RESUMEN Introducción: La sífilis en embarazadas, sigue siendo un gran problema de salud pública en todo el mundo, y en Paraguay, no es la excepción. La sífilis congénita puede provocar abortos, muertes fetales y neonatales, peso bajo al nacer, prematuridad y otras anomalías congénitas, el conocimiento general de la población en edad fértil es fundamental. Objetivo: Analizar los conocimientos y prácticas sobre sífilis materna y sífilis congénita en adolescentes embarazadas en un Hospital General de Paraguay. Metodología: Se realizó un estudio cualitativo, fenomenológico descriptivo. Para la recolección de datos se utilizó la entrevista, simple que fue grabada con previa autorización del participante, la conclusión y recomendación serán entregados a la institución y a las adolescentes embarazadas. Resultados: Participaron diez adolescentes, en su mayoría de 19 años de edad, cinco conocen que la sífilis se transmite a través de las relaciones sexuales, sin embargo, desconocen acerca de cómo se transmite la sífilis congénita. Cinco de las adolescentes menciona haber iniciado las relaciones sexuales a los 16 años. Dos adolescentes a los 15 años, dos a los 14 años y una a los 17 años, nueve de las adolescentes embarazadas mencionan acudir a sus controles prenatales de forma periódica. Dos aún no se han realizado el test de VDRL. Discusión: Se concluye en cuanto al conocimiento, que solo cinco de diez adolescentes conocen acerca de la sífilis, sin embargo, no conocen sobre la sífilis congénita. En cuanto a las prácticas preventivas, 10 acuden de forma periódica a sus controles prenatales.

ABSTRACT Introduction: Syphilis in pregnant women continues to be a major public health problem throughout the world, and in Paraguay, it is no exception. Congenital syphilis can cause abortions, fetal and neonatal deaths, low birth weight, prematurity, and other congenital anomalies; general knowledge of the population of childbearing age is essential. Objective: To analyze the knowledge and practices about maternal syphilis and congenital syphilis in pregnant adolescents in a General Hospital in Paraguay. Methodology: A qualitative, descriptive phenomenological study was carried out. A simple interview was used to collect data, which was recorded with prior authorization from the participant. The conclusion and recommendation will be delivered to the institution and to the pregnant adolescents. Results: Ten adolescents participated, mostly 19 years of age, five know that syphilis is transmitted through sexual relations, however, they do not know how congenital syphilis is transmitted. Five of the adolescent’s mention having started sexual relations at the age of 16. Two adolescents at 15 years old, two at 14 years old and one at 17 years old, nine of the pregnant adolescent’s mention attending their prenatal check-ups periodically. Two have not yet been tested for VDRL. Discussion: It is concluded in terms of knowledge that only five out of ten adolescents know about syphilis; however, they do not know about congenital syphilis. Regarding preventive practices, 10 attend their prenatal check-ups periodically.

ABSTRACT Wind energy is an important renewable source that has been considerably developed recently. In order to obtain successful 24-h lead-time wind power forecasts for operational and commercial uses, a combination of physical and statistical models is desirable. In this paper, a hybrid methodology that employs a numerical weather prediction model (Weather Research and Forecasting) and a neural network (NN) algorithm is proposed and assessed. The methodology is applied to a wind farm in northwestern Mexico, a region with high wind potential where complex geography adds large uncertainty to wind energy forecasts. The energy forecasts are then evaluated against actual on-site power generation over one year and compared with two reference models: decision trees (DT) and support vector regression (SVR). The proposed method exhibits a better performance with respect to the reference methods, showing an hourly normalized mean absolute percentage error of 6.97%, which represents 6 and 13 percentage points less error in wind power forecasts than with DT and SVR methods, respectively. Under strong synoptic forcing, the NN wind power forecast is not very accurate, and novel approaches such as hierarchical algorithms should be employed instead. Overall, the proposed model is capable of producing high-quality wind power forecasts for most weather conditions prevailing in this region and demonstrates a good performance with respect to similar models for medium-term wind power forecasts.

RESUMEN La energía eólica es una importante fuente de energía renovable que se ha desarrollado considerablemente en los últimos años. Con el fin de obtener pronósticos de energía eólica de alta precisión con 24 horas de anticipación para usos operativos y comerciales, se necesita una combinación de modelos físicos y estadísticos. En este artículo se propone y evalúa una metodología híbrida que emplea un modelo numérico (Weather Research and Forecasting) y un algoritmo de red neuronal (NN). La metodología se aplica a un parque eólico en el noroeste de México, una región con alto potencial eólico donde la compleja geografía agrega gran incertidumbre a los pronósticos de energía eólica. Los pronósticos de energía se evalúan usando la generación de energía real en el sitio de interés durante un año y se comparan con dos modelos de referencia: árboles de decisión (DT, por su sigla en inglés) y regresión de vectores de soporte (SVR). El método propuesto muestra un mejor desempeño respecto a los métodos de referencia, mostrando un error absoluto medio porcentual horario de 6.97%, lo que representa 6 y 13 puntos porcentuales menos de error en los pronósticos de energía eólica que con los métodos DT y SVR, respectivamente. El pronóstico de energía eólica NN no es muy preciso cuando tiene un fuerte forzamiento sinóptico, por lo que en su lugar deben emplearse enfoques novedosos como los algoritmos jerárquicos. En general, el modelo propuesto tiene la capacidad de producir pronósticos de energía eólica de alta calidad para la mayoría de las condiciones climáticas que prevalecen en esta región, y de- muestra un buen desempeño respecto a modelos similares para pronósticos de energía eólica a mediano plazo.

ABSTRACT BACKGROUND: Ankle taping (AT) is effective in preventing ankle sprain injuries in most common sports and is employed in rehabilitation and prevention sports. OBJECTIVE: This study aimed to investigate the effectiveness of AT to restricting excessive frontal plane ankle movements in semi-professional basketball players throughout the training session. DESIGN AND SETTING: A cross-sectional study was performed at the Universidad Europea de Madrid. METHODS: Forty male and female semi-professional basketball players were divided into two groups. The ankle dorsiflexion range of motion (ROM) and interlimb asymmetries in a weight-bearing lunge position were evaluated at four time points: 1) with no tape, 2) before practice, at 30 min of practice, and 3) immediately after practice. RESULTS: In male basketball players, no differences were observed in the right and left ankles between the baseline and 30 min and between baseline and 90 min of assessment. In female athletes, significant differences were reported between baseline and pre-training assessments for the right ankle and also significant differences between baseline and 90 min in both ankles. CONCLUSIONS: Ankle taping effectively decreased the ankle dorsiflexion ROM in male and female basketball players immediately after application. However, ROM restriction was very low after 30 and 90 min, as assessed in a single basketball practice. Therefore, the classic taping method should be revised to develop new prophylactic approaches, such as the implementation of semi-rigid bracing techniques or the addition of active stripes during training or game pauses.

ABSTRACT BACKGROUND: Current research supports the fact that prophylactic ankle taping (AT) is effective in preventing ankle injuries in amateur and elite sports athletes. OBJECTIVE: This study aimed to investigate the effect of AT on balance, knee valgus during drop jump and single-leg countermovement jump (SL-CMJ) landings, and ankle range of motion (ROM) restriction in healthy participants. DESIGN AND SETTING: A cross-sectional observational study was conducted at the Universidad Europea de Madrid, Madrid, Spain. METHODS: Participants: Thirty-nine healthy individuals participated in this study and performed the movements under two conditions (with and without tape). Outcome measurements: ankle ROM, balance, SL-CMJ height, flight time, ground time, and knee valgus. Before any intervention, a random process was developed with a 1:1 allocation ratio, and the participants were assigned to groups A (tape-no tape) and B (no tape-tape). RESULTS: Significant differences between tape and no-tape moments were observed for drop jump knee valgus flexion (P = 0.007), with an increase in knee valgus in participants with ankle taping. Similarly, the Y-balance testshowed a significant decrease in all variables (P = 0.001 and), ankle dorsiflexion (P = 0.001) in participants with ankle taping. CONCLUSIONS: AT is effective for immediate ankle ROM restriction. However, an increase in knee valgus during drop jump task and a decrease in lower limb balance were observed during drop jump task. Based on these results, it can be concluded that AT application in healthy individuals should not be recommended as it results in increase in injury risk factors.

Abstract Reinforced concrete structures, when subjected to fire, have their mechanical resistance reduced related to the behavioral change of the material. Many experimental and numerical research on the behavior of concrete exposed to fire have been carried out on beams and columns, with slabs being studied less frequently, mainly due to its size and consequently higher research costs. This paper carried out a numerical analysis of the thermomechanical behavior of reinforced concrete slabs exposed to fire, using finite element modeling. The parametric analysis carried out changing the aggregate type of concrete showed that when exposed to ISO834 fire curve, the displacement in the center of slab with siliceous aggregate was 47% higher than the slab with calcareous aggregate. Analyzing the crack opening, for slabs exposed to ISO834 fire curve, the first 1mm-cracks were noticed at 18min when using calcareous aggregate, while the slabs with siliceous aggregate started at 13min.

Resumo Estruturas de concreto armado, quando submetidas ao fogo, têm sua resistência mecânica reduzida em função da mudança de comportamento do material. Muitas pesquisas experimentais e numéricas sobre o comportamento do concreto exposto ao fogo têm sido realizadas em vigas e pilares, sendo as lajes menos estudadas, principalmente devido à sua dimensão e consequentemente maiores custos de ensaio. Este artigo realizou uma análise numérica do comportamento termomecânico de lajes de concreto armado expostas ao fogo, utilizando modelagem por elementos finitos. A análise paramétrica realizada alterando o tipo de agregado do concreto mostrou que, quando exposta à curva de incêndio ISO834, o deslocamento no centro da laje com agregado silicioso foi 47% maior do que a laje com agregado calcário. Analisando a abertura de fissuras, para as lajes expostas à curva de incêndio ISO834, as primeiras fissuras de 1mm foram notadas aos 18min quando se utilizou agregado calcário, enquanto as lajes com agregado silicioso iniciaram aos 13min.

Due to its multiple applications, zinc oxide (ZnO) is one of the most used materials in science and technology. Therefore, this research carried out the synthesis of ZnO and Pt-ZnO nanoparticles (NPs) by the direct precipitation method, which is characterized by being simple and reproducible, using two different precipitating agents, potassium hydroxide (KOH) and sodium hydroxide (NaOH); for the doping of Pt-ZnO NPs was used platinum acetylacetone. To evaluate the effect of the precipitating agent on the properties of each doped material, they were characterized by Fourier transform infrared spectroscopy, where the Zn-O vibrations were more pronounced using KOH. X-ray diffraction analysis shows a hexagonal structure (wurtzite) formation for ZnO with NaOH, obtaining a smaller crystal size than the other synthesized materials. Scanning electron microscopy analysis showed hexagonal and hemispherical shapes for ZnO (with NaOH and KOH) and Pt-ZnO (with NaOH), respectively; also, cylindrical shapes were obtained for Pt-ZnO (with KOH). The highest band gap obtained was for the Pt-ZnO material synthesized with KOH.

Resumen Introducción: Las diferentes vertientes que puede tomar el estudio de la actividad artesanal y su relación con el medio natural han representado un importante reto debido a la diversidad de pensamientos expresados, lo que conlleva un esfuerzo heurístico para identificar elementos explicativos que tuviesen puntos de encuentro suficientes y permitieran establecer una clasificación pertinente. Objetivo: La investigación tuvo como objetivo documentar las orientaciones temáticas que enmarcan los estudios ambientales de la actividad artesanal, esto mediante la revisión de distintas investigaciones que han abordado la relación entre artesanía y naturaleza. Método: Para ello, se llevó a cabo un análisis crítico del acervo bibliográfico identificando las orientaciones temáticas. La indagación se realizó tras el estudio de artículos científicos publicados en revistas indizadas, durante el periodo 2007 a 2022 y disponibles en acceso abierto en idioma español, inglés y portugués; además se consideraron los siguientes criterios: tipo de investigación, objetivo de la contribución, enfoque metodológico, ámbito territorial, orientación temática y disciplinaria. Resultados: Se identificaron cuatro grupos de aproximaciones temáticas: a) proceso de producción, acceso a materias primas, transformación y tecnologías; b) impacto de la producción sobre los recursos naturales; c) formas de organización social en el contexto local; d) comercialización y consumo en el mercado actual. Conclusiones: Si bien es posible establecer una propuesta de clasificación de los estudios ambientales de las artesanías, se requiere una visión ampliada de la realidad que supere las perspectivas parcelarias, y se consideren los paradigmas propios de la complejidad como argumentos para su estudio en México.

Abstract Introduction: The different aspects that the study of the craft activity and its relationship with the natural environment can take have represented an important challenge due to the diversity of thoughts expressed, which entails a heuristic effort to identify explanatory elements that have meeting points and allow a pertinent classification to be established. Objective: The objective of the research was to document the thematic orientations that frame environmental studies of craft activity, this through the review of different investigations that have addressed the relationship between crafts and nature. Method: For this, a critical analysis of the bibliographical collection was carried out, identifying the thematic orientations. The investigation was carried out after the study of scientific articles published in indexed journals, during the period 2007 to 2022 available in open access in Spanish, English and Portuguese; in addition, the following criteria were considered: type of research, objective of the contribution, methodological approach, territorial scope, thematic and disciplinary orientation. Results: Four groups of thematic approaches were identified: a) production process, access to raw materials, transformation, and technologies; b) impact of production on natural resources; c) forms of social organization in the local context; d) commercialization and consumption in the current market. Conclusions: Although it is possible to establish a proposal for the classification of environmental studies of handicrafts, an expanded vision of reality is required that goes beyond parcel perspectives, considering the paradigms of complexity as arguments for their study in Mexico.

Resumo Introdução: O artigo apresenta uma pesquisa sobre memes relacionados à área de biblioteconomia no Facebook. Ressalta-se a importância do tema, uma vez que ainda não foi suficientemente estudado a partir das Ciências da Informação, especialmente na área de biblioteconomia. O objetivo da análise é compreender as mensagens, significados e representações que derivam desses memes, e sugere-se que a Iconografia pode ser uma disciplina útil para abordar este fenômeno. Metodologia: Esta pesquisa é descritiva com desenho misto com ênfase em técnicas qualitativas de interpretação de resultados a partir da reflexão de memes bibliotecários para o trabalho bibliotecário. O método utilizado foi a análise iconográfica, que foi utilizada para a descrição e classificação dos memes. Resultados: São expostas as ligações existentes entre o conteúdo e os significados dos memes de biblioteca no Facebook. Conclusões: Os resultados permitem descrever os significados vinculados ao trabalho bibliotecário dos memes bibliotecários no Facebook.

Abstract Introduction: The article presents a research on memes related to the field of library science on Facebook. The importance of the topic is emphasized, as it has not been sufficiently studied from the Information Sciences, especially in the library science field. The aim of the analysis is to understand the messages, meanings, and representations derived from these memes, and it is suggested that Iconography can be a useful discipline to approach this phenomenon. Methodology: This research is a descriptive mixed design with an emphasis on qualitative techniques for interpreting results based on the reflection of library science memes for library work. The method used was iconographic analysis, which was used for the description and classification of memes. Results: The existing links between the content and meanings of library science memes on Facebook are exposed. Conclusions: The results allow describing the meanings related to the library work of library science memes on Facebook.

Resumen Introducción: El artículo presenta una investigación sobre memes relacionados con el campo de la bibliotecología en Facebook. Se destaca la importancia del tema, ya que aún no ha sido suficientemente estudiado desde las ciencias de la información, especialmente en el campo bibliotecológico. El objetivo del análisis es comprender los mensajes, significados y representaciones que se derivan de estos memes, y se sugiere que la iconografía puede ser una disciplina útil para abordar este fenómeno. Metodología: La presente investigación es descriptiva de diseño mixto con énfasis en técnicas cualitativas para la interpretación de resultados basados en el reflejo de los memes bibliotecológicos para el quehacer bibliotecario. El método utilizado para la descripción y clasificación de los memes fue el análisis iconográfico. Resultados: Se exponen los nexos existentes entre el contenido y los significados de los memes bibliotecológicos en Facebook. Conclusiones: Los resultados permiten describir los significados vinculados al quehacer bibliotecario de los memes bibliotecológicos en Facebook.

Resumen El cultivo de cacao (Theobroma cacao L.) para el departamento de Nariño representa una alternativa productiva frente a la sustitución de cultivos ilícitos, del cual dependen pequeños y medianos productores; sin embargo, la alta humedad relativa, temperatura y precipitaciones, así como el manejo inadecuado fitosanitario, provocan alta incidencia de enfermedades como Moniliophthora roreri y Phytophthora sp. y limitando rendimiento productivo. En este sentido, es necesario la identificación de clones de cacao adaptados a las condiciones de la zona y tolerantes a las principales enfermedades. El objetivo de este estudio fue evaluar el potencial productivo y sanitario en etapas iniciales de desarrollo de cuatro clones de cacao; TCS 01, TCS 06, TCS 13 y TCS 19 bajo condiciones ambientales del Pacífico Nariñense. Para el análisis estadístico se utilizó el software SAS 9.4, empleando el procedimiento Glimminx para analizar las variables y se ajustó el análisis a la distribución de Poisson. Además, se utilizó pruebas de Tukey cuando se presentaron diferencias significativas. El Clon TCS 19, presentó los mejores resultados en producción (1.44 kg grano seco árbol-1) superando al testigo comercial ICS 95 (0.6 kg grano seco árbol-1). En tema sanitario, M. roreri fue la enfermedad con mayor incidencia, especialmente en los genotipos TCS 01 (38.67%) y TCS 13 (25.85%). Los rendimientos de los materiales evaluados superaron el promedio de producción nacional (460 kg ha-1) y regional (560 kg ha-1). Según estos resultados, TCS 19 podría potencialmente considerarse como recurso genético promisorio para el desarrollo de la cacaocultura de la Costa Pacífica Nariñense.

Abstract The cacao (Theobroma cacao L.) crop for the department of Nariño represents a productive alternative to the substitution of illicit crops, on which small and medium producers depend; nevertheless, high relative humidity, temperature, and rainfall, as well as inadequate phytosanitary management, cause a high incidence of diseases such as Moniliophthora roreri and Phytophthora sp., limiting productive yield. In this sense, it is necessary to identify cacao clones adapted to the conditions of the area and tolerant to the main diseases. This study aimed to assess the productive and sanitary potential in the initial stages of development of four cacao clones, TCS 01, TCS 06, TCS 13, and TCS 19, under environmental conditions of the Nariño Pacific. The SAS 9.4 software was used for the statistical analysis, employing the Glimmix procedure to analyze the variables, and the analysis was adjusted to the Poisson distribution. In addition, Tukey’s tests were used when there were significant differences. The clone TCS 19 presented the best results in production (1.44 kg dried bean tree-1), surpassing the commercial control ICS 95 (0.6 kg dried bean tree-1). In terms of health, M. roreri was the disease with the highest incidence, especially in the genotypes TCS 01 (38.67%) and TCS 13 (25.85%). The yields of the materials evaluated exceeded the average national (460 kg ha-1) and regional (560 kg ha-1) production. According to these results, TCS 19 could potentially be considered a promising genetic resource for the development of cacao farming on the Pacific Coast of Nariño.

La hemocromatosis es una enfermedad caracterizada por el excesivo depósito de hierro en múltiples órganos, entre ellos hígado, páncreas, piel y corazón. La infiltración de este último es un importante factor en morbilidad y mortalidad. Presentamos un caso de un paciente pediátrico con insuficiencia cardíaca terminal que ameritó trasplante cardíaco, que resultó sin complicaciones. Posterior a la cirugía, mostró mejoría bioquímica y clínica, lo que influyó positivamente en su calidad de vida y prolongó su supervivencia.

Resumen Introducción y objetivo. En el abordaje clínico de la parálisis facial periférica existen opciones terapéuticas enfocadas a restaurar la función motora facial, como son las cirugías estáticas y dinámicas; sin embargo, la asimetría facial es un problema persistente. La neurectomía selectiva del nervio facial (NSNF) es una cirugía utilizada recientemente para el manejo de las sincinesias e hipercinesias producidas como secuela en parálisis facial. El objetivo del presente trabajo es analizar los resultados en la mejoría de la asimetría facial de nuestros pacientes sometidos a NSNF para el tratamiento de la hipercinesia contralateral de la parálisis facial mediante la implementación de la escala Sunnybrook Facial Grading Scale (SFGS). Material y método. Estudio prospectivo observacional descriptivo analizando una muestra de 100 pacientes con diagnóstico de parálisis facial periférica atendidos en el Hospital de San José, Bogotá, Colombia. Describimos variables demográficas, y una vez identificados los pacientes sometidos a NSNF, utilizamos la historia clínica para hacer la estadificación de la escala descrita y comparamos los resultados en el pre y postoperatorio. Describimos también la técnica quirúrgica utilizada. Resultados. Evidenciamos una diferencia en la puntuación de la escala SFGS dada por un incremento en la puntuación en 4 pacientes sometidos al procedimiento, con diferencias estadísticamente significativas. Conclusiones. En nuestra experiencia, La NSNF es útil en el manejo de la asimetría facial persistente como secuela de parálisis facial.

Abstract Background and objective. In the clinical approach of the peripheral facial paralysis there are therapeutic options focused on restoring facial motor function, such as static and dynamic surgeries; however, facial asymmetry is a persistent problem. Selective facial nerve neurectomy (SFNN) is a widely used surgery for the management of synkinesias and hyperkinesias as sequelae of pasalysis. Our objective is to analyze the results in the improvement of facial asymmetry of patients undergoing SFNN for the treatment of contralateral hyperkinesia of facial paralysis through the implementation of the Sunnybrook Facial Grading Scale (SFGS). Methods. A prospective observational descriptive study is designed for a sample of 100 patients diagnosed with peripheral facial paralysis treated at the Hospital de San José, Bogotá, Colombia. Demographic variables were described, and once the patients undergoing SFNN were identified, the clinical history is used to carry out the staging of the scale described and the results are compared in the pre and postoperative period. A description of the surgical technique used was made. Results. A difference in the SFGS scale classification score was identified due to an increase in the score in the postoperative period of 4 patients that were treated with SFNN with statistically significant differences. Conclusions. In our experience, SFNN is useful in the management of persistent facial asymmetry as a consequence of facial palsy.

ABSTRACT Nutcracker syndrome caused by aorto-mesenteric compression of the left renal vein can be treated with surgical transposition. A review of this treatment was carried out at the Instituto de Previsión Social. Two women aged fifteen and twenty-six, who had low back pain and hematuria, were identified. They were discharged on the fourth and fifth postoperative day. The patients showed no symptoms after five and nine months of follow-up.

RESUMEN: El Síndrome de Nutcracker producido por compresión aorto-mesenterica de la vena renal izquierda puede tratarse con transposición quirúrgica. Se realizó revisión de dicho tratamiento realizado en el Instituto de Previsión Social. Se identificaron dos mujeres de 15 y 26 años, que presentaron dolor lumbar y hematuria. Egresaron al cuarto y quinto día de postoperatorio. Las pacientes no presentaron síntomas a los cinco y nueve meses de seguimiento.

ABSTRACT Introduction: Medical Residents' perceptions of the EE (Educational Environment) correspond to an important construct to evaluate and improve the quality of medical training programs. However, reliable and valid measurement can be problematic, especially when instruments developed and tested in one culture are translated for use in another. Objective: To analyze the metric properties for the validation of the Postgraduate Hospital Educational Environment Measure (PHEEM) in doctors who take specialization courses (residents), offered by the National Commission of Medical Residencies (CONAREM) of Paraguay during 2019. Materials and Methods: Cross-sectional study on the perception of the educational environment in medical residents of the CONAREM Training Units during the year 2019. The validity of the construct was tested with confirmatory factor analysis (CFA) and exploratory (EFA), and with the approach of underlying variable (UVA). Cronbach's alpha was used to measure the internal consistency and unidimensionality of each set of elements that refer to each of the factors (Autonomy, Teaching and Social Support). Results: 495 Paraguayan resident physicians from 23 CONAREM Training Units participated in the study. The PHEEM survey in Spanish showed a Cronbach's alpha of 0.9489 at a general level as acceptable, and in the subscales of autonomy of 0.8538, of teaching 0.9351 (both perceived as very good), while the social support one measured 0.7460 (good). Conclusion: PHEEM is a valid tool to evaluate the educational environment (EE) in medical residences in Paraguay.

RESUMEN Introducción: Las percepciones de los residentes sobre el AE (Ambiente Educacional) corresponden a un constructo importante para evaluar y mejorar la calidad de los programas de formación médica. Sin embargo, la medición confiable y válida puede ser problemática, especialmente cuando los instrumentos desarrollados y probados en una cultura se traducen para su uso en otra. Objetivo: Analizar las propiedades métricas para la validación de la Medida de Entorno Educativo Hospitalario de Postgrado (PHEEM) en médicos que realizan cursos de especialización (residentes), ofrecidos por la Comisión Nacional de Residencias Médicas (CONAREM) de Paraguay durante el 2019. Materiales y Métodos: Estudio transversal sobre la percepción del ambiente educacional en médicos residentes de las Unidades Formadoras de CONAREM durante el año 2019. La validez del constructo se probó con análisis factorial confirmatorio (CFA) y exploratorio (EFA), y con el enfoque de variable subyacente (UVA). Se utilizó el alfa de Cronbach para medir la consistencia interna y la unidimensionalidad de cada conjunto de elementos que se refieren a cada uno de los factores (Autonomía, Enseñanza y Apoyo Social). Resultados: Participaron del estudio 495 médicos residentes del Paraguay de 23 Unidades Formadoras de CONAREM. La encuesta PHEEM en español mostró un alfa de Cronbach de 0,9489 a nivel general como aceptable, y en las subescalas de autonomía de 0,8538, de enseñanza 0,9351 (ambas percibidas como muy buenas) mientras que la de apoyo social midió 0,7460 (buena). Conclusión: El PHEEM constituye una herramienta válida para evaluar el ambiente educacional (AE) en las residencias médicas en Paraguay

Resumen Antecedentes: El tratamiento de la infección crónica por el virus de la hepatitis C (VHC) con antivirales de acción directa logra tasas de respuesta virológica sostenida superiores a 95 %. Sin embargo, el manejo del fracaso virológico sigue siendo un desafío clínico y la evidencia sobre el retratamiento es limitada, especialmente en poblaciones como los receptores de trasplante hepático (TH). Objetivo: Este estudio evaluó el régimen de sofosbuvir más glecaprevir/pibrentasvir (GLE/PIB) en receptores de TH en quienes falló el régimen basado en inhibidores de la proteína no estructural 5A (NS5A). Material y métodos: Estudio retrospectivo de 111 pacientes trasplantados entre enero de 2018 y diciembre de 2020; 18 pacientes presentaron infección recurrente por VHC posterior al TH, tres de ellos tuvieron antecedentes de al menos un régimen basado en inhibidores de NS5A. Se inició terapia de rescate con sofosbuvir más GLE/PIB durante 12 semanas posterior al TH; se registraron las características basales de los pacientes y sus desenlaces. Resultados: En los tres pacientes se logró obtener una carga viral indetectable de VHC a las 12 semanas de finalizar el tratamiento. No se observaron eventos adversos graves. Conclusión: En nuestra serie, sofosbuvir más GLE/PIB durante 12 semanas demostró ser una terapia de rescate efectiva y segura posterior al TH en pacientes previamente tratados con inhibidores de NS5A.

Abstract Background: Treatment of chronic hepatitis C virus (HCV) infection with direct-acting antivirals achieves a sustained virologic response rates higher than 95%. However, virologic failure remains a clinical challenge, and data on retreatment are limited, especially in special populations such as liver transplant (LT) recipients. Objective: This study evaluated the sofosbuvir plus glecaprevir-pibrentasvir (GLE/PIB) regimen in LT recipients who had failed to a nonstructural protein 5A (NS5A) inhibitor-based regimen. Material and methods: Retrospective study of 111 liver transplant recipients between January 2018 and December 2020; 18 patients presented with HCV recurrent infection after LT, out of whom three had a history of at least one NS5A inhibitor-based regimen. Salvage therapy with sofosbuvir plus GLE/PIB was started for 12 weeks; baseline characteristics and outcomes were recorded. Results: All three patients (100%) achieved an undetectable HCV viral load 12 weeks after treatment completion. No serious adverse events were observed. Conclusion: In our series, sofosbuvir plus GLE/PIB for 12 weeks is an effective and safe salvage therapy after LT in patients previously treated with NS5A inhibitors.