Resumen: Objetivo: Caracterizar el comportamiento de COVID-19 en niños chilenos hospitalizados en unidades de paciente crítico pediátrico (UPCP) y evaluar factores de riesgo para COVID-19 severo. Pacientes y Método: Estudio multicéntrico cohorte prospectivo, pacientes 0-18 años con SARS-CoV-2 confirmado hospitalizados en UPCP. Se registraron variables clínicas, laboratorio, imagenológicas y terapéuticas. Se comparó “COVID-19 leve/moderado” versus “COVID-19 severo” utilizando mediana con rango intercuartil (RIC), test U Mann-Whitney, Test Fisher de dos colas y análisis multivariado binario forward para ajuste de variables para “COVID-19 severo”. Significativo p < 0,05. Resultados: 219 pacientes, 55,3% hombres, mediana edad 86 meses (RIC: 13,5-156). Comorbilidades principales: obesidad, enfermedades respiratorias. Mortalidad global: 3,6%. “COVID-19 severo” (26,5%) mostró más leucopenia, linfopenia, más inflamación y alteración de órganos (p < 0,05). También desarrolló más Sepsis/shock, SDRA y disfunción de órganos, requirió más terapia hemodinámica, antiinflamatoria, anticoagulación, antibioterapia, con mayor estadía en UPCP/hospitalaria (p < 0,05) y mortalidad de 13,8%. Factores de riesgo asociados a “COVID-19 severo”: shock al ingreso (aOR 28,44 [IC95%: 10,45-77,4]), obesidad (aOR 3,55 [IC95%: 1,3-9,6]), condensación (aOR 3,1 [IC95%: 1,1-8,7]), atelectasia (aOR: 8.7 [IC95%: 1,17-64,3]), corticoides dosis de estrés (aOR 7,7 [IC95%: 1,9-30,6]), antibioterapia precoz (aOR: 12,02 [IC95%: 1,11-130,02]), inmunodeficiencia adquirida/ congénita (aOR: 19,2 [IC95%: 1,19-321]) y patología oncológica (aOR: 10,7 [IC95%: 2,14-47,8]). Conclusión: En esta cohorte pediátrica chilena, el perfil de paciente que ingresó a UPCP fue de sexo masculino en edad escolar con comorbilidad asociada. Factores de riesgo asociados a COVID-19 severo fueron: presencia de comorbilidades (inmunodeficiencia adquirida/congénita, patología oncológica y obesidad), shock al ingreso y condensaciones en las imágenes radiológicas.

Abstract: Objectives: To characterize the COVID-19 disease profile in Chilean children hospitalized in pediatric intensive care units (PICU) and to evaluate risk factors associated with severe COVID-19. Patients and Method: A multicenter prospective cohort study with patients 0-18 years of age with confirmed SARS-CoV-2 hospitalized in PICU. Clinical, laboratory, imaging, and therapeutic variables were recorded. We compared ”mild/moderate COVID-19” with ’’severe COVID-19” using median with interquartile range (IQR), Mann-Whitney U test, two-tailed Fisher’s test, and forward binary multivariate analysis to adjust variables for “severe COVID-19”. A p < 0.05 was considered significant. Results: From 16 PICUs, 219 patients were recruited, 55.3% were male, with a median age of 86 months (IQR: 13.5-156). The most frequent comorbidities were obesity and respiratory diseases. Overall mortality was 3.6%. “Severe COVID-19” (26.5%) showed more leukopenia, lymphopenia, increased inflammatory parameters, and altered organ function (p < 0.05). It also developed more sepsis/shock, ARDS, and organ dysfunction, requiring more hemodynamic, anti-inflammatory, anticoagulation, and antibiotic therapy, with a longer stay in the PICU/hospital (p < 0.05), and 13.8% of mortality. Risk factors associated with “severe COVID-19” were shock on admission to the PICU [aOR 28.44 (95%CI 10.45-77.4)], obesity [aOR 3.55 (95%CI 1.3-9.6)], consolidation [aOR 3.1 (95%CI 1.1 -8.7)], atelectasis [aOR: 8.7 (95%CI 1.17-64.3)], stress dose of corticosteroids [aOR 7.7 (95%CI 1.9-30.6)], early antibiotic therapy [aOR: 12.02 (95%CI 1.11-130.02)], acquired/congenital immunodeficiency [aOR: 19.2 (95%CI: 1.19-321)], and oncological pathology [aOR 10.7 (95%CI 2.14-47.8)]. Conclusion: In this Chilean pediatric cohort, most patients with COVID-19 admitted to de PICU were male, of school age, with associated comorbidity. Risk factors for developing severe COVID-19 were the presence of comorbidities such as acquired/congenital immunodeficiency, oncological pathology, and obesity, in addition to shock on admission and consolidations on X-rays.

Abstract: Objectives: To characterize the COVID-19 disease profile in Chilean children hospitalized in pediatric intensive care units (PICU) and to evaluate risk factors associated with severe COVID-19. Patients and Method: A multicenter prospective cohort study with patients 0-18 years of age with confirmed SARS-CoV-2 hospitalized in PICU. Clinical, laboratory, imaging, and therapeutic variables were recorded. We compared ”mild/moderate COVID-19” with ’’severe COVID-19” using median with interquartile range (IQR), Mann-Whitney U test, two-tailed Fisher’s test, and forward binary multivariate analysis to adjust variables for “severe COVID-19”. A p < 0.05 was considered significant. Results: From 16 PICUs, 219 patients were recruited, 55.3% were male, with a median age of 86 months (IQR: 13.5-156). The most frequent comorbidities were obesity and respiratory diseases. Overall mortality was 3.6%. “Severe COVID-19” (26.5%) showed more leukopenia, lymphopenia, increased inflammatory parameters, and altered organ function (p < 0.05). It also developed more sepsis/shock, ARDS, and organ dysfunction, requiring more hemodynamic, anti-inflammatory, anticoagulation, and antibiotic therapy, with a longer stay in the PICU/hospital (p < 0.05), and 13.8% of mortality. Risk factors associated with “severe COVID-19” were shock on admission to the PICU [aOR 28.44 (95%CI 10.45-77.4)], obesity [aOR 3.55 (95%CI 1.3-9.6)], consolidation [aOR 3.1 (95%CI 1.1 -8.7)], atelectasis [aOR: 8.7 (95%CI 1.17-64.3)], stress dose of corticosteroids [aOR 7.7 (95%CI 1.9-30.6)], early antibiotic therapy [aOR: 12.02 (95%CI 1.11-130.02)], acquired/congenital immunodeficiency [aOR: 19.2 (95%CI: 1.19-321)], and oncological pathology [aOR 10.7 (95%CI 2.14-47.8)]. Conclusion: In this Chilean pediatric cohort, most patients with COVID-19 admitted to de PICU were male, of school age, with associated comorbidity. Risk factors for developing severe COVID-19 were the presence of comorbidities such as acquired/congenital immunodeficiency, oncological pathology, and obesity, in addition to shock on admission and consolidations on X-rays.

Resumen: Objetivo: Caracterizar el comportamiento de COVID-19 en niños chilenos hospitalizados en unidades de paciente crítico pediátrico (UPCP) y evaluar factores de riesgo para COVID-19 severo. Pacientes y Método: Estudio multicéntrico cohorte prospectivo, pacientes 0-18 años con SARS-CoV-2 confirmado hospitalizados en UPCP. Se registraron variables clínicas, laboratorio, imagenológicas y terapéuticas. Se comparó “COVID-19 leve/moderado” versus “COVID-19 severo” utilizando mediana con rango intercuartil (RIC), test U Mann-Whitney, Test Fisher de dos colas y análisis multivariado binario forward para ajuste de variables para “COVID-19 severo”. Significativo p < 0,05. Resultados: 219 pacientes, 55,3% hombres, mediana edad 86 meses (RIC: 13,5-156). Comorbilidades principales: obesidad, enfermedades respiratorias. Mortalidad global: 3,6%. “COVID-19 severo” (26,5%) mostró más leucopenia, linfopenia, más inflamación y alteración de órganos (p < 0,05). También desarrolló más Sepsis/shock, SDRA y disfunción de órganos, requirió más terapia hemodinámica, antiinflamatoria, anticoagulación, antibioterapia, con mayor estadía en UPCP/hospitalaria (p < 0,05) y mortalidad de 13,8%. Factores de riesgo asociados a “COVID-19 severo”: shock al ingreso (aOR 28,44 [IC95%: 10,45-77,4]), obesidad (aOR 3,55 [IC95%: 1,3-9,6]), condensación (aOR 3,1 [IC95%: 1,1-8,7]), atelectasia (aOR: 8.7 [IC95%: 1,17-64,3]), corticoides dosis de estrés (aOR 7,7 [IC95%: 1,9-30,6]), antibioterapia precoz (aOR: 12,02 [IC95%: 1,11-130,02]), inmunodeficiencia adquirida/ congénita (aOR: 19,2 [IC95%: 1,19-321]) y patología oncológica (aOR: 10,7 [IC95%: 2,14-47,8]). Conclusión: En esta cohorte pediátrica chilena, el perfil de paciente que ingresó a UPCP fue de sexo masculino en edad escolar con comorbilidad asociada. Factores de riesgo asociados a COVID-19 severo fueron: presencia de comorbilidades (inmunodeficiencia adquirida/congénita, patología oncológica y obesidad), shock al ingreso y condensaciones en las imágenes radiológicas.

Abstract The paper’s aim is to analyse the effect of both trade and financial liberalization on Mexico’s capital formation and intersectoral productive linkages. The impact of both exports and foreign direct investment (FDI) on the stock of capital and their impulse and dispersion effects across the country’s various productive sectors is empirically assessed during the period 1999-2020. Our main results suggest: i) an increase in both exports and FDI did not bring about an increment in the stock of capital; ii) one effect of FDI was the fragmentation of most local subsectors and their lack of international insertion; iii) a significant statistical relationship between FDI and forward linkages does not seem to exist and iv) a negative relationship between variations in productivity/competitiveness and fixed capital formation was found.

Resumen El objetivo de este trabajo es analizar el impacto de la apertura económica en la formación de capital y los encadenamientos intersectoriales. Con este fin, evaluamos empíricamente el impacto de las exportaciones y la inversión extranjera directa (IED) en el acervo de capital y la capacidad de arrastre/dispersión a nivel multisectorial en México durante el periodo 1999-2020. Nuestros principales resultados sugieren que: i) un aumento de las exportaciones y la inversión externa no propició un incremento en el acervo de capital; ii) uno de los efectos de la IED fue la fragmentación de la mayoría de los subsectores locales y la falta de inserción internacional; iii) no existe una relación estadísticamente significativa entre la IED y los encadenamientos hacia adelante; y, por último, encontramos una relación negativa entre las variaciones de la productividad/competitividad y la formación de capital.

RESUMEN Introducción: la endocarditis infecciosa es una enfermedad de una variada presentación clínica. Es cada vez más frecuente debido a los cuidados relacionados con la salud. Objetivo: determinar las complicaciones de los pacientes con endocarditis infecciosa bacteriana al momento del diagnóstico y su relación con el agente causal y ofrecer una descripción general de las características demográficas y clínicas presentes en pacientes del Hospital Nacional, Itauguá, Paraguay, en el periodo 2017-2021. Material y métodos: estudio descriptivo, observacional, retrospectivo que incluyo 37 pacientes con el diagnóstico de endocarditis infecciosa con germen aislado. Resultados: la edad media fue 45 ±14 años, la mayoría provenía del área urbana y era del sexo masculino (65%). La comorbilidad más frecuente fue enfermedad renal crónica (50%). Los procedimientos invasivos (catéter venoso central simple) fueron el foco de bacteriemia más frecuente (65,22%). La válvula más comprometida fue la aórtica, la complicación más frecuente fue la insuficiencia cardiaca (70,27%), hubieron 49% de desenlaces fatales. El germen más frecuente y causante de la mayor morbimortalidad fue Staphylococcus aureus (43,24%). Conclusión: la enfermedad renal crónica fue el principal factor de riesgo. Ser portador de catéter venoso simple de hemodiálisis estuvo relacionado al aislamiento del Staphylococcus aureus como agente causal más frecuente. Este germen estuvo relacionado a la alta tasa de complicaciones al momento del ingreso y con el alto porcentaje de desenlaces fatales.

ABSTRACT Introduction: Infective endocarditis is a disease with a varied clinical presentation. It is becoming more frequent due to health-related care. Objective: To determine the complications of patients with bacterial infective endocarditis at the time of diagnosis and their relationship with the causal agent and offer a general description of the demographic and clinical characteristics present in patients of the Hospital Nacional of Itauguá, Paraguay, in the period 2017- 2021. Material and methods: Descriptive, observational, retrospective study that included 37 patients diagnosed with infective endocarditis with isolated germ. Results: The mean age was 45±14 years, the majority came from the urban area and was male (65%). The most frequent comorbidity was chronic kidney disease (50%). Invasive procedures (simple central venous catheter) were the most frequent source of bacteremia (65.22%). The most compromised valve was the aortic, the most frequent complication was heart failure (70.27%) and there was 49% of fatal outcomes. The most frequent germ and cause of the highest morbidity and mortality was Staphylococcus aureus (43.24%). Conclusion: Chronic kidney disease was the main risk factor. Being a carrier of a simple venous hemodialysis catheter was related to the isolation of Staphylococcus aureus as the most frequent causal agent. This germ was related to the high rate of complications at the time of admission and the high percentage of fatal outcomes.

ABSTRACT Background: Leishmaniasis is a vector-borne disease caused by a parasite protozoon from the genus Leishmania. Among the molecular techniques applied for detecting these parasites, real-time PCR with High Resolution Melting (PCR-HRM) proved advantageous since it simultaneously determines both the presence and species of the pathogen in one step, through amplification and later analysis of curves generated by melting temperature. Methods: Based on this molecular technique, the goal of this study was to estimate the PCR-HRM sensitivity for Leishmania spp. detection in different canine tissues by evaluating biological samples obtained from popliteal, submandibular, and pre-scapular lymph nodes, from bone marrow and ear pinnae of 28 stray dogs captured in the metropolitan area of Asunción (Paraguay). Results: The rk39 immunochromatographic test showed that 25/28 tested dogs (89%) presented antibodies against L. infantum. In 20/25 dogs that tested positive for rk39 (80%), it was possible to detect Leishmania spp. by PCR-HRM and determine that the species corresponded entirely to L. infantum. Regarding the analysis of different tissues, the parasite was detected in all popliteal lymph node samples, followed by high detection in submandibular (at 95%) and pre-scapular lymph nodes (at 90%), bone marrow (at 85%), and ear pinnae (at 85%). Conclusions: This study demonstrated that the use of real-time PCR-HRM using the molecular marker hsp70 was a highly sensitive method for simultaneously detecting and identifying Leishmania species in different tissues taken from infected dogs. In addition, the usefulness of ear pinnae as easily accessible tissue for molecular diagnosis was emphasized.

This article continues our presentation of the Brazilian Psychiatric Association guidelines for the management of patients with suicidal behavior, with a focus on screening, intervention, postvention, prevention, and promotion. For the development of these guidelines, we conducted a systematic review of the MEDLINE (via PubMed), Cochrane Database of Systematic Reviews, Web of Science, and SciELO databases for research published from 1997 to 2020. Systematic reviews, clinical trials, and cohort/observational studies on screening, intervention, and prevention in suicidal behavior were included. This project involved 14 Brazilian psychiatry professionals and 1 psychologist selected by the Psychiatric Emergencies Committee of the Brazilian Psychiatric Association for their experience and knowledge in psychiatry and psychiatric emergencies. Publications were evaluated according to the 2011 Oxford Center for Evidence-Based Medicine (OCEBM) Levels of Evidence Classification. Eighty-five articles were reviewed (of 5,362 initially collected and 755 abstracts on the drug approach). Forms of screening, intervention, and prevention are presented. The intervention section presents evidence for psychotherapeutic and drug interventions. For the latter, it is important to remember that each medication is effective only for specific groups and should not replace treatment protocols. We maintain our recommendation for the use of universal screening plus intervention. Although the various studies differ in terms of the populations evaluated and several proposals are presented, there is already significant evidence for certain interventions. Suicidal behavior can be analyzed by evidence-based medicine protocols. Currently, the best strategy is to combine several techniques through the Safety Plan. Nevertheless, further research on the topic is needed to elucidate some approaches with particular potential for intervention and prevention. Systematic review registry number: CRD42020206517

Suicide is a global public health problem that causes the loss of more than 800,000 lives each year, principally among young people. In Brazil, the average mortality rate attributable to suicide is approximately 5.23 per 100,000 population. Although many guidelines have been published for the management of suicidal behavior, to date, there are no recent guidelines based on the principles of evidence-based medicine that apply to the reality of suicide in Brazil. The objective of this work is to provide key guidelines for managing patients with suicidal behavior in Brazil. This project involved 11 Brazilian psychiatry professionals selected by the Psychiatric Emergencies Committee (Comissão de Emergências Psiquiátricas) of the Brazilian Psychiatric Association for their experience and knowledge in psychiatry and psychiatric emergencies. For the development of these guidelines, 79 articles were reviewed (from 5,362 initially collected and 755 abstracts). In this review, we present definitions, risk and protective factors, assessments, and an introduction to the Safety Plan. Systematic review registry number: CRD42020206517

Personality Organization Diagnosis, proposed by Dr. Otto F. Kernberg and his team from the Personality Disorder Institute in New York, has been an important contribution to the understanding and treatment of personality disorders. The aim of this article is to make an updated review of this approach, addressing a general understanding of what is personality, and subsequently deepening the differential diagnosis of the neurotic and borderline personality organization. Furthermore, within de borderline spectrum, those high, medium, and low functioning will be distinguished, considering its severity and prognosis. Finally, a synthesis of the personality assessment process will be carried put, which consist of the Structural Interview

Resumen El diagnostico estructural propuesto por el Dr. Otto F. Kernberg y su equipo de trabajo del Instituto de Trastornos de Personalidad en Nueva York ha sido una gran contribución tanto para la comprensión de la personalidad como para el tratamiento de estos casos. El objetivo del presente artículo es realizar una revisión actualizada de este enfoque, abordando una comprensión general de la personalidad, y posteriormente profundizar en el diagnóstico diferencial de la organización neurótica y limítrofe. Además, dentro del espectro limítrofe se distinguirá aquellos cuadros de funcionamiento alto, medio, y bajo, considerando su grado de severidad, y pronostico. Finalmente, se hará una síntesis del proceso de evaluación que consiste en la entrevista estructural.

Table grapes are the most widespread fruit species in Chile, requiring a large amount of agrochemical products. Due to this large requirement, agrochemicals such as herbicides need to be applied precisely and in an environmentally safe manner in order to achieve the desired target. Weeds are a limiting factor in vine nurseries, where Cyperus rotundus, Sorghum halepense, and Cynodon dactylon are the hardest species to control. In this case, application though nozzles is of vital importance for a correct herbicide distribution and dosage over the target. However, the use of herbicides in vine nurseries has not been widely practiced and literature on the subject is very scarce. In this project, a comparative study between conventional extended range flat spray (XR) and drift effect nozzles (TT turbo teejet; DG drift guard; AI air injection) was conducted. Weed control with glyphosate and phytotoxicity in Vitis vinifera cv. Thompson Seedless self-rooted nursery plants were evaluated, under wind drift conditions of 5.8 km h-1. This wind drift and the low angle of elevation of the nozzle (35 cm) caused the herbicide to reach the vine, generating the same visual plant toxicity damage regardless of the nozzle type used, with an increasing damage from day 7 to 28 after application (DAA). A gradual decrease was observed from 36 DAA onwards. Although no differences between the nozzles with respect to drift damage were detected, the use of the DG nozzle resulted in a lower percentage of sprouting weeds. This may be due to the DG nozzle having significantly reduced drift compared to conventional or standard nozzles, and, in turn, generating smaller droplets than AI, favoring their retention on the leaves.

El área plantada de vid en Chile es la mayor superficie de frutales, con un efecto en una alta tasa de uso de agroquímicos, sobre todo en los viveros, en los cuales las malezas son un factor limitante, siendo Cyperus rotundus L., Sorghum halepense (L. Pers) y Cynodon dactylon (L. Pers), las especies de más difícil control. Este cambio requiere que las aplicaciones de agroquímicos como los herbicidas sean más precisos y seguros con el medio ambiente, evitando además el daño por deriva, sobre todo por la reducida distancia entre las hileras. Dentro del equipamiento de aplicación, las boquillas son de vital importancia debido a que permiten dosificar la mezcla y distribuirla sobre el objetivo, pero los estudios de aplicaciones en viveros son bastante reducidos, sin encontrarse mucha literatura al respecto. Se realizó un estudio comparativo entre boquillas abanico plano de rango extendido (XR) y antideriva (TT turbo teejet; DG baja deriva; AI inyección de aire) en donde se evaluó la fitotoxicidad en plantas de Vitis vinifera cv. Thompson Seedless (auto-enraizadas en vivero) y el control de malezas con glifosato, bajo condiciones de viento (5,8 km∙h-1). En estas condiciones de viento, y baja altura de la boquilla (35 cm), la cantidad de herbicida que llega a la vid producto de la deriva genera el mismo daño fitotóxico visual y de materia seca independientemente de la boquilla utilizada, con un aumento del daño visual desde el día 7 al 28 después de aplicación (DDA), y luego un descenso gradual desde el día 36 DDA. Aunque no se notaron diferencias entre las boquillas con respecto al daño por deriva, sí hubo en el control de las malezas, donde la boquilla DG presenta uno de los menores porcentajes de control de re-brotación en las malezas evaluadas, mayormente debido a que no produce gotas tan chicas que pudiesen derivar, ni tan grandes que afecten su permanencia en la hoja.

Abstract Introduction: The wet form of age-related macular degeneration (WAMD) is related to the expression of vascular endothelial growth factor (VEGF). Several single nucleotide polymorphisms (SNPs) in the VEGF gene are associated with different expression patterns of this cytokine (functional polymorphisms). In this study, we considered 4 SNPs that are located in the promoter region (rs699947 A/C, rs833061 C/T, rs1005230 C/T and rs1570360 A/G) and two in the 5’ untranslated region (rs2010963 C/G and rs25648 C/T) that have an effect on transcriptional regulation. Objective: To associate functional SNPs with WAMD in a Mexican population. Methods: Through allelic discrimination assays, consisting in polymerase chain reactions with Taqman® probes, the polymorphisms were genotyped. Genotype frequencies were compared using all inheritance models. Results: SNPs were genotyped in 105 patients diagnosed with WAMD (61 women and 44 men, mean age 74.28 ± 8.32 years), and in 102 healthy control subjects (61 women and 41 men, mean age 67.41 ± 5.78 years). Genotypes in both groups were in Hardy-Weinberg equilibrium. In all SNPs analyzed, the minor allele frequency was statistically significant different between the groups. Genotypes were not statistically significant different between the WAMD and the control groups (p > 0.05). Conclusion: No association was observed between the studied SNPs and the presence of WAMD in the analyzed Mexican population. We consider that further analysis in larger samples is necessary to confirm these findings.

Resumen Introducción: La degeneración macular relacionada con la edad (DMRE) exudativa está asociada con la expresión del factor de crecimiento vascular endotelial (VEGF). Varios polimorfismos de un solo nucleótido (SNP) en el gen VEGF están asociados con diferentes patrones de expresión de esta citocina (polimorfismos funcionales). En este estudio consideramos 4 SNP que están ubicados en la región promotora (rs699947 A/C, rs833061 C/T, rs1005230 C/T y rs1570360 A/G) y dos en la región 5’ no traducida (rs2010963 C/G y rs25648 C/T) que tienen efecto sobre la regulación de la transcripción. Objetivo: Asociar SNP funcionales con la DMRE exudativa en población mexicana. Métodos: A través de reacción en cadena de la polimerasa con ensayos de discriminación alélica con sondas Taqman®, los polimorfismos fueron genotipados. Las frecuencias genotípicas se compararon utilizando todos los modelos de herencia. Resultados: Los SNP fueron genotipados en 105 pacientes diagnosticados con DMRE exudativa (61 mujeres y 44 hombres, edad promedio 74.28 ± 8.32 años) y en 102 sujetos control sanos (61 mujeres y 41 hombres, edad promedio 67.41 ± 5.78 años). Los genotipos en ambos grupos estaban en el equilibrio de Hardy-Weinberg. En cualquiera de los SNP analizados, la frecuencia de alelos menores fue diferente entre los grupos, con significación estadística. Los genotipos no mostraron diferencias estadísticamente significativas entre la DMRE exudativa y los grupos control (p > 0.05). Conclusión: No se encontró asociación entre los SNP estudiados y la presencia de DMRE exudativa en la población mexicana analizada. Consideramos necesario un análisis adicional en muestras más grandes para confirmar estos hallazgos.

Objective: To present the essential guidelines for pharmacological management of patients with psychomotor agitation in Brazil. Methods: This is a systematic review of articles retrieved from the MEDLINE (PubMed), Cochrane Database of Systematic Reviews, and SciELO databases published from 1997 to 2017. Other relevant articles in the literature were also used to develop these guidelines. The search strategy used structured questions formulated using the PICO model, as recommended by the Guidelines Project of the Brazilian Medical Association. Recommendations were summarized according to their level of evidence, which was determined using the Oxford Centre for Evidence-based Medicine system and critical appraisal tools. Results: Of 5,362 articles retrieved, 1,731 abstracts were selected for further reading. The final sample included 74 articles that met all inclusion criteria. The evidence shows that pharmacologic treatment is indicated only after non-pharmacologic approaches have failed. The cause of the agitation, side effects of the medications, and contraindications must guide the medication choice. The oral route should be preferred for drug administration; IV administration must be avoided. All subjects must be monitored before and after medication administration. Conclusion: If non-pharmacological strategies fail, medications are needed to control agitation and violent behavior. Once medicated, the patient should be monitored until a tranquil state is possible without excessive sedation. Systematic review registry number: CRD42017054440.

Objective: To present the essential guidelines for non-pharmacological management of patients with psychomotor agitation in Brazil. Methods: These guidelines were developed based on a systematic review of articles published from 1997 to 2017, retrieved from MEDLINE (PubMed), Cochrane Database of Systematic Review, and SciELO. Other relevant articles identified by searching the reference lists of included studies were also used to develop these guidelines. The search strategy used structured questions formulated using the PICO model, as recommended by the Guidelines Project of the Brazilian Medical Association. Recommendations were summarized according to their level of evidence, which was determined using the Oxford Centre for Evidence-based Medicine system and critical appraisal tools. Results: We initially selected 1,731 abstracts among 5,362 articles. The final sample included 104 articles that fulfilled all the inclusion criteria. The management of agitated patients should always start with the least coercive approach. The initial non-pharmacological measures include a verbal strategy and referral of the patient to the appropriate setting, preferably a facility designed for the care of psychiatric patients with controlled noise, lighting, and safety aspects. Verbal de-escalation techniques have been shown to decrease agitation and reduce the potential for associated violence in the emergency setting. The possibility of underlying medical etiologies must be considered first and foremost. Particular attention should be paid to the patient’s appearance and behavior, physical signs, and mental state. If agitation is severe, rapid tranquilization with medications is recommended. Finally, if verbal measures fail to contain the patient, physical restraint should be performed as the ultimate measure for patient protection, and always be accompanied by rapid tranquilization. Healthcare teams must be thoroughly trained to use these techniques and overcome difficulties if the verbal approach fails. It is important that healthcare professionals be trained in non-pharmacological management of patients with psychomotor agitation as part of the requirements for a degree and graduate degree. Conclusion: The non-pharmacological management of agitated patients should follow the hierarchy of less invasive to more invasive and coercive measures, starting with referral of the patient to an appropriate environment, management by a trained team, use of verbal techniques, performance of physical and mental assessment, use of medications, and, if unavoidable, use of the mechanical restraint. Systematic review registry number: CRD42017054440.

Abstract Within the pests that affect the avocado crop we find Oligonychus perseae or better known as crystalline spider. This mite produces affectations in the epidermis of the leaves discoloring the injured areas, in severe attacks they cause defoliation and low production, all this as a result of the extraction of the cellular content of the tissues. In the State of Mexico, there are about 10 000 hectares planted with avocado, with an average production of 15. 602 t ha-1. The spatial distribution of O. perseae in four municipalities producing avocado var. Hass through the application of geostatistical analysis and ordinary krigeado. The results show that the crystalline spider populations are presented in an aggregate way, adjusting mostly spherical models. The area infested with the mite exceeded 73% of the municipality in all samples and the maximum number of individuals found was 1 445 organisms per tree. The most affected municipalities were Coatepec Harinas and Donato Guerra.

Resumen Dentro de las plagas que afectan al cultivo de aguacate encontramos Oligonychus perseae o mejor conocida como araña cristalina. Este ácaro produce afectaciones en la epidermis de las hojas decolorando las áreas lesionadas, en ataques severos causan defoliación y baja producción, todo esto a consecuencia de la extracción del contenido celular de los tejidos. En el Estado de México, existen cerca de 10 000 ha plantadas con aguacate, con una producción promedio de 15.602 t ha-1. Se determinó la distribución espacial de O. perseae en cuatro municipios productores de aguacate var. Hass mediante la aplicación de análisis geoestadístico y el krigeado ordinario. Los resultados muestran que las poblaciones de araña cristalina se presentan de manera agregada ajustándose a modelos esféricos en su mayoría. La superficie infestada con el ácaro superó 73% del municipio en todos los muestreos y el número máximo de individuos encontrados fue de 1 445 organismos por árbol. Los municipios más afectados fueron Coatepec Harinas y Donato Guerra.

ABSTRACT The systematic development of the country's tourism sector is evidenced by the growth in demand for recreation centers and healthy recreation, which generally have a high degree of positioning in the target to which they are directed. Specifically in the parish "La Avanzada" located in Santa Rosa city of the Province of El Oro, it is observed that it has 3 public freshwater spas, which have been declining in relation to the fluctuation of tourists due to the positioning of the Terminal Terrestrial Binational and the Regional Airport of the canton that is frequently visited by tourists of their own and other origins. By means of the elaboration of a proposal that allows to structure a tourism marketing plan adapting digital and advertising tools, it is intended to promote tourism in the aforementioned parish. Through the necessary advertising media such as technological tools and under a tourism marketing approach, in addition to the use of ATL and BTL advertising guidelines, the collection or repositioning of these spas is sought in accordance with the acceptance and subsequent increase in demand in its use.

RESUMEN El desarrollo sistemático del sector turístico del país se evidencia a través del crecimiento de la demanda de los centros de recreación y de sano esparcimiento que, en general, poseen un alto grado de posicionamiento en el target al cual están dirigidos. Concretamente en la parroquia “La Avanzada” ubicada en el cantón Santa Rosa de la Provincia de El Oro se observa que poseen 3 balnearios públicos de agua dulce, que se han visto en decaída en relación a la fluctuación de turistas debido al posicionamiento del Terminal Terrestre Binacional y el Aeropuerto Regional del cantón que es visitado frecuentemente por turistas propios y de otras procedencias. Mediante la elaboración de una propuesta que permita estructurar un plan de marketing turístico adecuando herramientas digitales y publicitarias se pretende potenciar el turismo en la parroquia antes nombrada. A través de los medios publicitarios necesarios como las herramientas tecnológicas y bajo un enfoque de marketing turístico, además de la utilización de lineamientos de publicidad ATL y BTL se busca la captación o reposicionamiento de estos balnearios en correspondencia a la aceptación y posterior incremento de la demanda en su uso.

Resumen Definimos acidosis láctica en presencia de pH<7,35, lactato en sangre >2,0 mmol/ly PaCO2 <42 mmHg. Por otro lado, la definición de acidosis láctica grave es controvertida. La causa principal de acidosis láctica grave es el estado de choque. La acidosis láctica pormetformina es rara, pero alcanza una mortalidad del 50%. La acidosis metabólica, incluyendo a la acidosis láctica, puede recibir tratamiento específico o tratamiento general con bicarbonato de sodio, trihidroxiaminometano, carbicarb o hemodiafiltracion continua. El éxito del tratamiento de la acidosis láctica yace en el control de la fuente etiológica; la terapia de reemplazo renal intermitente o continua está perfectamente justificada, y el argumento para decidir cuál utilizar es el estado de choque. Presentamos el informe de un caso de un paciente masculino con intoxicación por metformina como intento suicida, quien desarrolló acidosis láctica y falla orgánica múltiple; la base para el éxito del caso fue el tratamiento con hemodiafiltración continua.

Abstract Lactic acidosis is defined as the presence of pH <7.35, blood lactate >2.0 mmol/L and PaCO2 <42 mmHg. However, the definition of severe lactic acidosis is controversial. The primary cause of severe lactic acidosis is shock. Although rare, metformin-related lactic acidosis is associated with a mortality as high as 50%. The treatment for metabolic acidosis, including lactic acidosis, may be specific or general, using sodium bicarbonate, trihydroxyaminomethane, carbicarb or continuous haemodiafiltration. The successful treatment of lactic acidosis depends on the control of the aetiological source. Intermittent or continuous renal replacement therapy is perfectly justified, shock being the argument for deciding which modality to use. We report a case of a male patient presenting with metformin poisoning as a result of attempted suicide, who developed lactic acidosis and multiple organ failure. The critical success factor was treatment with continuous haemodiafiltration.