Abstract The EPAs approach has had a great impact on medical education since it emerged in 2005. Its dissemination has required translation into several languages, sometimes generating terminological and meaning confusion. This paper is the result of an expert consensus procedure regarding the translation of key terms for understanding the EPA approach in Spanish and Portuguese. It was carried out through a process of meaning analysis of each term in its idiomatic context and of the practice of health professionals training in Latin America. Participated on this consensus by twelve professionals, teachers and scholars involved in the implementation and training with EPAs in eight countries, who participated as coordinator, facilitators or participants in the International Course Ins and Outs of EPAs for Latin America.

Resumen El enfoque de EPAs ha tenido un gran impacto en la educación médica desde que surgió en 2005. Su difusión a través de diferentes regiones del mundo ha requerido traducción a varios idiomas, y en algunas ocasiones ha generado confusiones terminológicas y de significado. Este artículo es el resultado de un consenso respecto de la traducción de términos clave para la comprensión del enfoque en español y portugués. Se llevó a cabo a través de un proceso de análisis de significado de cada término en el contexto idiomático y de la realidad de la formación de profesionales de la salud en Latinoamérica. Estuvo a cargo de doce profesionales, docentes y académicos involucrados en la implementación y formación con EPAs en ocho países, que formaron parte como responsables, facilitadores o participantes del International Course Ins and Outs of EPAs 2021 para Latinoamérica.

RESUMEN En Paraguay, así como en las Américas, la leishmaniasis constituye una de las problemáticas de salud pública importante, debido a su complejidad tanto epidemiológica, clínica y biológica, afectando especialmente a los más pobres y en los países en vía de desarrollo. Polygonum punctatum Elliot. pertenece a la familia Polygonaceae, la medicina popular le atribuye varias propiedades, por medio de estudios anteriores se confirma que diferentes extractos de esta planta presentan actividad antibacteriana, antiinflamatoria y antifúngica. En este trabajo, se evaluó la actividad citotóxica del extracto etanólico de Polygonum punctatum de la familia Polygonaceae en concentraciones de 100, 50 y 25 µg/ml en células de macrófagos de ratones, en los cuales no se encontró actividad citotóxica. Además, se evaluó la actividad leishmanicida por medio de estudios experimentales in vitro a concentraciones de 100, 75, 50, 25, 20 y 10 µg/ml frente a tres cepas de parásitos: Leishmania infantum, L. amazonensis y L. braziliensis, en los cuales se observó una actividad de 58 y 56% de lisis de parásitos con el extracto de 100µg/ml frente a las cepas de L. braziliensis y L. infantum, respectivamente y 51% para L. amazonensis. Estos resultados son prometedores, y aportan una base para el desarrollo y búsqueda de nuevos tratamientos para la leishmaniasis, sin embargo, son necesarios estudios posteriores en cuanto a aislamiento e identificación del compuesto y evaluación en modelos animales in vivo.

ABSTRACT In Paraguay, as well as in the Americas, leishmaniasis constitutes one of the important public health problems, due to its epidemiological, clinical, and biological complexity, especially affecting the poorest and developing countries. Polygonum punctatum Elliot belongs to the Polygonaceae family, and popular medicine attributes several properties to it. Previous studies confirmed that different extracts of this plant have antibacterial, anti-inflammatory and antifungal activity. In this work, the cytotoxic activity of the ethanolic extract of Polygonum punctatum was evaluated at concentrations of 100, 50 and 25 µg/ml in mouse macrophage cells, in which no cytotoxic activity was found. In addition, the leishmanicidal activity was evaluated through experimental in vitro studies at concentrations 100, 75, 50, 25, 20 and 10 µg/ml against three strains of parasites: Leishmania infantum, L. amazonensis and L. braziliensis. Activities of 58 and 56% of parasite lysis were observed with the 100 µg/ml extract against strains of L. braziliensis and L. infantum, respectively, and 51% for L. amazonensis. These results are promising and provide a basis for the development and search of a new treatment for leishmaniasis. However, further studies are necessary regarding the isolation and identification of the compound and its evaluation in in vivo animal models.

ABSTRACT Background: Older adults are a vulnerable group in the current context of the COVID-19 pandemic, due to confinement their mental and physical health deteriorates; hence, the importance of the use of Information and Communication Technologies that contribute to their emotional well-being, by favoring social relationships. Objective: Identify the relationship that Information and Communication Technologies have on the emotional well-being of older adults during the COVID-19 pandemic. Development: Searches were made in PubMed, Web of Science, SciELO and LILACS using the terms pandemic, COVID-19, mental health, emotional well-being, loneliness, social media, social connections, digital platforms, older people, elderly people, ICT and social networking sites. Inclusion and exclusion criteria were taken into account. In cross-sectional studies, an association was found between emotional well-being and the use of Information and Communication Technologies, however, a significant number of empirical studies identified the digital divide as an obstacle for older adults to be able to use technologies as a medium for interaction. Searches were made in PubMed, Web of Science, SciELO and LILACS using the terms pandemic, COVID-19, mental health, emotional well-being, loneliness, social media, social connections, digital platforms, older people, elderly people, ICT and social networking sites. Inclusion and exclusion criteria were taken into account. In cross-sectional studies, an association was found between emotional well-being and the use of Information and Communication Technologies, however, a significant number of empirical studies identified the digital divide as an obstacle for older adults to be able to use technologies as a medium for interaction. Conclusions: The results of the review show a positive relationship between emotional well-being and the use of ICT; it is considered relevant to continue with research in older adults subjected to confinement.

RESUMEN Fundamento: Los adultos mayores son un grupo vulnerable en el contexto actual de pandemia por COVID-19, debido al confinamiento su salud mental y física se deteriora; de ahí, la importancia del uso de Tecnologías de la Información y la Comunicación que contribuyen a su bienestar emocional, al favorecer las relaciones sociales. Objetivo: Identificar la relación que tienen las Tecnologías de la Información y la Comunicación en el bienestar emocional de los adultos mayores durante la pandemia por COVID-19. Desarrollo: Se realizaron búsquedas en PubMed, Web of Science, SciELO y LILACS con la utilización de los términos pandemic, COVID-19, mental health, emotional well-being, loneliness, social media, social connections, digital platforms, older people, elderly people, ICT y social networking sites. Se tuvieron en cuenta criterios de inclusión y exclusión. En estudios transversales se encontró una asociación entre el bienestar emocional y el uso de las Tecnologías de la Información y la Comunicación, sin embargo, un número importante de estudios empíricos identificaron la brecha digital como un obstáculo para que los adultos mayores pudieran usar las tecnologías como un medio para la interacción. Conclusiones: Los resultados de la revisión muestran una relación positiva entre el bienestar emocional y el uso de las TIC; se considera relevante continuar con la investigación en adultos mayores sometidos a confinamiento.

Abstract Elbow breadth relative to height is recognized as an adequate index of skeletal robustness (frame index -FI). The objective of this paper is to estimate and describe reference percentile values of frame index in girls and boys, aged 4 to 14 years, from three Argentine provinces. The sample included 7883 schoolchildren (3913 males and 3970 females) from the provinces of Buenos Aires, Chubut and Mendoza. Anthropometric measurements of elbow breadth (mm) and height (cm) were made between 2014 and 2018 following standardized protocols. From these variables, FI [(elbow breadth /height)*100] was estimated and the percentiles by age and sex were calculated using the LMS method. FI values were higher at the age of 4 years, while after that age the percentile values showed a downward behavior, until reaching the lowest value at age 14. The comparison between sexes indicated higher values in males than in females at all ages and in the different percentile curves. The tabulated and graphed values of FI can be considered a local reference and used in epidemiological and anthropological studies for inferring bone structure of girls and boys, and in the monitoring of hidden obesity in individuals with normal body mass index.

Resumen El ancho bicondíleo humeral en relación con la talla se reconoce como un adecuado índice de la robustez esquelética (IRE). El objetivo del presente trabajo es estimar y describir valores percentilares de referencia del índice de robustez esquelética de niñas y niños de 4 a 14 años, residentes en tres provincias argentinas. La muestra incluyó 7883 escolares (3913 varones y 3970 mujeres) de las provincias de Buenos Aires, Chubut y Mendoza. Las mediciones antropométricas del ancho bicondíleo humeral (mm) y la talla (cm) se realizaron entre los años 2014 y 2018 siguiendo protocolos estandarizados. A partir de estas variables se estimó el IRE [(ancho bicondíleo humeral/talla)*100] y se calcularon los percentiles por edad y sexo usando el método LMS. Los valores del IRE fueron mayores a la edad de 4 años, en tanto que luego de esa edad los valores percentilares mostraron un comportamiento descendente, hasta alcanzar, a los 14 años, el menor valor. La comparación entre sexos indicó valores mayores en varones que en mujeres en todas las edades y en las diferentes curvas percentilares. Los valores tabulados y graficados del IRE pueden considerarse una referencia local y ser empleados en estudios epidemiológicos y antropológicos que requieran inferir la contextura ósea de niñas y niños y en el monitoreo de la obesidad oculta en individuos con índice de masa corporal normal.

Resumen En este trabajo se analiza la relación entre nivel educativo materno (NEM) y estado nutricional infantil y adolescente. Se realizó un estudio antropométrico en 3166 escolares de 3 a 14 años de La Plata (Buenos Aires) y, a partir del peso corporal, la talla y el índice de masa corporal (IMC), se determinaron categorías nutricionales. El NEM se indagó mediante la aplicación de una encuesta. La mayor parte de la población presentó estado nutricional saludable, aunque se observó un sesgo hacia el exceso de peso, independientemente del NEM. La talla fue la variable más informativa y diferenciadora de la población en relación con el NEM: los escolares cuyas madres tuvieron niveles educativos bajos mostraron tallas menores y mayor riesgo de padecerla, en tanto que el grupo con NEM alto exhibió tallas superiores y dimorfismo sexual. La mayor escolaridad materna parece redundar en un mejor crecimiento infantil a largo plazo.

Resumo Este documento analisa a relação entre o nível educacional materno (NEM) e o estado nutricional da criança e do adolescente. Foi realizado um estudo antropométrico em 3166 alunos de 3 a 14 anos de idade em La Plata (Buenos Aires) e as categorias nutricionais foram determinadas com base no peso corporal, altura e índice de massa corporal (IMC). O NEM foi investigado por meio de uma pesquisa. A maioria da população apresentou um estado nutricional saudável, embora tenha sido observada uma tendência ao excesso de peso, independentemente do NEM. A altura era a variável mais informativa e diferenciadora da população em relação ao NEM: as crianças em idade escolar cujas mães tinham baixos níveis educacionais apresentavam alturas menores e maior risco de sofrer comisso, enquanto o grupo com alto NEM apresentava alturas maiores e dimorfismo sexual. Uma maior escolaridade materna parece resultar em um melhor crescimento infantil em longo prazo.

Abstract This paper analyses the relationship between maternal educational level (MEL) and child and adolescent nutritional status. An anthropometric study was carried out on 3166 schoolchildren aged 3 to 14 years from La Plata (Buenos Aires) and nutritional categories were determined based on body weight, height and body mass index (BMI). The MEL was obtained by means of a survey. Most of the population presented healthy nutritional status, although a bias towards overweight was observed, regardless of the MEL. Height was the most informative and differentiating variable of the population in relation to the MEL: schoolchildren whose mothers had low educational levels showed smaller heights and higher risk of suffering from it, while the group with high MEL showed higher heights and sexual dimorphism. Higher maternal schooling seems to result in better child growth in the long run.

Resumen Introducción. El concepto de empatía se ha integrado como uno de los elementos centrales para el logro final del proceso de enseñanza-aprendizaje en estudiantes de ciencias de la salud. Objetivo. Estimar y comparar los niveles de empatía entre estudiantes y profesores de pregrado de odontología de la Universidad Central del Este (República Dominicana). Materiales y métodos. Estudio transversal. La población de estudio (n=264) se dividió en dos grupos: el primero, compuesto por estudiantes de primero a quinto año de la carrera de odontología (N=223; n=215) distribuidos en dos áreas (básica-preclínica y clínica), y el segundo, por los docentes de ambas áreas en la escuela de odontología de la universidad (N=53; n=49). Se utilizó la Escala de Empatía Médica de Jefferson (Versión-S). El análisis descriptivo de los datos incluyó la estimación de medias, desviaciones estándar y porcentajes, y la confiabilidad de los datos se estimó mediante CC de Cronbach; además, se realizó un ANOVA bifactorial, calculándose el tamaño del efecto y la potencia de la prueba, y en los casos en que la prueba exacta de Fisher fue significativa para algún factor, se utilizó la prueba de Tukey para estimar las diferencias entre las medias. El nivel de significancia estadística utilizado fue α<0.05 y β<0.20. Resultados. Los valores globales de empatía y de la dimensión Cuidado con compasión en los profesores no difirieron significativamente con los obtenidos por los estudiantes (área básica-preclínica y clínica), pero sí hubo diferencias entre los estudiantes de ambas áreas (p<0.05). En las dimensiones Adopción de perspectiva y Ponerse en los zapatos del otro no existieron diferencias entre los tres subgrupos (p=0.428 y p=0.866). Conclusión. Los niveles de empatía y de la dimensión Cuidado compasivo de los profesores no difieren de los de los estudiantes en general (ambas áreas).

Abstract Introduction: The concept of empathy has been incorporated as one of the key elements for the achievement of the teaching-learning process goals in health science students. Objective: To estimate and compare the levels of empathy among dental students and professors in the undergraduate dental medicine program at the Universidad Central del Este (Dominican Republic). Materials and methods: Cross-sectional study. The study population (n=264) was divided into two groups: the first consisted of students in their first to fifth year of dental school (N=223; n=215), distributed in two areas (basic-preclinical and clinical courses), while the second group comprised professors working in both areas in the dental school of the university (N=53; n=49). The Jefferson Scale of Empathy (S-Version) was used. The descriptive analysis of the data included the estimation of means, standard deviations and percentages, and the reliability of the data was estimated using Cronbach's alpha. In addition, a two-way ANOVA was performed, calculating the effect size and the statistical power of the test; furthermore, when the Fisher's exact test was significant for any factor, Tukey's test was used to estimate differences between means. A significance level of α<0.05 and β<0.20 was established. Results: Overall empathy scores and compassionate care dimension scores among the professor group did not differ significantly from the scores obtained by the students (basic-preclinical and clinical area), but there were differences between students from both areas (p<0.05). There were no significant differences between the three subgroups in the Perspective Taking and Walking in the Patient's Shoes dimensions (p=0.428 and p=0.866). Conclusion: The levels of empathy and compassionate care dimension of professors are similar to those of students in general (regardless of the area).

RESUMO Introdução: Os lipomas são esporádicos na mão e representam menos de 5% dos tumores de partes moles nesta topografia. Os lipomas gigantes, ainda menos comuns, são definidos por terem um diâmetro maior do que 5cm. Métodos: Executamos uma análise retrospectiva dos casos de pacientes com lipomas gigantes de mão, atendidos no período de 2017-2020, no Hospital Pasteur e Hospital de Clínicas, em Montevidéu, Uruguai. Resultados: Obtivemos quatro pacientes no período estudado. A idade de apresentação foi entre 51 e 62 anos (média de 57 anos). Três dos lipomas eram intramusculares profundos e um era superficial aos músculos regionais. O maior possuía eixo mais extenso de 70mm. Todos eram sintomáticos. A ressecção marginal foi realizada em todos eles, e o pós-operatório transcorreu sem intercorrências ou recorrências. A histopatologia confirmou lipoma típico em três casos, e lipoma com metaplasia óssea no outro. Conclusão: Lipomas gigantes de mão se apresentam como tumores indolores e de crescimento lento, que podem ser sintomáticos ao comprimir estruturas adjacentes. A ressonância magnética é o estudo de imagem escolhido para estes casos. O tratamento aplicável é a ressecção cirúrgica marginal e a recorrência é pouco comum.

ABSTRACT Introduction: Lipomas are sporadic in hand and represent less than 5% of soft tissue tumors in this topography. Giant lipomas, even less common, are defined as having a diameter greater than 5 cm. Methods: We performed a retrospective analysis of the cases of patients with giant lipomas of the hand seen in the period 2017-2020, at Hospital Pasteur and Hospital de Clínicas, in Montevideo, Uruguay. Results: We obtained four patients during the study period. The age of presentation was between 51 and 62 years (mean 57 years). Three lipomas were deep intramuscular, and one was superficial to the regional muscles. The largest had a longer axle of 70mm. All were symptomatic. Marginal resection was performed in all of them, and the postoperative period was uneventful or recurrent. Histopathology confirmed typical lipoma in three cases and lipoma with bone metaplasia in the other. Conclusion: Giant lipomas of the hand present as painless, slow-growing tumors that may be symptomatic when compressing adjacent structures. Magnetic resonance imaging is the imaging study of choice for these cases. The applicable treatment is marginal surgical resection, and recurrence is uncommon.

Background: Anticoagulation in continuous renal replacement therapy (CRRT) is essential to counteract the coagulation cascade activation, induced by the dialysis circuit. Heparin is the most widely used anticoagulant, followed by regional citrate anticoagulation (RCA). Aim: To determine the effectiveness and safety of anticoagulant treatment with citrate in CRRT. Material and Methods: Retrospective study of adults in CRRT hospitalized between the years 2014 and 2020 in critical units, who required change to RCA according to established protocols. Results: We studied 24 patients aged 63 ± 13 years (12 females). The reasons for admission were acute kidney injury (AKI) in 80% and stage 5 chronic kidney disease in 20%. The indication of RCA in 75% of patients was by coagulation of more than 3 circuits in 24 hours. The duration of the circuit in RCA was 18.5 ± 4.8 hours versus 11.9 ± 4.9 hours with heparin (p < 0.0001). There were 19 mild complications that did not affect the RCA. Conclusions: RCA is feasible to perform, it is a safe and efficient procedure if it is protocolized, allowing a longer duration of the dialysis circuit.

ABSTRACT Introduction: The advance in the dissimilar treatments and professional skills around the surgical intervention in the American continent goes together with the development that exists in Europe, and Cuba is not exempt of the progresses reached until the present time. Objective: To diagnose the inadequacies in the development of the general surgeons professional skills, in the mediate preoperative care. Methods: A quasi-experimental investigation of 60 specialist doctors and residents, in charge of the mediate preoperative care was carried out in Dr. Juan Bruno Zayas Alfonso Teaching General Hospital from Santiago de Cuba, from December, 2019 to May, 2021, for which 2 groups were conformed: A (study group) and B (control group), with 30 members each one. The selected variables were analyzed and the dimensions to demonstrate the correspondence with the indicators of these variables were defined. Results: There was prevalence of the male sex in both groups and the 15 - 44 age group (83.3 % in group A and 90.0 % in group B). The most affected dimensions in decreasing order were: training, cognitive, scientific - investigative and axiological. The triangulation of the instruments showed that the variable professional performance was in a high level of affectation. Conclusion: The theoretical and empiric investigations for the characterization of the current state of the general surgeons allowed to determine that inadequacies existed in all the explored dimensions, which made difficult the development of the professional skills related to the mediate preoperative care.

RESUMEN Introducción: El avance en los disímiles tratamientos y habilidades profesionales en torno a la intervención quirúrgica en el continente americano va aparejado al desarrollo que existe en Europa, y Cuba no queda exenta de los progresos alcanzados hasta la actualidad. Objetivo: Diagnosticar las insuficiencias en el desarrollo de las habilidades profesionales de los cirujanos generales, en la atención preoperatoria mediata. Métodos: Se realizó una investigación cuasi - experimental de 60 médicos especialistas y residentes, encargados de la atención preoperatoria mediata en el Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba, desde diciembre de 2019 hasta mayo de 2021, para lo cual se conformaron 2 grupos: A (de estudio) y B (de control), con 30 integrantes cada uno. Se analizaron las variables seleccionadas y se definieron las dimensiones para demostrar la correspondencia con los indicadores de dichas variables. Resultados: Existió un predominio del sexo masculino en ambos grupos y de las edades entre 15 - 44 años (83,3 % en el grupo A y 90,0 % en el B). Las dimensiones más afectadas en orden decreciente fueron: superación, cognitiva, científico - investigativa y axiológica. La triangulación de los instrumentos arrojó que la variable desempeño profesional se encontraba con un nivel de afectación alto. Conclusiones: Las indagaciones teóricas y empíricas para la caracterización del estado actual de los cirujanos generales permitieron determinar, que existían insuficiencias en todas las dimensiones exploradas, lo cual dificultó el desarrollo de las habilidades profesionales relacionadas con la atención preoperatoria mediata.

Abstract: Objective: To describe the outcome and associated complications with the use of peripherally inser ted central venous catheters in neonates, and to identify risk factors associated with the presence of major complications. Subjects and Method: Analytical study of the follow-up of catheters placed in 541 neonates hospitalized in a neonatal intensive care unit. Outcome and complications were descri bed. To assess risk factors associated with major complications, multivariate logistic regression analy sis was used. Results: 655 catheters were placed in 541 infants with birth-weight ranging from 420g to 4.575g. The mean duration was 11.6 ± 8.5 days. 29 patients (4.4%) presented major complications, and associated bloodstream infection was the most frequent (n = 17), determining an infection rate of 2.25 %o catheter days. Infections were more frequent among catheters lasting > 14 days: 9/179 (5%) vs 8/476 (1.7%) of those lasting ≤ 14 days (p < 0.05). Other complications included: pleural effusion due to extravasation (n = 6) and atrial thrombosis (n = 3). Multivariate analysis showed that the presence of major complications was associated with a gestational age < 28 weeks: OR 5.9 (95% CI 1.2 to 40), and upper extremities use: OR 3.2 (95% CI 1.1-7.0). Infections were associated with a greater number of punctures during placement: OR 2.1 (95% CI 1.2-4.8) for each puncture and ges tational age < 28 weeks: OR 7.9 (95% CI: 1.4-73). Conclusion: The use of catheters was long-lasting and with a low rate of major complications, which were more common in extremely preterm infants. Infections were associated with an increased number of punctures and duration > 14 days. Other complications were more frequent when upper extremities insertion was used.

Resumen: Objetivo: Describir la evolución y complicaciones asociadas al uso del catéter venoso central de inserción periférica en recién nacidos e identificar los factores de riesgo asociados a ellas. Sujetos y Método: Estudio analítico del seguimiento de catéteres instalados en 541 recién nacidos hospita lizados en una Unidad Neonatal. Se caracterizan su evolución y complicaciones. Para evaluar los factores de riesgo asociados a complicaciones se realizó análisis de regresión logística multivariado. Resultados: Se instalaron 655 catéteres en 541 recién nacidos con peso de nacimiento entre 420 y 4.575 g. La duración promedio fue de 11,6 ± 8,5 días. En 29 pacientes (4,4%) se observaron compli caciones mayores, siendo la más frecuente la infección del torrente sanguíneo (n = 17), determinando una tasa de 2,25 %o días-catéter. Ellas fueron más frecuentes en aquellos catéteres que permanecie ron > 14 días: 9/179 (5%) vs 8/476 (1,7%) de los ≤ 14 días (p < 0,05). Entre las complicaciones no infecciosas destacaron: derrame pleural por extravasación (n = 6) y trombosis auricular (n = 3). El análisis multivariado mostró que ellas se asociaron a una edad gestacional < 28 semanas: OR 5,9 (IC95%: 1,2-40) y a su instalación en extremidades superiores OR 3,2 (IC95% 1,1-7,0). Las infeccio nes se asociaron a > número de punciones en su instalación: OR 2,1 (IC95% 1,2-4,8) por punción y edad gestacional < 28 semanas: OR 7,9 (IC 95%: 1,4-73). Conclusión: Los catéteres resultaron de larga duración y baja tasa de complicaciones mayores. Éstas se presentan mayormente en prematuros extremos. Las infecciones se asociaron a > número de punciones y duración > 14 días, las otras com plicaciones se asociaron con la instalación en extremidades superiores.

ABSTRACT The present work aims to analyze in schoolchildren living in the productive belt of La Plata: a) the relationship between high blood pressure (HBP) and excess weight (EW), and b) the geographical distribution of that relationship. During the 2015-2017 school years, the systolic and diastolic blood pressure (mmHg), weight (kg), and height (cm) of 2,268 schoolchildren, from 6 to 12 years old, residing in different communities in the peri-urban area of La Plata were surveyed. The cases of HBP and EW were determined. Information on the socio-environmental conditions of residence was obtained through a structured survey. The prevalence of HBP and EW, and the frequencies of environmental conditions were calculated and compared using Chi square tests (X2). Furthermore, the incidence of EW on HBP was analyzed using logistic regression. The results indicated that 44.9% of the schoolchildren presented EW and 19.4% HBP. The Multiple comparisons of HPB among community centers made it possible to differentiate two regions: a northern region (NR), with the lowest prevalence of HBP and EW, and a southern region (SR), with the highest prevalence. The variables of the residence environment were significantly different between both regions and the incidence of EW on HBP was higher in the SR. It is concluded that the productive belt of La Plata presents a worrying reality in relation to children's health. The analysis from the urbanization process shows that the NR is less urbanized, while the SR is more urbanized and registers higher prevalence rates of HBP with a higher incidence of EW over the occurrence of HBP.

RESUMEN El presente trabajo tiene por objetivo analizar en escolares que viven en el cinturón productivo de La Plata: a) la relación entre presión arterial elevada (PAE) y exceso ponderal (EP) y b) la distribución geográfica de dicha relación. Durante los ciclos lectivos 2015-2017 se relevaron: presión arterial sistólica y diastólica (mmHg), peso (kg) y talla (cm) de 2.268 escolares entre 6 y 12 años, residentes en distintos centros comunales del periurbano platense y se determinaron los casos de PAE y EP. Se obtuvo información del entorno socio-ambiental de residencia mediante una encuesta estructurada. Se calcularon prevalencias de PAE y EP y frecuencias de las características del entorno, que fueron comparadas mediante pruebas de Chi cuadrado (X2). Se analizó, además, la incidencia del EP sobre la PAE mediante regresión logística. El 44,9% de los escolares presentó EP y el 19,4% PAE. Las comparaciones múltiples para PAE entre centros comunales permitieron diferenciar dos regiones: región norte (RN) con menores prevalencias de PAE y EP y región sur (RS) con mayores prevalencias. Las variables del entorno de residencia fueron significativamente diferentes entre ambas regiones y la incidencia del EP sobre la PAE fue mayor en la RS. Se concluye que el cinturón productivo de La Plata, presenta una realidad preocupante en materia de salud infantil. El análisis a partir del proceso de urbanización, muestra que la RN es menos urbanizada y la RS más urbanizada y registra prevalencias de PAE más elevadas con mayor incidencia del EP sobre la ocurrencia de PAE.

ABSTRACT The aim of this work was to know find out the nutritional status and the environmental and socio-economic characteristics of schoolchildren residence residing in the productive peri-urban area of La Plata city, Buenos Aires, Argentina. During the 2014-2017 school years, weight and height were measured and body mass index was calculated for 3,696 schoolchildren, between 3 and 14 years of age, residing in six localities situated in the peri-urban area of La Plata city. Information about the children’s context of residence was obtained through surveys, and it indicated an impoverished environment, with poor sanitation, parents with low level of education and mostly non-formalized employment. There was 4.8 % of linear growth retardation and 0.5% of acute malnutrition, 24.6% of overweight and 18.2% of obesity. The coexistence of both extremes of malnutrition illustrates a nutritional paradox in the environment of healthy food production.

RESUMEN El objetivo fue conocer el estado nutricional y las características ambientales y socio-económicas de residencia de escolares del periurbano productivo de la ciudad de La Plata, Buenos Aires, Argentina. Entre los ciclos lectivos 2014-2017 se relevó peso y talla y se calculó el índice de masa corporal de 3.696 escolares, de entre 3 y 14 años de edad, residentes en seis localidades ubicadas en la periferia de la ciudad de La Plata. La información acerca del contexto de residencia se obtuvo mediante encuestas e indicó un ambiente empobrecido, con escaso saneamiento, padres con bajo nivel de instrucción y empleo mayoritariamente no formalizado. Hubo 4,8% de retraso lineal del crecimiento, 0,5% de desnutrición aguda, 24,6% de sobrepeso y 18,2% de obesidad. La coexistencia de ambos extremos de malnutrición ilustra una paradoja nutricional en el entorno de la producción de alimentos saludables.

COVID-19 infection causes a systemic inflammatory response, which mainly presents as a febrile syndrome with respiratory involvement. We report a 37-year-old male who consulted for myalgia, nausea and epigastric pain lasting three days. On admission, he had crepitations at the lung bases. The initial laboratory showed a creatine kinase of 62,768 U/L, a LDH of 1,110 IU/L, a creatinine a 2.1 mg/dL, an aspartate aminotransferase of 1,347 IU/L, a D-dimer of 1,140 ng/mL, a ferritin of 1,201 ng/mL and a lymphocyte count of 810 cells/mm3. The chest CT scan was compatible with multifocal pneumonia, suggesting a COVID-19 infection. COVID-19 PCR was positive. The patient was managed with hydration, sodium bicarbonate, ceftriaxone, and azithromycin, with a good clinical response.

ABSTRACT During the last decade, diverse countries among them Cuba, are reviewing approaches and methodologies being used to train the specialist doctors. On this regard, historical and logical references which give bases to the natural and traditional medicine are evaluated in this work, for the professional skills of the internal medicine resident. Likewise, the different stages through which the natural and traditional therapies have developed in Cuba, and how this therapeutic group have been strengthen from the theoretical and practical point of view are described.

RESUMEN Durante la última década, en numerosos países, entre ellos Cuba, se revisan los enfoques y las metodologías que se han utilizado para formar a los médicos especialistas. Al respecto, en el presente artículo se evalúan los referentes histórico-lógicos que fundamentan el uso de la medicina natural y tradicional para el desempeño profesional del residente de medicina interna. Asimismo, se describen las diferentes etapas por las que ha transitado la implementación de las terapias naturales y tradicionales en Cuba y cómo se ha fortalecido dicho arsenal terapéutico desde el punto de vista teórico-práctico.

ABSTRACT We conducted an experiment to evaluate the effect of a polyherbal additive with metabolites such as antioxidants, vitamins, and small hydrolysable tannoids oils on productive parameters and blood metabolites in finishing lambs. Forty male Hampshire × Suffolk lambs (23.79±2.24 kg) were used in a completely randomized experimental design. Treatments consisted of dietary inclusion of a polyherbal additive based on Emblica officinalis and Ocimum sanctum at 0, 5, 10, and 15 g/kg dry matter for 60 d. There were no effects on daily gain, dry matter intake, feed conversion, back fat thickness, and Longissimus dorsi area; however, hot carcass dressing improved linearly as the level of herbal additive supplementation was increased. The antioxidants of the polyherbal additive linearly inhibited lipid oxidation of the meat (24 h; day 10) and improved its water-holding capacity (24 h). Meat lightness after 1 d was reduced linearly, but no changes were detected in other color parameters. Metabolites (glucose, urea, cholesterol) related to energy or protein metabolism were not affected by the herbal additive. Lymphocytes and basophiles were reduced linearly whereas monocytes and segmented neutrophils increased linearly for polyherbal additive. The inclusion of the polyherbal additive does not improve daily gain or feed efficiency in finishing lambs but improves the carcass dressing and antioxidant capacity of the meat.