis media insesgada entre 0,34 y 0,51, que permite establecer que estos marcadores sean útiles para obtener mayor discriminación entre mutantes en S. betaceum. Las distancias genéticas oscilaron entre 0,30 y 1,0. El 81,28 % de estos registros se dieron entre 0,60 y 0,90; esto revela bajo nivel de cambios, debido al DES. Estos pequeños cambios contribuyeron a enriquecer la variabilidad genética de la muestra tratada con DES. Los marcadores RAMs fueron útiles para detectar cambios entre plantas provenientes de semillas tratadas con DES y plantas normales. La variabilidad genética entre tratamientos con DES fueron más altos que tratamientos sin DES. Las similitudes genéticas fueron bajas entre plantas tratadas y no tratadas y fueron altas, entre no tratadas. Los cambios producidos por DES fueron de baja magnitud; sin embargo, produjeron cambios en los niveles de variabilidad genética.

ABSTRACT The raw material for plant breeding is genetic variability, which is low in species in the process of domestication that have not been subjected to selection, as is the case with Solanum betaceum. One of the technologies to increase genetic variability is mutagenesis induction. The objective was to evaluate, through RAMs markers, the molecular variations present in S. betaceum seedlings from seeds previously subjected to different concentrations of the mutant agent diethyl sulfate (DES). The polymorphic loci ranged from 87.5 to 100%, number of effective alleles (Ne) between 1.0 and 1.99. The most polymorphic loci were observed in TG, AG, ACA, and CGA, which showed a mean unbiased heterosis between 0.34 and 0.51 with an average of 0.44, which allows establishing that these markers are useful to obtain greater discrimination between mutants in S. betaceum. Genetic distances ranged from 0.30 to 1.0. The 81.28% of these records were between 0.60 and 0.90. This reveals a low level of changes due to DES. These small changes contribute to enriching the genetic variability of the DES-treated sample. The RAMs markers were useful for detecting changes between plants from DES treated seeds and normal plants. Genetic variability between DES treatments was higher than non-DES treatments. Genetic similarities were low between treated and untreated plants and were high among untreated plants. The changes produced by DES were of low magnitude, however, they produced changes in the levels of genetic variability.

RESUMO O hamartoma combinado de retina e epitélio pigmentar da retina consiste em um tumor intraocular raro com comportamento benigno. O hamartoma combinado de retina e epitélio pigmentar da retina foi descrito na literatura apresentando dano retiniano variável, desde o envolvimento epirretiniano parcial até distorção completa das camadas retinianas e do epitélio pigmentar da retina. Relatamos o caso de uma menina de 8 anos com estrabismo de longa data que foi diagnosticada com hamartoma combinado de retina e epitélio pigmentar da retina, com base na avaliação de imagem multimodal. Exploramos os achados de imagem específicos de estudos usando tomografia de coerência óptica de domínio espectral, autofluorescência, angiografia por tomografia de coerência óptica e angiografia fluorescente.

ABSTRACT Combined hamartoma of the retina and retinal pigment epithelium is a rare, benign intraocular tumor. Hamartoma of the retina and retinal pigment epithelium has been described in the literature as a condition presenting with variable retinal damage, ranging from partial epiretinal involvement to complete distortion of the retinal layers and retinal pigment epithelium. We report the case of an 8-year-old girl presenting with longstanding strabismus who was diagnosed with Hamartoma of the retina and retinal pigment epithelium based on multimodal imaging assessment. We explored the particular imaging findings from studies using spectral-domain optical coherence tomography, fundus autofluorescence, optical coherence tomography angiography, and fluorescein angiography.

RESUMEN Introducción: El presente artículo resume la guía de práctica clínica (GPC) para la prevención, diagnóstico y manejo de infecciones asociadas al acceso de hemodiálisis en el Seguro Social del Perú (EsSalud). Objetivo: Proveer recomendaciones clínicas basadas en evidencia para la prevención, diagnóstico y tratamiento de infecciones asociadas al acceso de hemodiálisis en EsSalud. Metodología: Se conformó un grupo elaborador de la guía (GEG) que incluyó especialistas y metodólogos. El GEG formuló 7 preguntas clínicas. Se realizó búsquedas sistemáticas de revisiones sistemáticas y estudios primarios en PubMed y CENTRAL de Cochrane entre noviembre del 2019 y marzo del 2020. Se seleccionó la evidencia para responder a las preguntas clínicas planteadas. La certeza de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). El GEG usó la metodología GRADE para revisar la evidencia y formular recomendaciones, los puntos de buena práctica clínica y el flujograma de tratamiento. Finalmente, la GPC fue aprobada con Resolución N° 116-IETSI-ESSALUD-2020. Resultados: La presente GPC abordó 7 preguntas clínicas, divididas en tres temas: tamizaje, diagnóstico, estadiaje y tratamiento. En base a estas preguntas se formularon 12 recomendaciones (11 fuertes y 1 condicional), 33 puntos de buena práctica clínica y 2 flujogramas de manejo. Conclusión: El presente artículo resume la metodología y las conclusiones basadas en evidencias de la GPC para la prevención, diagnóstico y tratamiento de infecciones asociadas al acceso de hemodiálisis en EsSalud.

ABSTRACT Introduction: This article summarizes the clinical practice guidelines (CPG) for the prevention, diagnosis and management of infections associated with hemodialysis access of the Peruvian Health Social Security (EsSalud). Objective: To provide clinical recommendations based on evidence for the prevention, diagnosis and management of infections associated with hemodialysis access in EsSalud. Methods: A guideline development group (GDG) was established, including medical specialists and methodologists. The GDG formulated 7 clinical questions to be answered in this CPG. Systematic searches of systematic reviews and primary studies (when pertinent) were conducted in PubMed, and CENTRAL (Cochrane) from November 2019 to March 2020. The evidence was selected to answer each of the clinical questions. The accuracy of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work meetings, the GEG used the GRADE methodology to review the evidence and formulate the recommendations, the points of good clinical practice and the treatment flowchart. Finally, the CPG was approved with Resolution No. 116-IETSI-ESSALUD-2020. Results: The present CPG addressed 7 clinical questions of four topics: prevention, diagnosis and treatment. Based on these questions, 12 recommendations (11 strong recommendations and 1 weak recommendation), 33 points of good clinical practice, and 2 flowcharts were formulated. Conclusion: This paper summarizes the methodology and evidence-based conclusions from the CPG for the prevention, diagnosis and management of infections associated with hemodialysis access of EsSalud.

Resumen: Antecedentes y Objetivos: En un experimento de restauración iniciado en 2006 en un pastizal inducido, dentro de un paisaje dominado por selva tropical lluviosa en Los Tuxtlas, Veracruz, se establecieron 24 parcelas cercadas, con tres tratamientos de restauración. Nuestro objetivo fue determinar, mediante fototrampeo, cuáles especies de mamíferos terrestres medianos o grandes (≥1 kg de peso) y con qué frecuencia visitaban las parcelas, a 12 años de iniciado el experimento. Métodos: Se utilizaron cámaras-trampa, en 18 de las 24 parcelas. Se hicieron dos muestreos, uno en el periodo lluvioso de 2018 y otro en el seco de 2019. Se determinó el número de especies y de registros fotográficos independientes para cada una, en cada tratamiento (parcelas excluidas del forrajeo del ganado: a) sin adición de plantas -sucesión natural-; con plantación de árboles, b) dispersados por viento y c) dispersados por animales) y temporada de muestreo. Resultados clave: El esfuerzo total de muestreo fue de 290 días/cámara-trampa. En el periodo lluvioso se obtuvieron 12 fotografías y cuatro vídeos de tlacuache (Didelphis spp.), armadillo (Dasypus novemcinctus) y guaqueque mexicano (Dasyprocta mexicana). En la época seca se registró al armadillo en 10 fotografías y cinco vídeos. Hubo pocos registros de mamíferos medianos, en comparación con fototrampeos en la selva conservada de la zona, y en solo siete de las 18 parcelas muestreadas. En general, hubo más registros en parcelas con cualquier tipo de plantación que en las de sucesión natural y esto fue más evidente en la época de lluvias. Conclusiones: La respuesta de los mamíferos medianos terrestres a la restauración parece ser más lenta que la registrada para otros grupos faunísticos (p. ej., murciélagos). Para evaluar la recuperación de la funcionalidad ecológica que incluye los roles ecológicos que desempeñan los mamíferos medianos en este experimento, se debe continuar y ampliar el esfuerzo de monitoreo.

Abstract: Background and Aims: In an experiment initiated in 2006 in an induced pasture, within a landscape dominated by tropical rainforest, in Los Tuxtlas, Veracruz, 24 fenced plots with three restoration treatments were established. Our objective was to determine with camera trapping, which species of medium or large terrestrial mammals (≥1 kg in weight), and with what frequency, visited the plots 12 years after the establishment of the experiment. Methods: Camera traps were used in 18 of the 24 plots. Two censuses were carried out, one in the rainy season of 2018 and the other in the dry season of 2019. The number of species and the independent photographic records of each one were determined for each treatment (plots excluded from cattle: a) with no addition of plants -natural succession-; with tree plantations, b) dispersed by wind, and c) dispersed by animals) and each sampling season. Key results: The total sampling effort was 290 camera trap days. For the rainy season, 12 photographs and four videos of opossum (Didelphis spp.), nine-banded armadillo (Dasypus novemcinctus) and Mexican agouti (Dasyprocta mexicana) were obtained. For the dry season, the armadillo was recorded in 10 photographs and five videos. There were few records of medium-sized mammals, compared to photo trapping in conserved forest in the area and only in seven of the 18 sampled plots. Overall, there were more records in plantations than in natural succession, and this was more evident in the rainy season. Conclusions: The response of medium-sized terrestrial mammals to restoration seems to be slower than recorded for other faunal groups (e.g., bats). To assess the recovery of ecological functionality that includes the ecological roles played by medium-sized mammals in this experiment, monitoring effort should be continued and expanded.