Resumo Este estudo teve como objetivo estimar a prevalência de alterações na autopercepção de saúde mental durante a pandemia de COVID-19 e seus fatores associados em quatro países da América Latina. Este é um estudo transversal de dados coletados de adultos em 2021 por meio da pesquisa Resposta Colaborativa à COVID-19 da Academia McDonnell na Universidade Washington em St. Louis (Estados Unidos). A amostra foi composta por 8.125 pessoas do Brasil, Colômbia, México e Chile. O estudo utilizou um modelo linear generalizado para uma variável de desfecho binário com uma conexão logística e efeitos fixos do país. No total, 2.336 (28,75%) pessoas consideraram ter sofrido alterações na autopercepção de saúde mental. Os desempregados (OR = 1,40; IC95%: 1,24-1,58), aqueles com qualidade de vida ruim/regular (OR = 5,03; IC95%: 4,01-6,31) e aqueles com alto nível socioeconômico (OR = 1,66; IC95%: 1,41-1,96) apresentaram maior risco de alterações na autopercepção de saúde mental do que aqueles com emprego em tempo integral, excelente qualidade e baixo nível socioeconômico. De acordo com o modelo de efeitos fixos, os brasileiros que viviam no país durante a pandemia, que discordavam das decisões do governo (OR = 2,05; IC95%: 1,74-2,42) e não confiavam em seu governo (OR = 2,10; IC95%: 1,74-2,42) apresentaram maior risco de alterações na autopercepção de saúde mental. Quase 30% dos entrevistados indicaram que a pandemia da COVID-19 alterou sua autopercepção de saúde mental. Esse desfecho estava associado a fatores políticos, sociodemográficos e de risco à saúde. Estes achados devem ajudar os formuladores de políticas a desenvolver intervenções comunitárias pós-pandemia.

Resumen Este estudio tuvo como objetivo estimar la prevalencia de alteraciones en la autopercepción de la salud mental durante la pandemia de COVID-19 y sus factores asociados en cuatro países de América Latina. Este es un estudio transversal de datos recopilados de adultos en el 2021 por medio de la investigación Respuesta Colaborativa a COVID-19 de la Academia McDonnell en la Universidad Washington en St. Louis (Estados Unidos). La muestra estuvo compuesta por 8.125 personas de Brasil, Colombia, México y Chile. El estudio utilizó un modelo lineal generalizado para una variable de desenlace binario con un enlace logístico y efectos fijos por país. En total, 2.336 (28,75%) personas consideraron que habían sufrido alteraciones en la autopercepción de la salud mental. Los desempleados (OR = 1,40; IC95%: 1,24-1,58), aquellos con calidad de vida mala/regular (OR = 5,03; IC95%: 4,01-6,31) y aquellos con alto nivel socioeconómico (OR = 1,66; IC95%: 1,41-1,96) presentaron mayor riesgo de alteraciones en la autopercepción de la salud mental que aquellos con empleo a tiempo completo, excelente calidad y bajo nivel socioeconómico. Según el modelo de efectos fijos, los brasileños que vivían en el país durante la pandemia y que no estuvieron de acuerdo con las decisiones del gobierno (OR = 2,05; IC95%: 1,74-2,42) y no confiaban en su gobierno (OR = 2,10; IC95%: 1,74-2,42) presentaron mayor riesgo de alteraciones en la autopercepción de la salud mental. Casi el 30% de los encuestados indicaron que la pandemia de COVID-19 alteró su autopercepción de la salud mental. Este desenlace se asoció con factores políticos, sociodemográficos y de riesgo a la salud. Estos hallazgos deben ayudar a los formuladores de políticas a desarrollar intervenciones comunitarias pospandémicas.

Abstract This study aimed to estimate the prevalence of alterations in self-perceived mental health during the COVID-19 pandemic and their associated factors in four Latin American countries. This is a cross-sectional study based on data collected from adults in 2021 through the Collaborative Response COVID-19 Survey by the MacDonnell Academy at Washington University in St. Louis (United States). The sample was composed of 8,125 individuals from Brazil, Colombia, Mexico, and Chile. A generalized linear model for a binary outcome variable with a logistic link and fixed country effects was used. There were 2,336 (28.75%) individuals who considered having suffered alterations in self-perceived mental health. Unemployed individuals (OR = 1.40; 95%CI: 1.24-1.58), those with bad/regular quality of life (OR = 5.03; 95%CI: 4.01-6.31), and those with high socioeconomic status (OR = 1.66; 95%CI: 1.41-1.96) had a higher risk of self-perceived mental health alterations than those with full-time employment, excellent quality, and low socioeconomic status. According to the fixed-effects model, Brazilians living in the country during the pandemic, who disagreed with their government’s decisions (OR = 2.05; 95%CI: 1.74-2.42) and lacked trust in their government (OR = 2.10; 95%CI: 1.74-2.42) had a higher risk of having self-perceived mental health alterations. Nearly 30% of respondents indicated that the COVID-19 pandemic altered their self-perceived mental health. This outcome was associated with political, sociodemographic, and health risk factors. These findings should help policymakers develop post-pandemic community interventions.

Resumen El Caribe sur (SCA) representa la ecorregión más productiva del Atlántico tropical noroccidental (TNWA). Con el propósito de establecer la diversidad e inventario de los copépodos pelágicos en la ecorregión, presentamos datos no publicados obtenidos a partir de cruceros oceanográficos efectuados en aguas oceánicas y neríticas de Venezuela (1967-1968). Complementamos esta información con trabajos previos para obtener una lista sistemática de las especies de copépodos pelágicos conocidas para el SCA. A partir de este análisis, determinamos 346 especies y 2 subespecies, 11 especies representan nuevos registros para el SCA. Además, para el TNWA, este estudio permite: 1) establecer la expansión en el intervalo de distribución de algunas especies, 2) registrar la presencia en el SCA de todas las especies incluidas en 12 de 42 familias observadas en la provincia, 3) determinar que en las familias Corycaeidae y Paracalanidae, el número de especies registradas es mayor al documentado previamente para el TNWA. La curva acumulativa de especies indica que en el SCA, la diversidad de los copépodos pelágicos está subestimada y los cálculos sugieren que la cantidad de especies potenciales a registrar en futuros estudios es de 12 a 48% del valor aquí establecido.

Abstract The Southern Caribbean (SCA) represents the most productive ecoregion of the Tropical Northwestern Atlantic (TNWA) province. In order to assess the diversity of pelagic copepods in the ecoregion, we present an inventory based on unpublished data obtained from several oceanographic cruises made in oceanic and neritic waters of Venezuela (1967-1968). We complement this information with previous regional surveys to obtain a revised systematic checklist of the pelagic copepod species in the SCA. We included in our list a total of 346 species and 2 subspecies; up to 11 species represent new records. This study allowed us to: 1) expand the distributional range of some species within the TNWA, 2) record the occurrence, in the SCA, of all species known to 12 of 42 families to occur in the TNWA, 3) determine that the number of species of Corycaeidae and Paracalanidae in the SCA is greater than previously documented for the TNWA. Overall, the species accumulation curve resulting from our data analysis allowed us to determine that the diversity of pelagic copepods is underestimated; our estimations suggest that the potential species number that can be recorded in the SCA is 12 to 48% above the figure herein established.

RESUMEN Introducción. La infección por el virus de Epstein-Barr (VEB) es la causa más frecuente de mononucleosis infecciosa, y también está asociada a varios tipos de cáncer. La prevalencia de la infección por este virus varía en diferentes poblaciones y no hay publicaciones sobre la epidemiología de esta infección en Paraguay. Objetivo. Describir la seroprevalencia de la infección por VEB en estudiantes universitarios y las características sociodemográficas asociadas. Materiales y Métodos. Estudio transversal en estudiantes de una universidad pública del departamento Alto Paraná, Paraguay. Se incluyeron 101 participantes, mediante muestreo de casos consecutivos. Se aplicó un cuestionario y se tomó muestras sanguíneas. Se determinó la presencia de anticuerpos por el método ELISA de captura de IgG específicos contra el antígeno de la cápside viral - VCA del VEB, además se evaluaron factores asociados a la seropositividad. Resultados. La seroprevalencia global fue 89,1% (90/101), asociado (p<0,025) a la condición socioeconómica baja (93,4% vs 76%, OR: 4.9 [IC 95%: 1,2 - 16,3]). Conclusión. La seroprevalencia contra el virus de Epstein-Barr es alta en estudiantes universitarios y está asociada a la condición socioeconómica baja.

ABSTRACT Introduction. Infections by Epstein-Barr virus (EBV) is the most common cause of infectious mononucleosis and is also linked to multiple cancers. The prevalence of EBV infection varies in different populations and there is no publication about the epidemiology of this infection in Paraguay. Objective. To describe the seroprevalence among university students and associated sociodemographic characteristics. Material and Methods. Cross-sectional study in students from a public university in Alto Paraná, Paraguay. A total of 101 participants were recruited through consecutive sampling. A questionnaire was applied and blood samples were obtained. Antibodies were determined by Epstein-Barr Virus IgG anti-VCA capture ELISA method, and factors associated with seropositivity were evaluated. Results. The overall seropositivity was 89,1% (90/101), which was associated (p<0,025) with low socioeconomic status (93,4% vs 76%, OR: 4.9 [95% CI: 1.2 - 16.3]). Conclusion. The seroprevalence to EBV is high in college students which is associated to low socioeconomic condition.

Abstract To account for the global trend towards a healthier diet, in recent years the snack market has grown substantially, with a demand for products that are more beneficial to consumers' health. Extruded snacks from a mixture of cereals, quinoa, and corn, with and without the addition of vegetables were used. Snacks made from a mixture of rice flour and quinoa high protein flour (HHP) supplied by SEGALCO S.A.S., (Popayán, Colombia) were studied. Thus, the use of sources of phenolic compounds such as Beet, Broccoli, Avocado, and Spinach, combined with sources of protein such as quinoa, can increase the nutritional quality of snack products. A combination of cereals and vegetables can produce nutrient-rich products. In this paper, phenolic compounds (given in mg AGE/g sample d.b.) and antioxidant capacity were determined using ABTS•+, DPPH and FRAP (in mg AEAC /g sample d.b.). The highest content of phenolic compounds was found in Spinach 4% and HHP snacks (5.7 ± 0.3 and 3.5 ± 0.2 AGE/g sample d.b., respectively). Kale (2%) and Beet (4%) snacks showed a significant increase in antioxidant capacity using the ABTS•+ method. The antioxidant capacity determined using the DPPH method increased significantly in snacks made from Beet (4%), Broccoli (4%), Avocado (4%), and Spinach (4%). Using FRAP, the antioxidant capacity showed a significant increase in Kale snacks (2%) and a significant decrease in Spinach snacks (4%). In conclusion, snacks with an elevated antioxidant potential can be produced from vegetables such as kale, which can be an alternative for the food industry to develop healthier products and satisfy market trends.

Abstract Controlled release systems can modify the release rate of drugs and direct them to specific sites of action, making them more effective and/or reducing the adverse effects. The objective of this study was investigated, poly(β-hydroxybutyrate) (PHB) and poly(ε-caprolactone) (PCL) nanospheres to improve the delivery of Simvastatin (SIM). Nanospheres were prepared by the emulsion/evaporation technique of the solvent, varying the amount of SIM added. The SIM quantification was performed using a validated high-performance liquid chromatography method. The average diameter and PDI of formulations without SIM were lower 250 nm and 0.3, respectively. Nanospheres containing 30% of SIM showed values of 265 nm and 0.09, respectively. The average zeta potential was -31.8 mV, suggesting the predominance of repulsive forces that prevent aggregation. In vitro release suggest transport occurs by diffusion. Morphological analysis demonstrated spherical particles and rough surfaces. In conclusion, data suggest that PHB/PCL nanospheres are promising delivery systems to SIM.

Resumen El objetivo del presente estudio fue analizar el efecto de la percepción de riesgo de covid-19 sobre las prácticas de automedicación en población mexicana. Se encuestó a 526 participantes mayores de 18 años, 68.4% mujeres y 31.6% hombres residentes del noroeste de México, y mediante un modelo estructural se analizó la relación y prevalencia de la automedicación. La percepción del riesgo a la covid-19 se correlacionó negativamente con las prácticas de automedicación, lo que indica que las personas que siguen las recomendaciones de cuidados preventivos tienden a reducir el uso de la automedicación y a mejorar su automedicación emocional. Además, el estudio muestra que al menos la mitad de los participantes han consumido fármacos durante la pandemia. La automedicación es un problema de salud crítico, es por ello que los programas de concientización sobre los efectos adversos de los medicamentos son necesarios, ya que pueden ayudar a reducir la automedicación.

Abstract The objective of the present study was to analyze the effect of the risk perception of covid-19 on self-medication practices in Mexican population. A total of 526 participants over 18 years of age were surveyed, 68.4% women and 31.6% men residing in northwestern Mexico. Using a structural model, the relation and prevalence of self-medication were analyzed. Risk perception about covid-19, consisting of preventive practices and the perception of the threat of the pandemic, was negatively correlated with self-medication practices, which indicates that people who follow preventive care recommendations tend to reduce the use of self-medication and to improve emotional self-medication. Furthermore, the study shows that at least half of the participants have used drugs during the pandemic without medical prescription. Self-medication is a critical health problem; therefore, awareness programs about the adverse effects of medications can help reduce self-medication practices in Mexico.

OBJECTIVES: To assess the clinical response to and the histomorphometric effects of microablative fractional radiofrequency (MFR) in women with symptomatic vulvar lichen sclerosus (VLS). METHODS: This was a pilot study on the use of MFR for the treatment of VLS. Upon recruitment and at each treatment session, all participants were examined and each of their symptoms were rated on a visual analog scale. After the procedure, the participants completed a satisfaction questionnaire. We compared the morphometric findings of vulvar biopsies performed at enrollment and after the last treatment session. The participants were divided into three groups according to previous treatment with corticosteroids: G1, no previous treatment; G2, treated for up to 5 years; and G3, treated for >5 years. RESULTS: This study included 26 women. After two to three sessions, most participants in all groups became either “asymptomatic” or “much better” than before treatment and were “very satisfied” or “satisfied” with the intervention. Pruritus and burning sensation were the most frequently reported symptoms. Nearly 40% of the participants in all groups reported complete remission of symptoms. The improvement was rated as moderate or higher by 80%, 76%, and 66% of the women in groups 1, 2, and 3, respectively. The improvement of symptoms persisted for 11 months (range, 7-16 months), on average, after the treatment. Type III collagen concentration significantly increased and was associated with important symptom improvement. Tissue trophism and vascularization also increased but did not reach statistical significance, probably because of the small number of cases. CONCLUSIONS: MFR may be an effective and safe treatment for symptomatic VLS.

RESUMEN INTRODUCCIÓN. El tiempo es un factor importante en el tratamiento del ACV agudo, con la pandemia de covid-19 se puede ver afectada la adherencia a las guías. Se han reportado tasas de ACV en presencia de covid-19 alrededor del 5%, además un aumento en el tiempo de consulta de los pacientes en otras regiones del mundo y una mayor ocupación de camas de UCI para patologías respiratorias que usualmente se destinan a pacientes con ACV. Este documento recoge las recomendaciones del comité de Enfermedad Cerebrovascular de la Asociación Colombiana de Neurología basados en la literatura y votadas por consenso. OBJETIVOS. Proporcionar una guía rápida adaptada a los diferentes escenarios de atención de ACV en Colombia, divididos en centro listo, primario y avanzado incluyendo una ruta de atención para paciente con sospecha de covid-19 denominada Código ACV protegido, que incluye el uso de elementos de protección personal para pacientes y personal de salud. PUNTOS PRINCIPALES. Dentro de las recomendaciones principales está el cuestionario de tamizaje al ingreso a urgencias, uso de tapabocas para el paciente, considerar todo Código ACV sospechoso de covid-19, toma de PCR para covid-19 en todos los ACV y llevar a zona buffer. En sospecha de oclusión proximal incluir tomo-grafía de tórax a la evaluación de imágenes. CONCLUSIONES. Establecer pautas de atención durante la pandemia covid-19 permite optimizar protección para pacientes y personal de salud, disminuir retrasos y tratar de evitar que pacientes no reciban el tratamiento adecuado en los diferentes niveles de atención del sistema de salud.

SUMMARY INTRODUCTION. Time is an important factor in the treatment of acute stroke, with the COVID-19 pandemic adherence to guidelines can be affected. Stroke rates in the presence of COVID-19 have been reported around 5%, in addition to an increase in the consultation time of patients in other regions of the world and a greater occupation of ICU beds for respiratory pathologies that are usually intended for patients with stroke. This document contains the recommendations of the Cerebrovascular Disease Committee of the Colombian Neurology Association based on the literature and voted by consensus. OBJECTIVES. Provide a quick guide adapted to the different stroke care scenarios in Colombia, divided into ready, primary and advanced centers, including a care route for a patient with suspected COVID-19 called the protected stroke code, which includes the use of protection elements for the patient and the healthcare team. MAIN FACTS. Among the main recommendations are the screening questionnaire on admission to the emergency department, the use of face masks for the patient, considering all suspected stroke code as COVID-19, taking the PCR for COVID-19 in all strokes and taking them to the buffer zone. In suspected large vessel occlusion, include chest tomography to image evaluation. CONCLUSIONS. Establishing guidelines of care during the COVID-19 pandemic allows optimizing protection for patients and health care personnel, reducing delays and trying to avoid patients not receiving adequate treatment at different levels of attention in the health system.

ABSTRACT Introduction: The military preparation in its different edges is one of the hardest processes that live the subjects that develop work in favor of the defense and maintenance of the peace of the nations. It is expected that this preparation will progressively impact the physical condition and body composition of the soldiers in order to contribute to a better performance in their daily tasks. Objective: To compare the anthropometric profile of Chilean military men in a situation of conscripted soldiers and permanent staff. Methods: 83 male military subjects aged between 18.91 ± 1.76 and 51.19 ± 7.96 years were evaluated, body mass index, body composition and somatotype were estimated. Results: Higher values of body mass index (28.64 ± 3.56), muscle tissue 37.57 ± 5.02 kg and adipose tissue (24.95 ± 7.88 kg) were found in permanent staff and lower values in conscripted soldiers (22.53 ± 2.39) p < 0.000 muscle tissue (33.85 ± 4.11 kg), adipose tissue (18.12 ± 5.01) p < 0.024. In the somatotype components, similarly, there were significant differences (p <0.000) in endomorphy, mesomorphy and ectomorphy. Conclusion: The military subjects present significant differences in terms of body composition, somatotype and weight status according to their contractual situation. The use of the body mass index would be complex to use in military subjects, since these can be erroneously classified in the categories established for the body mass index.

RESUMEN Introducción: La preparación militar en sus distintas aristas es uno de los procesos más duros que viven los sujetos que desarrollan labores en pro de la defensa y mantenimiento de la paz de las naciones. Se espera que esta preparación impacte de manera progresiva en la condición física y composición corporal de los soldados con la finalidad de aportar a un mejor desenvolvimiento en sus labores diarias. Objetivo: Comparar el perfil antropométrico de varones militares chilenos en situación de soldados conscriptos y personal cuadro permanente. Métodos: Se valoraron 83 sujetos militares varones con edades entre los 18,91 ± 1,76 y 51,19 ± 7,96 años, se estimó el índice de masa corporal, la composición corporal y el somatotipo. Resultados: Se encontraron valores más elevados de índice de masa corporal (28,64 ± 3,56), tejido muscular (37,57 ± 5,02 kg) y tejido adiposo (24,95 ± 7,88 kg) en el personal cuadro permanente y menores valores en soldados conscriptos (22,53 ± 2,39) p < 0,000, tejido muscular (33,85 ± 4,11 kg), tejido adiposo (18,12 ± 5,01 kg), p < 0,024. En los componentes del somatotipo, de igual forma, hubo diferencias significativas (p < 0,000) en endomorfía, mesomorfía y ectomorfia. Conclusiones: Los sujetos militares presentan diferencias significativas en cuanto a la composición corporal, el somatotipo y el estado ponderal según su situación contractual. El uso del índice de masa corporal sería complejo de utilizar en sujetos militares, ya que pueden ser erróneamente clasificados en las categorías establecidas para este índice.

RESUMEN El presente artículo reporta los resultados de una investigación experimental, obtenidos en el secado de granos de café variedad Castilla, originarios de Santander, Colombia. Los experimentos fueron llevados a cabo a través de dos técnicas: radiación térmica y radiación electromagnética. Veinte experimentos fueron realizados, 10 en un horno microondas a 2.450 MHz-1.080W, y 10 en un horno eléctrico convencional con temperatura controlada a 50 ± 2°C. Las pruebas fueron hechas a muestras de grano con cascarilla, sin cascarilla y a la sola cascarilla. En cada experimento se determinó la relación de humedad adimensional del proceso de secado, y su coeficiente de difusión, de acuerdo con la segunda ley de Fick. Se encontró que el coeficiente de difusión de las muestras secadas en horno microondas fue veintidós veces mayor que el respectivo coeficiente de las muestras secadas en horno eléctrico. Las muestras secadas por radiación térmica mantuvieron una temperatura uniforme, en contraste con las muestras secadas por microondas. Los resultados son de gran utilidad para el posterior estudio de sistemas híbridos de secado de granos de café.

ABSTRACT This article reports a comparative study of experimental results obtained during the drying of Castilla-variety coffee beans from Santander, Colombia. They were performed by two means: thermal and electromagnetic radiation. Twenty experiments were carried out, ten tests in a microwave cavity at 2,450 MHz-1,080W, and ten tests using a conventional electric oven with temperature controlled at 50 ± 2°C. Experiments were made using samples of coffee beans with parchment, without parchment, and of the only-parchment. For each sample, dimensionless moisture ratio and diffusion coefficients were determined, according to the second law of Fick. We found that the diffusion coefficient of the samples dried in a microwave cavity was twenty-two times higher than the diffusion coefficient of samples dried with thermal radiation. Likewise, it was observed that samples in conventional oven showed a uniform temperature, in contrast with those heated by microwave radiation. Such results are useful for designing hybrid systems for drying coffee beans.

Resumen Introducción: la estimación temprana del riesgo en falla cardiaca aguda puede ayudar en la toma de decisiones clínicas. Objetivo: identificar los factores de riesgo asociados a mortalidad intrahospitalaria en pacientes con falla cardiaca aguda. Métodos: análisis de una cohorte retrospectiva de pacientes mayores de 18 años ingresados a hospitalización por falla cardiaca aguda en un hospital de tercer nivel, entre los años 2012 y 2016. Resultados: se incluyeron 247 pacientes, con edad promedio de 62,8 años; predominó el sexo masculino con un 60%. El 84% de los pacientes tenía falla cardiaca con fracción de expulsión disminuida (mediana de 25%). La mortalidad intrahospitalaria fue de 9,3% y la acumulada a 30 días y 6 meses posterior al egreso hospitalario fue de 10,9 y 14,1%, respectivamente. Los dos predictores asociados a muerte intrahospitalaria fueron el nitrógeno ureico en sangre (BUN)> 37 mg/dl (OR: 10,8; 95% IC: 4,10-28,8) y la presión arterial sistólica (PAS) ≤ 125 mm Hg (OR: 3,42; 95% IC:1,15-10,0). El modelo de árbol de regresión y clasificación (CART) identificó como el mejor predictor de mortalidad los niveles elevados de BUN (≥ 32,5 mg/dl), seguido por la presión sistólica disminuida (< 97 mm Hg) y finalmente por los niveles elevados de creatinina (≥ 1,75 mg/dl). Conclusión: el análisis mediante el CART permite clasificar en forma temprana la probabilidad de muerte por un árbol de riesgo que incluye el BUN ≥ 32,5 mg/dl, la presión sistólica < 97 mm Hg y los niveles de creatinina ≥ 1,75 mg/dl.

Abstract Introduction: The early estimation of risk in acute heart failure may help in the taking of clinical decisions. Objective: To identify the risk factors associated with in-hospital mortality in patients with acute heart failure. Methods: An analysis was performed on a retrospective cohort of patients greater than 18 years admitted to a tertiary hospital due acute heart failure between the years 2010 and 2016. Results: A total of 247 patients were included, with a mean age of 62.8 years, and of which 60% were male. The large majority (84%) of the patients had heart failure with a reduced ejection fraction (median 25%). The in-hospital mortality was 9.3%, and the accumulated rate at 30 days and 6 months after hospital discharge was 10.9% and 14.1%, respectively. The two predictors associated with in-hospital death was a blood urea nitrogen (BUN) > 37 mg/dL (OR: 10.8; 95% CI: 4.10-28.8) and a systolic blood pressure (SBP) ≤ 125 mmHg (OR: 3.42; 95% CI: 1.15-10.0). The classification and regression tree (CART) model identified elevated levels of as the best predictor of mortality, followed by a decreased systolic pressure (< 97 mmHg), and finally due to elevated creatinine levels (≥ 1,75 mg/dL). Conclusion: The analysis using the classification and regression tree (CART) model can provide an early classification of the probability of death by a risk tree that includes BUN ≥ 32.5 mg/dL, systolic pressure <97 mm Hg, and creatinine levels ≥ 1.75 mg/dL.

ABSTRACT Introduction: Joint hypermobility (JHM) implies an increased range of motion that exceeds what is considered normal for the examined joint. Objetive: To determine the frequency of JHM in first-year medical students of the Facultad de Ciencias Médicas of Universidad Nacional de Asunción (FCM-UNA) and its association to gender. Methods: Cross-sectional observational study. A physical examination was performed using the Beighton scoring system. Individuals who scored 4 or more points were considered to have JHM. Results: 100 students were included. 38% scored at least 4 points to diagnose them with JHM. 1% met all criteria. The item that evaluates forward bending of the spine was the most frequent among students. 84.2% of the individuals with criteria for JHM were women. There is a significant difference between the presence of JHM between women and men (p = 0.001). Conclusion: There is a substantial amount of individuals who meet JHM criteria among first-year medical students of the FCM-UNA. Women were identified with JHM more frequently than men.

RESUMEN Introducción: La hipermoviildad articular (HMA), implica un aumento del rango de movilidad de las articulaciones que excede lo considerado normal para la articulación examinada Objetivo: Determinar la frecuencia de HMA en estudiantes de primer curso de la carrera de medicina de la Universidad Nacional de Asunción y su asociación según el sexo de los individuos incluidos. Metodología: Estudio observacional de corte transversal. Se realizó un examen físico con el test de Beighton, que consiste en un sistema de puntos y se consideró a los individuos con HMA a aquel que sumara 4 o más puntos en el test. Resultados: se incluyeron 100 estudiantes, de los cuales el 38% cumplió como mínimo con 4 puntos suficientes para diagnosticarlos con HMA. El 1% cumplió con todos los crite- rios. El item que evalúa la flexión de la columna, fue el más frecuentemente identificado en- tre los estudiantes. El 84,2% de los individuos con criterio para HMA fueron mujeres. Existe una diferencia significativa entre la presencia de HMA entre mujeres y hombres (p=0.001). Conclusión: Existe una frecuencia importante de individuos que cumplen con criterios de HMA en el primer curso de la carrera de medicina de la FCM-UNA. Las mujeres fueron identificadas con HMA con mayor frecuencia con relación a los hombres.

Resumen Objetivos: Realizar el análisis estructural de fragmentos de bosque seco tropical encontrados en la ecorregión estratégica de la Tatacoa y su área de influencia en el sur del departamento del Tolima; y detallar los patrones de estructura vertical, horizontal y total para generar conocimiento que permita enriquecer los pocos estudios existentes y contribuir al uso sostenible, conservación y restauración de los bosques secos del valle interandino del Magdalena. Metodología: Se seleccionaron 12 relictos boscosos y se estableció una parcela de ¼ de ha en cada uno; se midieron e identificaron los árboles con DAP ≥ 5 cm, caracterizando la estructura horizontal mediante el índice de valor de importancia y cociente de mezcla; se realizaron perfiles de vegetación, diagramas de dispersión de Ogawa; se calcularon distribuciones diamétricas y área basal. Resultados: Se encontró que los bosques tienden a ser homogéneos con dominancia de especies tales como Curatella americana, Astronium graveolens, Anacardium excelsum, Trichilia sp., Anadenanthera peregrina, Guazuma ulmifolia y Tabebuia chrysantha. La estructura vertical mostró dos tendencias, una de bosques de porte bajo en áreas planas a onduladas y otra con bosques más altos en áreas de pendiente. La mayoría de los bosques tienen tres estratos y pocos árboles emergentes. La distribución diamétrica tiende a tener estructura de modelo exponencial en j invertida a excepción de dos bosques. El área basal por hectárea osciló entre 3-23 m2. Los bosques presentan patrones similares a bosques del norte del Tolima, la Costa Atlántica y otras regiones neotropicales como Bolivia y Perú. Conclusiones: Estos bosques presentan estados sucesionales intermedios, aunque son muy intervenidos aún tienen un potencial importante de biodiversidad forestal y podrían tomarse como ecosistemas de referencia para procesos de restauración ecológica del valle interandino del Magdalena.

Abstract Objectives: to carry out the structural analysis of fragments of tropical dry forest found in the Strategic Ecoregion of La Tatacoa and its area of influence in the south of the department of Tolima, and to detail the vertical, horizontal and total structure patterns to generate knowledge that allows enriching the few existing studies and contribute to the sustainable use, conservation and restoration of the dry forests of the inter-Andean valley of Magdalena. Methodology: Twelve forest relicts were selected and a plot of ¼ ha was established in each one. They were measured and trees with DBH ≥ 5 cm were identified characterizing the horizontal structure by means of the Importance Value Index (IVI) and mixing ratio. Vegetation profiles and Ogawa scatter diagrams were made; diametric distributions and basal area were calculated. Results: It was found that forests tend to be homogeneous, with dominance of species such as Curatella americana, Astronium graveolens, Anacardium excelsum, Trichilia sp, Anadenanthera peregrina, Guazuma ulmifolia and Tabebuia crhysantha. The vertical structure showed two tendencies, one of low forests on flat to undulated areas, and another with higher forests in steep areas. Most forests have three arboreal strata and few emerging trees. The diameter distribution tends to have an exponential model structure in reversed J shape curve with the exception of two forests. The basal area per hectare ranged from 3 to 23 m2. Forests have similar patterns to forest in northern Tolima, the Atlantic coast and other neotropical regions such as Bolivia and Peru. Conclusions: these forests have intermediate successional stages and, although they are heavily intervened, still have an important potential for forest biodiversity and could be considered as reference ecosystems for ecological restoration processes in the Andean valleys of the Magdalena River.

RESUMEN Objetivo: identificar determinantes sociales de salud, en el ámbito familiar, en preescolares de Anapoima, Cundinamarca, y su relación con la prevalencia de experiencia de caries. Métodos: en el marco de la Alianza por un Futuro Libre de Caries-Capítulo Colombia (AFLC-CC), se valoró la prevalencia de experiencia de caries en niños preescolares de Anapoima, Cundinamarca, usando el Sistema Internacional de Detección y Valoración de Caries (ICDAS) y el índice ceod (cariados, extraídos y obturados, por diente), y se caracterizaron sus familias y viviendas. Se hizo análisis descriptivo y usando 2 se exploraron asociaciones entre ceod e ICDAS y condiciones socioeconómicas, de infraestructura y prácticas de salud en las familias. Resultados: se valoraron 120 niños de jardines infantiles del municipio de Anapoima y se visitaron sus hogares. La prevalencia de experiencia de caries (ceod) fue de 33,3% (promedio: 1,3 ± 2,5); al incluir lesiones iniciales, fue de 46,7% (4,3 ± 7,0). Se encontró relación entre presencia de caries y tipo de problemas de salud bucal referidos por los padres, relación filial con el cuidador, asistencia al servicio de salud bucal y disponibilidad de un espacio para el cepillo (p < 0,05). Conclusiones: los niños valorados presentaron baja experiencia de caries, en comparación con referentes nacionales, lo cual se explica por los determinantes intermedios identificados en su ámbito familiar, en los que se evidencian condiciones económicas, de infraestructura y de conformación familiar favorables para las prácticas de salud. Es necesario profundizar en la comprensión de la relación entre determinantes sociales y salud bucal desde la esfera estructural y fortalecer las estrategias en salud, con miras a lograr poblaciones libres de caries.

ABSTRACT. Objective: identify social determinants of health in families of preschoolers from Anapoima, Cundinamarca, and their relationship with prevalence of caries experience. Methods: in the framework of the Alliance for a Caries-Free Future - Colombia Chapter (Alianza por un Futuro Libre de Caries-Capítulo Colombia, AFLC-CC), the prevalence of caries experience in preschool children from Anapoima, Cundinamarca, was assessed using the International Caries Detection and Assessment System (ICDAS) and the dmft (decayed, missing, filled teeth) index, characterizing their families and homes. Descriptive analysis was done, using X2 to explore associations between dmft and ICDAS with socioeconomic and infrastructure conditions, as well as health practices in families. Results: 120 kindergarten children from the municipality of Anapoima were assessed and their homes were visited. The prevalence of caries experience (dmft) was 33.3% (average: 1.3 ± 2.5); when initial lesions were included, the prevalence reached 46.7% (4.3 ± 7.0). There was a relationship between the presence of caries and type of oral health problems referred to by parents, kin relationship with caregiver, visits to the oral health service, and availability of a space for the toothbrush (p < 0.05). Conclusions: the assessed children showed low caries experience compared to national benchmarks, which can be explained by the intermediate determinants identified in their family environments, with economic, infrastructure and family structure conditions favorable to health practices. It is necessary to better understand the relationship between social determinants and oral health from a structural point of view and to strengthen health strategies, in order to achieve caries-free populations.

RESUMEN El síndrome neuroléptico maligno (SNM) es una complicación severa de los antipsicóticos, en especial los de primera generación como el haloperidol, que fue el primero en el que se describió esta patología, caracterizada por fiebre, rigidez, alteración del estado de conciencia y disautonomías. Por otro lado, la mielinólisis central pontina (ahora llamada síndrome de desmielinización osmótica) resulta de las alteraciones agudas séricas del sodio, como las que ocurren en las reposiciones de hiponatremia, y podría poner en riesgo la vida al igual que el SNM. La asociación de estas dos patologías es inusual y hasta el momento no se conoce con claridad su relación causal, producto de los pocos casos reportados. Aunque se conoce la mortalidad del síndrome neuroléptico maligno, la compañía de la mielinolisis central pontina podría aumentar la morbimortalidad de esta entidad, por lo cual es necesario reconocerla rápidamente para prevenir la aparición de complicaciones, ya que no cuenta con un tratamiento específico. Presentamos el caso de un paciente joven que cursó con estas dos patologías, y consideramos que la causa de la mielinolisis central pontina fue el haloperidol, así como del SNM. A pesar de ello, este medicamento continúa siendo muy seguro en la práctica clínica ya que la aparición de estas complicaciones es una reacción idiosincrática por algún tipo de susceptibilidad genética desconocida.

SUMMARY Neuroleptic malignant syndrome (NMS) is a severe complication of antipsychotics, especially those of first generation such as haloperidol, which was the first in which this pathology was described, characterized by: fever, rigidity, alteration of the state of consciousness and dysautonomies. On the other side, central pontine myelinolysis (Now Called Osmotic Demyelination Syndrome), search results of acute sodium alterations of sodium, as those occurring in hyponatremia replenings and could put life at risk just like the NMS. The association of these two pathologies is unusual and until now, their causal relationship, the result of the few cases reported, is not clearly known. Although the relationship of the neurological syndrome may be limited, the company of central myelolysis could increase the morbidity of this entity, so it is necessary to be required quickly to prevent the onset of complications, which does not have a specific treatment. We present the case of a young patient who has these pathologies and we consider that the cause of centralized myelinolysis is haloperidol as well as NMS, despite this, this medication continues to be very safe in clinical practice since the appearance of These complications is an idiosyncratic reaction due to some type of unknown genetic susceptibility.