RESUMEN Introducción: el cronotipo es la predisposición natural de cada individuo a experimentar picos de energía o momentos de descanso en función de su ritmo circadiano. Los individuos pueden tener cronotipos matutinos, vespertinos o intermedios, que pueden tener relación con el desarrollo de depresión. Objetivo: determinar la existencia de asociación entre el cronotipo y la sintomatología depresiva en una muestra de adultos. Metodología: este estudio observacional, descriptivo y exploratorio se realizó en agosto de 2023. Se incluyeron en este estudio adultos de ambos sexos. Se recolectaron datos sociodemográficos, y los participantes respondieron el Morningness-Eveningness Questionnaire de Horne y Östberg para evaluar el cronotipo, y el Patient Health Questionnaire de 2 ítems (PHQ-2) para evaluar los síntomas depresivos. Se utilizaron estadísticas descriptivas para todas las variables. Para la estadística inferencial, se utilizó la prueba de chi-cuadrado con un nivel de confianza del 95 %. Se utilizó odds ratio para cuantificar las relaciones. Resultados: un total de 105 personas participaron en el estudio, de las cuales el 58 % eran mujeres. La edad media de la muestra era de 29,4 ± 11,6 años. El 69 % de la muestra presentaba el cronotipo matutino, mientras que el 31 % presentaba el cronotipo vespertino. Se observó que el 31 % de los participantes puntuaba positivamente para depresión (PHQ-2 ≥ 3). Se encontró una relación entre el cronotipo y los puntos de corte del PHQ-2 (p=0,036). Se halló una OR=2,5 (IC 95%: 1,05-5,95) a favor del cronotipo vespertino para el desarrollo de depresión. Conclusión: casi siete de cada diez participantes tenían un cronotipo matutino, mientras que tres de cada diez dieron positivo en depresión. Los individuos con cronotipos vespertinos son más propensos a desarrollar síntomas depresivos que aquellos con cronotipos matutinos.

ABSTRACT Introduction: chronotype is the natural predisposition of each individual to experience peaks of energy or moments of rest according to their circadian rhythm. Individuals may have morning, evening, or intermediate chronotypes that may be related to the development of depression. Objective: to determine the existence of an association between chronotype and depressive symptomatology in a sample of adults. Methodology: this observational, descriptive, and exploratory study was conducted in August 2023. Adults of both sexes were included in this study. Sociodemographic data were collected, and participants answered the Morningness-Eveningness Questionnaire by Horne and Östberg to assess chronotype, and the 2-item Patient Health Questionnaire (PHQ-2) to assess depressive symptoms. Descriptive statistics were used for all the variables. For inferential statistics, the chi-squared test was used with a confidence level of 95 %. Odds ratio was used to quantify the relationships. Results: a total of 105 people participated in the study, 58 % of whom were women. The mean age of the sample was 29.4 ± 11.6 years. Sixty-nine percent of the sample presented the morning chronotype, while 31 % presented the evening chronotype. It was found that 31 % of the participants scored positively for depression (PHQ-2 ≥ 3). A relationship was found between chronotype and PHQ-2 cutoff points (p=0.036). An OR=2.5 (95 % CI 1.05-5.95) was found in favor of the evening chronotype for the development of depression. Conclusion: almost seven out of ten participants had a morning chronotype, whereas three out of ten were positive for depression. Individuals with evening chronotypes are more likely to develop depressive symptoms than those with morning chronotypes.

RESUMO Este estudo de caso propõe-se analisar o trabalho docente na Educação Infantil do Campo em turma multisseriada em escola ribeirinha no interior do Amazonas. A pesquisa, pautada metodologicamente na abordagem qualitativa, reafirma a relevância da temática em discussão, a fragilidade da implementação das políticas públicas direcionadas a esse público e a necessidade da valorização da formação contínua do professor frente às práticas pedagógicas. A prática docente tem papel mediador na construção do currículo de cunho histórico e cultural e ao direito das crianças que habitam o campo. propõese propõe se Amazonas pesquisa qualitativa discussão pedagógicas campo

ABSTRACT This case study aims to analyze the teaching work in Early Childhood Education in the Field in multigrade class in a riverside school in the hinterland of the state of Amazonas, Brazil. The research, methodologically based on the qualitative approach, reaffirms the relevance of the theme under discussion, the fragility of the implementation of public policies directed to this audience and the need to value the continuous training of the teacher facing the pedagogical practices. The teaching practice has a mediating role in the construction of the curriculum of historical and cultural nature and the rights of children who live in the countryside. Amazonas Brazil research approach discussion practices countryside

Resumo O campo da saúde tem como referente central e “alma” a produção do cuidado, um conceito polissêmico e polifônico, com um uso ubíquo, envolvido em disputas de sentidos. Propõe-se uma distinção entre cuidado e clínica, esta tida como uma construção sociotécnica que pode ou não ser subsumida pelo cuidado. Toma-se os conceitos de perspectivismo e de regimes de verdade como referenciais teóricos para as análises sobre o que pode ser enunciado como o cuidado em certo tempo e lugar: uma produção de mundos e de sentidos. Engendra-se uma espiral caleidoscópica intercessora para analisar tais sentidos, chegando a três grupos de perspectivas: o cuidado em saúde como um equivalente geral de práticas em saúde e intervenções clínicas, o cuidado em saúde como uma clínica integral e emancipatória, e o cuidado em saúde como uma micropolítica no encontro intercessor. São múltiplos mundos que carregam suas próprias verdades e as disputam entre si, por vezes misturando-se em composições de sentidos. Um marcador ético-estético-político que propomos para o uso do conceito cuidado em saúde seria a produção de mais vida nas vidas vividas.

Abstract The field of health has as its central reference and “soul” the production of care, a polysemic and polyphonic concept, with a ubiquitous, involved in disputes over meanings. A distinction between care and clinic was proposed, the latter considered a socio-technical construction that may or may not be subsumed by care. The concepts of perspectivism and truth regimes were taken as theoretical references for the analysis of what can be enunciated as care in a certain time and place: a production of worlds and meanings. An intercessory kaleidoscopic spiral was engendered to analyze those meanings, finding three groups of perspectives: health care as a general equivalent of health practices and clinical interventions, health care as an integral and emancipatory clinic, and health care as a micropolitics in the intercessory encounter. They are multiple worlds that carry their own truths and dispute between themselves, sometimes mixing in compositions of senses. An ethical- aesthetic-political marker that we propose for the use of the health care concept would be the production of more life in the lived lives.

Resumo O campo da saúde tem como referente central e “alma” a produção do cuidado, um conceito polissêmico e polifônico, com um uso ubíquo, envolvido em disputas de sentidos. Propõe-se uma distinção entre cuidado e clínica, esta tida como uma construção sociotécnica que pode ou não ser subsumida pelo cuidado. Toma-se os conceitos de perspectivismo e de regimes de verdade como referenciais teóricos para as análises sobre o que pode ser enunciado como o cuidado em certo tempo e lugar: uma produção de mundos e de sentidos. Engendra-se uma espiral caleidoscópica intercessora para analisar tais sentidos, chegando a três grupos de perspectivas: o cuidado em saúde como um equivalente geral de práticas em saúde e intervenções clínicas, o cuidado em saúde como uma clínica integral e emancipatória, e o cuidado em saúde como uma micropolítica no encontro intercessor. São múltiplos mundos que carregam suas próprias verdades e as disputam entre si, por vezes misturando-se em composições de sentidos. Um marcador ético-estético-político que propomos para o uso do conceito cuidado em saúde seria a produção de mais vida nas vidas vividas. alma “alma polifônico ubíquo sentidos Propõese Propõe se Tomase Toma lugar Engendrase Engendra perspectivas clínicas emancipatória intercessor si misturandose misturando éticoestéticopolítico ético estético político vividas

Abstract The field of health has as its central reference and “soul” the production of care, a polysemic and polyphonic concept, with a ubiquitous, involved in disputes over meanings. A distinction between care and clinic was proposed, the latter considered a socio-technical construction that may or may not be subsumed by care. The concepts of perspectivism and truth regimes were taken as theoretical references for the analysis of what can be enunciated as care in a certain time and place: a production of worlds and meanings. An intercessory kaleidoscopic spiral was engendered to analyze those meanings, finding three groups of perspectives: health care as a general equivalent of health practices and clinical interventions, health care as an integral and emancipatory clinic, and health care as a micropolitics in the intercessory encounter. They are multiple worlds that carry their own truths and dispute between themselves, sometimes mixing in compositions of senses. An ethical- aesthetic-political marker that we propose for the use of the health care concept would be the production of more life in the lived lives. soul “soul ubiquitous meanings proposed sociotechnical socio technical place perspectives interventions encounter themselves senses ethical aestheticpolitical aesthetic political lives

ABSTRACT Background: Irritability, as a trans dimensional symptom, is present in several mental disorders. This study investigated the psychometric properties of the Spanish version of the Brief Irritability Test (BITe). Subjects and Methods: The recruitment has been performed through an online survey launched through common social media (Facebook, Twitter) and messaging apps (WhatsApp, Telegram) from 1st to 31st May 2022. Subjects included were individuals ≥18 years old of age of both sexes. 1920 individuals were rated for the validation analysis. The BITe has been translated into Spanish and validated through confirmatory factor analysis. Participants have been also scored with the Aggression Questionnaire (AQ). Results: Kaiser-Meyer-Olkin (KMO) test was adequate (KMO=0.880) and sphericity tested significantly (p<0.001). The confirmatory analysis confirmed that the scale is one-dimensional. The model adjustment was good, according to all fit indices. Cronbach’s alpha also confirmed an excellent internal consistency (α=0.91). Scores between the two scales (the BITe and the AQ) have shown a good convergence (r=0.512; p<0.001). Conclusions: The Spanish version of the BITe is a unidimensional scale of five Likert-type items that shows good internal validity and high reliability, which implies that this version has excellent psychometric properties for both male and female Spanish-speakers.

RESUMEN Antecedentes: La irritabilidad, como síntoma transdimensional, está presente en varios trastornos mentales. Este estudio investigó las propiedades psicométricas de la versión española del Test Breve de Irritabilidad (BITe). Sujetos y métodos: el reclutamiento se realizó a través de una encuesta en línea lanzada a través de las redes sociales comunes (Facebook, Twitter) y aplicaciones de mensajería (WhatsApp, Telegram) del 1 al 31 de mayo de 2022. Los sujetos incluidos fueron personas ≥ 18 años de edad de ambos sexos 1920 individuos fueron calificados para el análisis de validación. El BITe ha sido traducido al español y validado mediante análisis factorial confirmatorio. Los participantes también han sido puntuados con el Cuestionario de Agresión (AQ). Resultados: la prueba de Kaiser-Meyer-Olkin (KMO) fue adecuada (KMO=0,880) y la esfericidad se probó significativamente (p<0,001). El análisis confirmatorio confirmó que la escala es unidimensional. El ajuste del modelo fue bueno, según todos los índices de ajuste. El alfa de Cronbach también confirmó una excelente consistencia interna (α=0,91). Las puntuaciones entre las dos escalas (BITe y AQ) han mostrado una buena convergencia (r=0,512; p<0,001). Conclusiones: La versión en español del BITe es una escala unidimensional de cinco ítems tipo Likert que muestra buena validez interna y alta confiabilidad, lo que implica que esta versión tiene excelentes propiedades psicométricas tanto para hombres como para mujeres hispanohablantes.

Resumen: Introducción: la sarcopenia puede presentarse en las enfermedades de larga evolución como la insuficiencia renal crónica. Su detección permite aplicar medidas terapéuticas específicas para evitar complicaciones. Objetivo: describir la frecuencia de sarcopenia en pacientes adultos con insuficiencia renal crónica del Hospital Nacional y Hospital Militar en 2021. Metodología: se aplicó un diseño estudio observacional, descriptivo, transversal. Se incluyeron a varones y mujeres, mayores de edad, portadores de insuficiencia renal crónica de los hospitales mencionados. La presencia de sarcopenia se evaluó con medidas antropométricas, la fuerza de presión palmar y la funcionalidad determinada con el cuestionario EuroQol-5D. Se midieron también variables demográficas y clínicas. Se reclutó un grupo control de sujetos jóvenes sanos para obtener parámetros antropométricos comparativos. La investigación fue aprobada por el Comité de Ética de la Universidad Privada del Este, Paraguay. Resultados: se incluyeron 119 pacientes con insuficiencia renal crónica, siendo 62 varones con edad media 56 ± 15 años y 57 mujeres con edad media 61 ± 16 años. Se recluta- ron 150 sujetos sanos, siendo 51 varones con edad media 26 ± 5 años y 99 mujeres con edad media 25 ± 5 años. La etiología predominante de la insuficiencia renal crónica fue la combinación de hipertensión arterial y diabetes mellitus (45,4%). Al medir las medidas antropométricas, la fuerza de presión palmar y la funcionalidad se confirmó sarcopenia en 38,66% de los pacientes. Comparando variables demográficas y clínicas entre los diferentes grados de sarcopenia, sólo la edad resultó mayor en los sujetos con sarcopenia severa. Conclusión: en pacientes con insuficiencia renal crónica la sarcopenia se confirmó en 38,66%.

Abstract: Introduction: Sarcopenia can present in longstanding diseases such as chronic kidney failure (CKD). Its detection enables the initiation of specific therapeutic measures to avoid complications. Objective: To describe the frequency of sarcopenia in adult patients with CKD at the Hospital Nacional and Hospital Militar in 2021. Methodology: We conducted an observational, descriptive, cross-sectional study design. The presence of sarcopenia was evaluated with anthropometric measurements. The hand grip strength and functionality was determined with the EuroQol5D questionnaire. Demographic and clinical variables were also measured. A control group of healthy young subjects was recruited to obtain comparative anthropometric parameters. The research was approved by the Ethics Committee of the Universidad Privada del Este, Paraguay. Results: 119 patients with CKD were included, 62 men with a mean age of 56 ± 15 years and 57 women with a mean age of 61 ± 16 years. 150 healthy subjects were recruited, 51 men with a mean age 26 ± 5 years and 99 women with a mean age 25 ± 5 years. The predominant etiology of CKD was the combination of arterial hypertension and diabetes mellitus (45.4%). Sarcopenia was confirmed in 38.66% of the patients using anthropometric measurements, hand grip strength and functionality. Comparing demographic and clinical variables between the groups with different stages of sarcopenia, only age was higher in the subjects with severe sarcopenia. Conclusion: Sarcopenia was confirmed in 38.66% of patients with CKD%.

Resumo A leishmaniose visceral canina é uma zoonose endêmica no Brasil. Os cães são os principais hospedeiros em ambientes urbanos. O tratamento ganhou popularidade desde que o governo brasileiro autorizou a miltefosina para tratamento canino. O objetivo deste estudo foi investigar o impacto clínico e parasitológico do tratamento a curto prazo com miltefosina e alopurinol, isoladamente e/ou em combinação. Foi avaliada a capacidade da farmacoterapia em reduzir os sinais clínicos da doença e também os níveis de anticorpos, usando-se o teste de anticorpos de fluorescência indireta (RIFI) e a carga parasitária na pele, via qPCR, após 28 dias de tratamento. Os protocolos terapêuticos promoveram declínio significativo dos sinais clínicos e da carga parasitária na pele dos cães (p < 0,01). Foi observada uma correlação moderada entre a carga parasitária da pele e o escore clínico em todos os três grupos de tratamento (r > 0,5). Já os níveis de anticorpos não diminuíram nesse curto período. Concluiu-se que o tratamento com alopurinol, em curto prazo, reduziu a quantidade de parasitos na pele dos cães com leishmaniose visceral. No entanto, sua eficiência é potencializada quando associada a miltefosina.

Abstract Canine visceral leishmaniasis is an endemic zoonosis in Brazil. Dogs are the main hosts in urban environments. The treatment has gained popularity since the Brazilian government authorized miltefosine for canine treatment. The aim of this study was to investigate the clinical and parasitological impact of short-term treatment with miltefosine and allopurinol, alone and in combination. We evaluated the ability of pharmacotherapy to reduce clinical signs of disease, antibody levels using the indirect fluorescence antibody test (IFAT) and skin parasite load via qPCR after 28 days of treatment. The therapeutic protocols promoted a significant decline in clinical signs and in the skin parasite load in dogs (p < 0.01). We observed a moderate correlation between the skin parasite load and the clinical score in all three treatment groups (r > 0.5) Antibody levels did not decrease in this short period. It was concluded that the treatment with allopurinol reduced the number of parasites in the skin of dogs with visceral leishmaniasis in the short term. However, its efficiency is potentiated when associated with miltefosine.

Resumo O uso de dietas ricas em carboidratos altamente fermentáveis e com baixos teores de fibras pode ocasionar desequilíbrio entre os microrganismos do rúmen com consequente acidose ruminal. Esse problema pode resultar em lesões na parede do rúmen, evoluindo com frequência para formação de ruminite. O presente estudo objetivou caracterizar lesões ruminais macroscópicas e microscópicas, observadas em bovinos confinados que apresentavam lesões podais ou abscesso hepático. Avaliou-se 1060 bovinos pelo exame post mortem. Foram encontradas lesões podais em 88 animais, abscesso hepático em 10 e lesões ruminais macroscópicas em 230 bovinos, sendo caracterizado 178 rumens com hiperqueratose, 41 com hiperemia, 9 com úlcera e 2 com neoplasia. Os 98 bovinos com lesões podais e abscesso hepático foram selecionados para realização de exame histopatológico. Desses, foram encontradas lesões macroscópicas em 23 e, microscópicas, em 23 animais. Dos 23 animais que apresentaram lesões macroscópicas, 10 tiveram as mesmas alterações verificadas na microscopia. Foram diagnosticados 7 casos de hiperqueratose na avaliação macro e microscópica. Dos 5 casos de hiperemia verificados na macroscopia, 2 casos foram identificados na microscopia e um caso de úlcera identificado na macroscopia também foi identificado na microscopia. A avaliação microscópica dos rumens permitiu identificar lesões em animais com lesões podais que não apresentam alterações macroscópicas ruminais.

Abstract Administration of diets rich in highly fermentable carbohydrates and low fiber content can cause an imbalance between the microorganisms in the rumen with consequent ruminal acidosis. This problem can cause lesions in the rumen wall, often progressing to rumenitis. The purpose of the present was to characterize macroscopic and microscopic ruminal lesions observed in confined feedlot cattle with claw lesions or liver abscess. A total of 1060 bovines were evaluated via postmortem examination. Claw lesions were identified in 88, liver abscess in 10, and macroscopic rumen lesions in 230 bovines; furthermore, 178 rumens were characterized with hyperkeratosis, 41 with hyperemia, 9 with ulcer, and 2 with neoplasia. The 98 bovines with claw lesions and liver abscess were selected for histopathological examination. Of these, macroscopic lesions were noted in 23 and microscopic lesions in 23 animals. Of the 23 animals that presented macroscopic lesions, 10 showed the same changes observed under microscopy. Seven cases of hyperkeratosis were diagnosed in the macro and microscopic evaluation. Of the 5 cases of hyperemia verified on macroscopy, 2 cases were identified via microscopy, and 1 case of ulcer identified through macroscopy and microscopy. The microscopic evaluation of the rumens allowed the identification of lesions in animals with claw lesions that did not present macroscopic rumen alterations.

ABSTRACT Introduction: coping with death is one of the most difficult tasks that medical students have to face. Objectives: to determine the level of coping with death in medical students. Methodology: we conducted an observational, cross-sectional, multicenter study. We included men and women, medical students from public and private universities from Paraguay in 2021, who agreed to participate in the study. A telematic questionnaire was used. Sociodemographic variables were measured. The level of coping was determined with the Bugen scale. The research was approved by the Comité de Ética of the Universidad Privada del Este, Asunción. Results: 504 students were included, 74 % being female and with a mean age of 22 ± 4 years. Most were born in Paraguay (88 %), were Catholic (73 %), registered as an organ donor (60 %), and had a recent history of the death of a family member or friend (76 %). The Bugen scale detected a low level of coping with death in 52 % of the women and 42 % of the men (p <0.05). Conclusion: coping with death in medical students was low. It is suggested to include courses or workshops to improve this aspect in the curriculum of the medical schools of Paraguay.

RESUMEN Introducción: el afrontamiento a la muerte constituye una de las situaciones más difíciles y estresantes a las que se tienen que enfrentar los estudiantes de medicina por el contacto cercano a pacientes en riesgo vital. Objetivos: determinar el nivel de afrontamiento a la muerte en estudiantes de medicina. Metodología: se aplicó diseño con enfoque cuantitativo, de tipo observacional, transversal, multicéntrico. Se incluyó a estudiantes de medicina del Paraguay, de ambos sexos, en agosto 2021, que aceptaban participar del estudio. Se utilizó un cuestionario telemático. Se midieron variables sociodemográficas. El nivel de afrontamiento se determinó con la escala de Bugen. La investigación fue aprobada por Comité de Ética de la Universidad Privada del Este, Asunción. Resultados: se incluyeron 504 estudiantes, siendo del sexo femenino 74 % y con edad media 22 ± 4 años. El 88 % de los encuestados eran de nacionalidad paraguaya (88 %) y 73 % de religión católica. La mayoría nació en Paraguay (88 %), era católica (73 %), se hallaba inscripta como donante de órganos (60 %) y tenía antecedente reciente de muerte de un familiar o amigo (76 %). La escala de Bugen detectó bajo nivel de afrontamiento a la muerte en 50 %, siendo 52 % en las mujeres y 42 % en los varones (p <0,05). Conclusión: el afrontamiento a la muerte en estudiantes de medicina fue bajo. Se sugiere incluir cursos, talleres y planes formativos dentro de las asignaturas o como actividades de extensión para mejorar ese aspecto en el currículo de las facultades de medicina del Paraguay.

Abstract: Radioactive Iodine 131 (I131) therapy is a Nuclear Medicine procedure used to treat patients with dif- fuse or nodular hyperthyroidism and in differentiated thyroid cancer (DTC) in metastatic stages. Diffuse Graves' hyperthyroidism and its nodular varieties require differentiated doses. In the present work, we sought to determine the absorbed doses of I131 involved in the treatment of hyperthyroidism, using physical dosimetry methods with the MIRD formalism that protocolizes the conjugate image dosimetry in Nuclear Medicine, compared with the comet and micronucleus test, with which We established the feasibility and sensitivity of the tests to the radiation doses involved. It has been possible to determine that the percentage of DNA in the comet's tail turns out to be a good indicator of the I131 absorption capacity in the thyroid gland, which as the concentration in blood decreases, greater repair of the damage could be demonstrated and can be used As a reference in new epidemiological studies as an indicator of treatment progression, the DNA repair capacity has also been demonstrated, allowing such extreme radiation doses to have a therapeutic action and can be distributed within a period of 50 to 100 days within the body. , allowing to observe the level of damage in the DNA molecule through the comet test.

Resumen: La terapia de Iodo radioactivo 131(I131) es un procedimiento de Medicina Nuclear utilizado para trata- miento de pacientes con hipertiroidismo nodular o difuso y en el cáncer diferenciado de tiroides (CDT) en estadios metastásico. El hipertiroidismo de Graves difuso y sus variedades nodulares requieren dosis diferenciadas. En el presente trabajo se buscó determinar las dosis absorbidas de I131 involucradas en el tratamiento de hipertiroidismo, utilizando métodos de dosimetría física con el formalismo MIRD que protocoliza la dosimetría de imágenes conjugadas en Medicina Nuclear, comparadas con el test del cometa y micronúcleos con lo cual establecimos la factibilidad y sensibilidad de los test a las dosis de radiación involucradas. Se ha podido determinar que el porcentaje de ADN en la cola del cometa resulta ser un buen indicador de la capacidad de absorción I131 en la glándula tiroides, que a medida que disminuya la concentración en sangre, se pudo demostrar mayor reparación del daño y puede utilizarse como referencia en nuevos estudios epidemiológicos como indicador de progresión del tratamiento, también se ha demostrado la capacidad de reparación del ADN permite que dosis de radiaciones tan extremas puedan tener una acción terapéutica y se pueda distribuir en un periodo de 50 a 100 días dentro del organismo, permitiendo observar el nivel de daño en la molécula de ADN por medio del test del cometa.

ABSTRACT Introduction: Cinema can be a useful tool for medical education. In Psychiatry, specifically, cinema allows us to explore representations of different mental disorders, what it is like to live with mental illness, stigma, medical ethics, the psychiatrist/patient relationship, among others. The objective of this study was to determine the presence of some type of psychopathology in films produced in Paraguay, so that they can be used as didactic tools in the teaching of Psychopathology. Methodology: The design of this research was qualitative and exploratory. For convenience, 10 Paraguayan films, produced between 2010 and 2019, were selected. The films were chosen taking into account their availability for viewing on Netflix, Amazon Prime Video, HBO GO, Apple TV+, and YouTube platforms, and in DVD format. Results: The following films were analyzed in search of psychopathology Universo Servilleta (2010), Cuchillo de Palo (2010), 7 cajas (2012), La Enamorada (2012), Latas Vacías (2014), La Chiperita (2015), Los Buscadores (2017), Leal (2018), Las Herederas (2018), and El Supremo Manuscrito (2019). In the selected films, characters with signs and symptoms that may be useful to teach some of the main psychiatric syndromes were found: depressive disorders, anxiety, suicide attempts, obsessive-compulsive traits, personality disorders, delusions, impulse control disorders, and addictions. Conclusion: Paraguayan cinema, increasingly rich and diverse, in addition to being a source of inspiration and entertainment, can help in the teaching of Medicine in general, and Psychiatry in particular.

RESUMEN Introducción: el cine puede ser una herramienta útil para la educación médica. En la Psiquiatría, específicamente, el cine permite explorar las representaciones de diferentes trastornos mentales, cómo es vivir con una enfermedad mental, el estigma, la ética médica, la relación psiquiatra/paciente, entre otros. El objetivo de este estudio fue determinar la presencia de algún tipo de psicopatología en películas producidas en Paraguay, con el fin de que las mismas puedan ser utilizadas como herramientas didácticas en la enseñanza de la Psicopatología. Metodología: el diseño de esta investigación fue de tipo cualitativo exploratorio. Se seleccionaron, por conveniencia, 10 películas paraguayas, producidas entre los años 2010 y 2019. Las películas se eligieron tomando en cuenta su disponibilidad de visualización en las plataformas Netflix, Amazon Prime Video, HBO GO, Apple TV+, YouTube, y en formato DVD. Resultados: se analizaron en busca de Psicopatología las siguientes películas Universo Servilleta (2010), Cuchillo de Palo (2010), 7 cajas (2012), La Enamorada (2012), Latas Vacías (2014), La Chiperita (2015), Los Buscadores (2017), Leal (2018), Las Herederas (2018), y El Supremo Manuscrito (2019). En las películas seleccionadas se encontraron personajes con signos y síntomas que pueden resultar útiles para enseñar algunos de los principales síndromes psiquiátricos: trastornos depresivos, ansiedad, intentos de suicidio, rasgos obsesivo-compulsivos, trastornos de la personalidad, ideas delirantes, alteraciones del control de los impulsos y adicciones. Conclusión: el cine paraguayo, cada vez más rico y diverso, además de ser una fuente de inspiración y entretenimiento, puede ayudar en la enseñanza de la Medicina en general, y de la Psiquiatría en particular.

Resumo: Introdução: A pandemia SARS-CoV-2 inspirou novo interesse nos fundamentos da patologia da síndrome da dificuldade respiratória do adulto (SDRA) associada ao COVID-19. Este estudo busca as causas da hipoxemia e sua mecânica ventilatória em pacientes em ventilação mecânica por COVID-19. Material e métodos: Estudo de coorte prospectivo. De 23 de março a 15 de maio de 2020, informações basais (comorbidades, estudos laboratoriais e escalas de prognóstico) e parâmetros ventilatórios e gasométricos foram coletados de todos os pacientes com mais de 18 anos que receberam ventilação mecânica para COVID-19 e acompanhados até o dia 15 de ventilação mecânica (VM). Resultados: Um total de 63 pacientes, 13 pacientes foram excluídos devido a prontuários incompletos. Com complacência pulmonar de 41.44 ± 12.18 mL/cmH2O, driving pressure (DP) de 12.18 ± 2.67 cmH2O, volume corrente (Vt) de 7.02 ± 1.11 mL/kg de peso previsto, shunts pulmonares de 23.38% (3.23-90.05), gradiente alveolo arterial 354.96 ± 75.37 mmHg e relação PaO2/FiO2 de 129 (48-309) mmHg. A análise linear de medidas repetidas para avaliação de pacientes que apresentavam extubação precoce versus VM prolongada, com diferenças estatisticamente significativas no Vt e DP (p = 0.04, p = 0.0005 respectivamente) quando eles elevam mais de 7.5 mL/kg e 13 cmH2O respectivamente. Conclusões: A hipoxemia nesses pacientes deve-se a duas causas: aumento dos shunts pulmonares e desequilíbrio ventilação/perfusão pulmonar. Um DP menor que 13 cmH2O e um Vt menor que 7.5 mL/kg devem ser mantidos em todos os dias de VM.

Abstract: Introduction: The SARS-CoV-2 pandemic has inspired new interest in the physiopathology of the acute respiratory distress syndrome (ARDS) due to COVID-19. This study describes the causes of hypoxemia and the respiratory mechanics in patients with COVID-19. Material and methods: Prospective unicentric cohort study. Patient data recorded from march 23rd till may 15th of 2020, we took basal data (comorbidities, laboratories and prognostic scales) and, ventilator and arterial blood gas data in patients aver 18 years of age which received mechanical ventilation (VM) due to COVID-19. We followed each patient for 15 days of mechanical ventilation. Results: A total of 50 patients, 13 were excluded due to incomplete data. The patients presented a mean of pulmonary compliance of 41.44 ± 12.18 mL/cmH2O, driving pressure (DP) 12.18 ± 2.67 cmH2O, tidal volume (Vt) 7.02 ± 1.11 mL/kg of predicted body weight, alveoloarterial gradient and PaO2/FiO2 relation 129 (48-309) mmHg. We ran a lineal repeated measure analysis to evaluate differences in mechanical ventilation on patients who where extubated early (Et) versus prolonged VM. With statistical significant differences with Vt and DP (p = 0.04, p = 0.0005 respectively) when they elevate more than 7.5 mL/kg y 13 cmH2O respectively. Conclusions: hypoxemia in mechanically ventilated patients due to augmented intrapulmonary shunts and ventilation/perfusion mismatch. In these patients throughout every day of VM, the Vt less than 7.5 mL/kg and DP less than 13 cmH2O.

Resumen: Introducción: La pandemia de SARS-CoV-2 ha inspirado un nuevo interés en los fundamentos de la patología del síndrome de dificultad respiratoria aguda (SDRA) asociado con COVID-19. Este estudio busca las causas de hipoxemia y su mecánica ventilatoria en los pacientes en ventilación mecánica por COVID-19. Material y métodos: Estudio de cohorte prospectivo. Del 23 de marzo al 15 de mayo de 2020 se recolectó información basal (comorbilidades, estudios de laboratorio y escalas pronósticas) y parámetros ventilatorios y gasométricos de todos los pacientes mayores de 18 años que recibieron ventilación mecánica por COVID-19 y se dio seguimiento hasta el día 15 de ventilación mecánica (VM). Resultados: Un total de 63 pacientes, se excluyeron 13 por expedientes incompletos. Con distensibilidad pulmonar de 41.44 ± 12.18 mL/cmH2O, driving pressure (DP) de 12.18 ± 2.67 cmH2O, volumen tidal (Vt) de 7.02 ± 1.11 mL/kg de peso predicho, cortocircuitos pulmonares de 23.38% (3.23-90.05), gradiente alveoloarterial 354.96 ± 75.37 mmHg y relación PaO2/FiO2 de 129 (48-309) mmHg. El análisis lineal de medidas repetidas a la evaluación de los pacientes que presentaron extubación temprana versus VM prolongada, con diferencias estadísticamente significativas en Vt y DP (p = 0.04, p = 0.0005 respectivamente) si elevan más de 7.5 mL/kg y 13 cmH2O respectivamente. Conclusiones: La hipoxemia en estos pacientes se debe a dos causas: aumento de cortocircuitos pulmonares y desequilibrio de ventilación/perfusión pulmonar. Se debe mantener una DP menor a 13 cmH2O y un Vt menor a 7.5 mL/kg en todos los días de VM.

Resumo Objetivos Demonstrar a prevalência de sintomas de depressão e ansiedade em pessoas com a síndrome do túnel do carpo atendidas em um ambulatório de cirurgia da mão e descrever as características clínicas e epidemiológicas dessa população. Métodos Foram avaliadas pessoas com o diagnóstico de síndrome do túnel do carpo na consulta inicial em um período de coleta de dados de 6 meses. Características clínicas e epidemiológicas foram anotadas, e as pessoas que possuíam diagnóstico de ansiedade e/ou depressão foram avaliadas. Resultados Um total de 101 pessoas apresentavam síndrome do túnel do carpo e destas, 38 apresentavam diagnóstico de depressão e 29 de ansiedade. Houve prevalência de mulheres de baixa renda, com predominância do nível de escolaridade fundamental. Mais da metade dos pacientes apresentava pelo menos uma comorbidade sistêmica associada. Conclusão Tanto para ansiedade como para depressão, as características que influenciaram estatisticamente nos sintomas em pacientes com síndrome do túnel do carpo independente das demais características avaliadas foram gênero, tabagismo, e renda familiar (p< 0,05).

Abstract Objectives To demonstrate the prevalence of depression and anxiety symptoms in patients with carpal tunnel syndrome treated at a hand surgery outpatient clinic and to describe the clinical and epidemiological characteristics of this population. Methods People diagnosed with carpal tunnel syndrome at the initial visit were evaluated over a 6-month period for data collection. Clinical and epidemiological characteristics were noted, and patients diagnosed with anxiety and/or depression were evaluated. Results In total, 101 people had carpal tunnel syndrome, including 38 diagnosed with depression and 29 with anxiety. Most patients were low-income women, with elementary school-level education. More than half of the patients had at least one associated systemic comorbidity. Conclusion Independent characteristics that statistically influenced anxiety and depression symptoms in patients with carpal tunnel syndrome were gender, smoking, and family income (p< 0.05).

Abstract: Objective: To present the case of a child with most likely diagnosed of abdominal tuberculosis, in order to have elements to suspect it and provide timely treatment. Case presentation: 3-year-old male patient, resident of Puebla, with Crouzon syndrome, who had a complete vaccination schedule and a history of contact with a patient with tuberculosis. His condition had approximately three weeks of evolution, with predominantly nocturnal fever; a few days before admission, vomiting, diarrhea, asthenia, adynamia, as well as abdominal pain in the mesogastrium and right iliac fossa were added. Upon arrival at the hospital, an exploratory laparotomy was performed for suspected appendicitis. During the surgery, data compatible with tuberculosis were observed, which was confirmed by histopathological study of the appendix, omentum and peritoneum. After two months of treatment for tuberculosis, the patient was discharged from the hospital as he showed improvement. Conclusion: Abdominal tuberculosis should be considered as a differential diagnosis in pediatric patients with long-standing fever and abnormal abdominal manifestations.

Resumen: Objetivo: Dar a conocer el caso de un niño con diagnóstico muy probable de tuberculosis abdominal, a fin de poder sospecharla y brindar tratamiento oportuno. Presentación de caso: Paciente masculino de 3 años, originario de Puebla, con síndrome de Crouzon, esquema de vacunación completo y quien tenía contacto directo con paciente con tuberculosis. Su padecimiento fue de aproximadamente tres semanas de evolución, con fiebre de predominio nocturno; unos días previo a su ingreso se agregó vómito, diarrea, astenia, adinamia, así como dolor abdominal en mesogastrio y fosa iliaca derecha. A su llegada al hospital, por sospecha de apendicitis se realiza laparotomía exploradora, observando datos compatibles con tuberculosis, confirmándose por estudio histopatológico en apéndice, epiplón y peritoneo. Después de dos meses de tratamiento anti-fímico, el paciente fue egresado del hospital por mejoría. Conclusión: En pacientes pediátricos con fiebre de larga evolución y manifestaciones abdominales, la tuberculosis abdominal se debe considerar como diagnóstico diferencial.